low-cost contingency management for smoking cessation

Conditions: Tobacco Use Cessation

Summary: an innovative low-cost form of contingency management has been developed in which participants receive the chance to draw vouchers from a fish bowl depending on whether or not their abstinence from tobacco is confirmed by expired-air carbon monoxide. the vouchers can be redeemed for prizes of varying value. this form of contingency management has been shown to be effective in the treatment of a variety of substance use disorders, but has not been investigated in a clinical trial focusing on smoking cessation. thus, the primary purpose of the proposed study will be to investigate the effects of a low-cost prize-based form of contingency management in the treatment of nicotine dependence. to accomplish this objective, we enrolled 103 current smokers into the study. the participants in study arm 1 received the contingency management intervention for 8 weeks, and the participants in study arm 2 had their smoking status assessed but did not receive the contingency management intervention. both interventions received brief counseling and nicotine replacement therapy. the counseling was conducted in two 60-minute individual sessions scheduled one week apart with two follow-up phone calls at weeks 3, 4, and 6. the primary outcome for this study was biochemically-validated smoking status at 3 months (end of treatment), and at 6- and 12-month follow-up. both continuous and point-prevalent abstinence rates were determined. saliva cotinine levels were measured in all participants reporting abstinence at each assessment. this study had 80% power to detect a 10% absolute difference in smoking cessation rates between the two treatment conditions (i.e., a 28% quit rate in study arm 1 versus a 18% quit rate in study arm 2) with alpha set at 0.05. these estimates included an anticipated 15% loss to follow-up over the 12-month study period.

contingency management as a treatment for substance use disorders involves the use of tangible rewards for confirmed abstinence. there is preliminary evidence that contingency management shows promise as a smoking cessation intervention. an innovative low-cost form of contingency management has been developed in which participants receive the chance to draw vouchers from a fish bowl depending on whether or not their abstinence from tobacco is confirmed by expired-air carbon monoxide. the vouchers can be redeemed for prizes of varying value. this form of contingency management has been shown to be effective in the treatment of a variety of substance use disorders, but has not been investigated in a clinical trial focusing on smoking cessation. thus, the primary purpose of the proposed study was to investigate the effects of a low-cost prize-based form of contingency management in the treatment of nicotine dependence. to accomplish this objective, we enrolled 103 current smokers into the study. the participants in study arm 1 received the contingency management intervention for 8 weeks, and the participants in study arm 2 had their smoking status assessed but did not receive the contingency management intervention. both interventions received brief counseling and nicotine replacement therapy. the counseling was conducted in two 60-minute individual sessions scheduled one week apart with two follow-up phone calls at weeks 3, 4, and 6. the primary outcome for this study was biochemically-validated smoking status at 3 months (end of treatment), and at 6- and 12-month follow-up. both continuous and point-prevalent abstinence rates were determined. saliva cotinine levels were measured in all participants reporting abstinence at each assessment. this study had 80% power to detect a 10% absolute difference in smoking cessation rates between the two treatment conditions (i.e., a 28% quit rate in study arm 1 versus a 18% quit rate in study arm 2) with alpha set at 0.05. these estimates included an anticipated 15% loss to follow-up over the 12-month study period.

Eligibility criteria:
inclusion criteria: * smoke at least 5 cigarettes per day * interested in quitting exclusion criteria: * cognitive impairment or unstable psychotic disorder that would significantly interfere with the individual's ability to participate in the study. * self-reported problem with alcohol or other drugs during the past three months * current use of any smoking cessation medication * presence of any contraindications for nicotine patches, lozenges, or gum * pregnancy

Keywords: tobacco use disorder