Incentive-based Smoking Cessation for Methadone Patients
Condition: Cigarette Smoking Among Patients Currently Receiving Methadone or Buprenorphine Treatment for Opioid Dependence
MeSH terms: Opioid-Related Disorders
Study type: Interventional
Phase: Phase 2

Summary: 
      The prevalence of cigarette smoking among patients receiving opioid agonist treatment, such
      as methadone or buprenorphine maintenance, is more than three-fold that of the general
      population and is associated with increased morbidity and mortality. The overarching goal of
      this project is to systematically develop a voucher-based contingency-management (CM)
      intervention for promoting initial and longer-term abstinence from cigarette smoking in
      patients receiving methadone or buprenorphine treatment for their opioid abuse.
    

Detailed description: 
      The prevalence of cigarette smoking among patients receiving opioid agonist treatment, such
      as methadone or buprenorphine maintenance, is more than three-fold that of the general
      population and is associated with increased morbidity and mortality. Despite these
      statistics, little is known about how to effectively help opioid-maintained patients to quit
      smoking. We believe a treatment that successfully promotes smoking cessation in these
      patients would offer exciting potential for dissemination. First, these treatment modalities
      are uniquely situated to offer an ideal setting for implementing smoking-cessation
      interventions. Many patients achieve significant periods of stability and drug abstinence and
      remain engaged in treatment for long periods of time, which can promote the frequent and
      prolonged clinical contact to enable success with smoking cessation. Second, opioid treatment
      programs often adhere to a uniform set of state and federal regulations, which could support
      the dissemination of an effective intervention throughout clinics across the country.
      Therefore, the overarching goal of this Behavior Therapy Development project is to
      systematically develop a voucher-based contingency-management (CM) intervention for promoting
      initial and longer-term abstinence from cigarette smoking in patients receiving methadone or
      buprenorphine treatment for their opioid abuse. Our first aim is to develop a CM treatment
      that will promote initial smoking abstinence in these patients using an intensive but brief
      2-week intervention (Study 1). Our second aim will then be to integrate procedures for
      establishing initial abstinence with those designed for maintaining abstinence with the
      overarching goal of promoting smoking cessation that is sustained after the incentive program
      is discontinued (Study 2).
    

Intervention name(s): incentive-based contingency management
Intervention type(s): Behavioral
Intervention description(s): Direct comparison of Contingent versus Noncontingent incentives in promoting abstinence from smoking among opioid-treatment patients. The biochemical measures of breath carbon monoxide levels and urinary cotinine are used to confirm smoking status. Participants receive voucher-based incentives either contingent upon demonstrating abstinence from recent smoking (Contingent condition) or independent of smoking status (Noncontingent control condition).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: smoking cessation; behavioral treatment; contingency management; opioid maintenance; methadone; buprenorphine