Contingency Management, Quitting Smoking, and ADHD
Condition: Cigarette Smoking; Smoking Cessation
Study type: Interventional
Phase: Phase 1

Summary: 
      The overall goal of the study is to evaluate how motivation and readiness for change are
      influenced in the context of a smoking cessation attempt. A total of 60 adult (i.e. age
      18-55) smokers (N=40 with ADHD; N=20 without ADHD) who are interested in quitting will be
      enrolled into a 3-arm trial allocated as follows. Twenty of the ADHD smokers and the 20
      non-ADHD smokers will be assigned to a traditional 8-week contingency management intervention
      in which monetary payments will be made contingent upon biologically verified evidence of
      smoking abstinence. The 20 additional ADHD smokers will be assigned to a treatment-as-usual
      condition (nicotine replacement; supportive counseling). During the treatment phase, subjects
      will be required to answer questions 4x/week in their daily lives via an EMA (Ecological
      Momentary Assessment).

      Specific Aim 1: To assess motivation to quit smoking and readiness for change prior to a quit
      attempt in treatment seeking ADHD and non-ADHD smokers. Hypothesis 1a: The investigators
      hypothesize that prior to a quit attempt, smokers with ADHD will exhibit significantly lower
      levels of intrinsic motivation to quit, and equal or higher levels of extrinsic motivation to
      quit compared to smokers without ADHD. Hypothesis 1b: The investigators hypothesize that
      smokers with ADHD will exhibit relatively less readiness for change than smokers without
      ADHD.

      Specific Aim 2: To assess how baseline levels of motivation to quit and readiness for change
      are influenced during a quit attempt as a function of both ADHD status and treatment
      modality. Hypothesis 2a. The investigators hypothesize that the CM intervention will result
      in relatively greater change in extrinsic motivation to quit versus intrinsic motivation to
      quit, and that this effect will be more pronounced among ADHD smokers. Hypothesis 2b: The
      investigators hypothesize that overall motivation to quit (intrinsic and extrinsic) and
      readiness for change will be significantly influenced by the CM intervention versus treatment
      as usual among ADHD smokers.

      Exploratory Aim 1: To assess the relative efficacy of a CM intervention versus treatment as
      usual in smokers with ADHD. The investigators hypothesize that CM will be more effective for
      promoting short-term (4-8 weeks) smoking abstinence, as well as for promoting longer-term
      (3-6 months) smoking cessation.

      Exploratory Aim 2: To assess the associations among smoking withdrawal/craving, affect, ADHD
      symptoms, and motivation to quit/readiness for change. The investigators hypothesize that
      higher levels of motivation and readiness for change will be associated with lower levels of
      self-reported withdrawal, craving, and negative affect.
    

Detailed description: 
      Individuals with ADHD have altered reinforcement/motivational functioning that are likely
      related to risk for smoking and recalcitrance for quitting. The investigators lab has
      demonstrated that the abstinence-induced reinforcing effects of cigarette smoking are more
      pronounced in ADHD smokers. However, in spite of these increases and demonstrated differences
      in withdrawal severity, interventions that provide reinforcement contingent on abstinence
      appear to work well for smokers with ADHD. To date, no studies have explicitly investigated
      how motivational processes are associated with smoking cessation attempts in ADHD smokers.
      The proposed pilot research is therefore highly innovative since it will evaluate how these
      processes change and influence outcomes during two different kinds of smoking cessation
      interventions. The project will also provide important pilot data on potential differences
      between ADHD and non-ADHD smokers in the context of a contingency management (CM) trial,
      which will help guide the development of more refined and targeted cessation interventions
      for this high risk group of smokers.
    

Intervention name(s): Contingency Management (CM); Transdermal nicotine skin patches (i.e. Habitrol); Supportive Counseling
Intervention type(s): Behavioral; Drug; Other
Intervention MeSH terms: Nicotine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: smoking, smoking cessation, contingency management, ADHD