|Recent Findings on the Use of Contingency Management with Cigarette Smokers
|Sunday, May 25, 2008
|10:30 AM–11:50 AM
|Area: BPH/EAB; Domain: Basic Research
|Chair: Alana M. Rojewski (University of Florida)
|Abstract: Cigarette smoking is the leading cause of preventable mortality and morbidity in the United States. Additionally, millions attempt to quit smoking each year, yet over half fail within the first few days of their quit attempt. One method that has reliably demonstrated effective in controlling smoking abstinence is contingency management, which provides reinforcers for smoking abstinence. The current series of presentations seeks to present some recent findings in smoking research using contingency management.
|Influence of Initial Abstinence on Impulsive Choice and the Relative Reinforcing Effects of Cigarette Smoking.
|JIN HO YOON (Baylor College of Medicine), Stephen Higgins (University of Vermont), Matthew P. Bradstreet (University of Vermont), Gary J. Badger (University of Vermont ), Colleen S. Thomas (University of Vermont)
|Abstract: The current study examined the relationship between smoking abstinence and impulsive choice as well the reinforcing effects of cigarette smoking. The study lasted for 14 consecutive days. Participants were provided monetary reinforcement for biochemically-based abstinence for either all 14 days or on day 14. On day 14, a 3-hr smoking preference test was conducted in which participants chose between money and cigarette smoking. Results showed that contingency management was effective in promoting abstinence. Furthermore, smoking abstinence was associated with decreased impulsive responding for cigarettes in addition to a decrease in the reinforcing efficacy of cigarettes.
|Efficacy of Lapse-Responsive Abstinence Reinforcement for Smoking Cessation.
|WENDY DONLIN WASHINGTON (Johns Hopkins University School of Medicine), Maxine Stitzer (Behavioral Pharmacology Research Unit), Elizabeth Houtsmuller (Johns Hopkins University)
|Abstract: Contingency management interventions have previously been successful in the treatment of smoking cessation. One way to decrease the probability of smoking is to deliver reinforcers (money or vouchers) contingent on providing evidence of recent smoking abstinence, such as cotinine-free urine samples or low carbon monoxide breath samples. These incentives increase the proportion of subjects initiating a period of smoking abstinence (e.g. Higgins et al, 2004; Dallery et al, 2007). In the current experiment, 99 adult smokers enrolled in a smoking cessation clinical trial. All participants were offered standard counseling and Zyban© (bupropion) to prepare for quitting smoking on a particular day. Upon reaching the quit day, subjects were instructed to call into an automated system to report smoking status daily for 2 weeks. If the participant self-reported a smoking relapse, they were invited to attend the clinic for “additional help” to quit smoking. If the participant agreed to return to the clinic, they were randomized into either a contingency management group (n=19) or a control group (n=20). Control participants received further advice and counseling on how to avoid smoking. Participants in the smoking cessation group received the advice and counseling, but were also offered the opportunity to earn up to $650 for attending the clinic several times a week and providing breath and urine samples that indicated recent smoking abstinence over the following four months. Smoking status was assumed to be positive if a participant did not attend a session. The contingency management group did not differ from the control group in smoking status at any point during the study. Attrition was a problem across the entire study, possibly accounting for a lack of group differences. Individual subjects who consistently attended follow up contingency management visits were more likely to submit smoking-abstinent samples than other subjects.
|A Deposit Contract Method to Deliver Abstinence Reinforcement for Cigarette Smoking.
|STEVEN E. MEREDITH (University of Florida), Jesse Dallery (University of Florida), Irene M. Glenn (University of Virginia)
|Abstract: Eight smokers were randomly assigned to a deposit ($50) or a no-deposit group. Participants made two video recordings per day of a breath carbon monoxide (CO) procedure with a web camera. The videos were made at home and sent electronically to researchers. Following a five-day baseline period, participants could earn vouchers for gradual reductions in breath CO during a four-day shaping condition, and then for achieving abstinence (CO = 4 ppm) during a ten-day abstinence induction phase. Smoking status was monitored during an additional 5-day return-to-baseline condition. Vouchers were exchanged for merchandise through internet vendors. Participants in both groups could earn a maximum of $78.80 for sustained abstinence. Any amount earned equal to or less than $50 represented reimbursement of the initial contract in the deposit group. Relative to baseline conditions, decreases in breath CO were observed during treatment in both groups, and many participants achieved sustained periods of abstinence. Although there were no clinically meaningful differences in abstinence rates between groups, the no-deposit group incurred costs of $178.50 in vouchers while the deposit group incurred no costs. The results suggest that a deposit contract method may represent a cost-effective model to deliver abstinence reinforcement for cigarette smoking.
|Motiv8: An Automated, Remote Internet-based Method for Delivering Abstinence Reinforcement for Cigarette Smoking.
|BETHANY R. RAIFF (University of Florida), Jesse Dallery (University of Florida), Jeb Jones (The Marcus Institute), Alana M. Rojewski (University of Florida), Steven E. Meredith (University of Florida), Mike Grabinski (red5group)
|Abstract: The present study is a randomized clinical trial of internet-based abstinence reinforcement for cigarette smoking. Smokers were assigned to a contingent voucher delivery group (CVD) or a noncontingent voucher delivery (NVD) group. From home, participants used a web camera to record themselves blowing into a carbon monoxide (CO) monitor. The video was submitted on a secure website, Motiv8, which provided immediate feedback about voucher deliveries and a graph of CO values. The first 3 days served as baseline. The next 4 days served as shaping, where participants received more stringent goals for CO values until a final goal of 4 ppm (i.e, negative). CVD participants earned vouchers for reaching their goal during shaping, whereas NVD participants were yoked to CVD participants with respect to voucher deliveries. The next 3 weeks served as the treatment condition. All participants had a goal of 4 ppm, but only CVD participants earned vouchers on a standard ascending schedule, with a reset contingency. A final 3-week thinning condition required participants to submit videos twice per week. Participants in the CVD group (n = 6) are showing a greater percentage (74%) of negative CO readings than participants in the NVD group (n = 3; 18%) during the treatment and thinning conditions. An internet-based abstinence reinforcement program is more effective at promoting abstinence when vouchers are contingent than when vouchers are noncontingent on abstinence.