Contingency Management for Smoking in Substance Abusers (SCMSUD)

Brown University

Status: Completed

Conditions: Substance Abuse

Treatments: Behavioral: Contingency Management; Drug: Nicotine Replacement Treatment (NRT); Behavioral: Brief Advice; Behavioral: Non-Contingent Reinforcement

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT00807742

1R01DA023995-01

R01DA023995 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The aim of this study is to determine whether contingent reinforcement for smoking abstinence, compared to noncontingent reinforcement, increases the effectiveness of brief counseling and nicotine replacement on smoking abstinence of substance abusers in residential treatment.

Full description

Substance abusers have a high prevalence and rate of smoking with little success in quitting, so stronger approaches are needed to encourage attempts to quit smoking.

The aim of this study is to determine whether contingent reinforcement for smoking abstinence (CM), compared to noncontingent reinforcement (NR), increases the effectiveness of brief counseling and nicotine replacement on smoking abstinence of substance abusers in residential treatment. The proposed study will be a 2-group design in which up to 274 substance abusers who smoke 10 or more cigarettes per day receive brief advice (4 sessions) and nicotine replacement (NRT) (8 weeks), and are randomized to 19 days of CM for smoking vs. a matched NR condition. The brief advice is adapted slightly for sobriety settings. Point-prevalence abstinence will be assessed at 1, 3, 6 and 12 months after starting treatment. Secondary aims evaluate effects of CM on substance use outcomes and potential mediators of effects on outcome, including within-treatment abstinence, motivation level and tolerance for smoking discomfort.

The significance is to add knowledge about the most effective ways to maximize smoking cessation among substance abusers, important given that no methods are known to work with this population.

Enrollment: 340 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• diagnosis of substance abuse or dependence by DSM-IV criteria
• in residential treatment at one particular agency
• currently smoking at least 10 cigarettes per day for the past 6 months

Exclusion criteria

• hallucinating or delusional or marked organic impairment (to the point of impairing ability to understand informed consent) according to medical records
• current use of nicotine replacement therapy, Zyban, or any other smoking cessation treatment
• medical exclusions for NRT: pregnant or nursing; treatment in the last 3 months for unstable angina, severe congestive heart failure, uncontrolled hypertension; lung cancer; supplemental oxygen; history of adverse reactions to NRT; allergies to adhesive; or any severe skin disease that requires treatment (e.g., psoriasis or eczema).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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340 participants in 2 patient groups

Contingency Management (CM)

Experimental group

Description:

Condition provides contingent monetary reinforcement for smoking reductions (first 5 days) then for smoking abstinence (subsequent 14 days). Expired carbon monoxide (CO) levels will be the basis for determining reductions and abstinence.

Treatment:

Behavioral: Contingency Management

Behavioral: Brief Advice

Drug: Nicotine Replacement Treatment (NRT)

Noncontingent Reinforcement (NR)

Active Comparator group

Description:

Controls for effects of receiving payments, providing daily breath samples for CO level, and degree of interaction between patient and research staff. NR will allow them to earn an amount which is matched in amount to the expected average earned in CM contingent only on providing breath samples independent of the CO level attained.

Treatment:

Behavioral: Brief Advice

Drug: Nicotine Replacement Treatment (NRT)

Behavioral: Non-Contingent Reinforcement