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Randomized Controlled Trial
. 2010 Feb;18(1):37-50.
doi: 10.1037/a0018649.

A contingency-management intervention to promote initial smoking cessation among opioid-maintained patients

Kelly E Dunn  1 , Stacey C Sigmon, Edward F Reimann, Gary J Badger, Sarah H Heil, Stephen T Higgins
Affiliations
Randomized Controlled Trial

A contingency-management intervention to promote initial smoking cessation among opioid-maintained patients

Kelly E Dunn et al. Exp Clin Psychopharmacol. 2010 Feb.

Abstract

Prevalence of cigarette smoking among opioid-maintained patients is more than threefold that of the general population and associated with increased morbidity and mortality. Relatively few studies have evaluated smoking interventions in this population. The purpose of the present study was to examine the efficacy of contingency management for promoting initial smoking abstinence. Forty methadone- or buprenorphine-maintained cigarette smokers were randomly assigned to a contingent (n = 20) or noncontingent (n = 20) experimental group and visited the clinic for 14 consecutive days. Contingent participants received vouchers based on breath carbon monoxide levels during Study Days 1 to 5 and urinary cotinine levels during Days 6 to 14. Voucher earnings began at $9.00 and increased by $1.50 with each subsequent negative sample for maximum possible of $362.50. Noncontingent participants earned vouchers independent of smoking status. Although not a primary focus, participants who were interested and medically eligible could also receive bupropion (Zyban). Contingent participants achieved significantly more initial smoking abstinence, as evidenced by a greater percentage of smoking-negative samples (55% vs. 17%) and longer duration of continuous abstinence (7.7 vs. 2.4 days) during the 2 week quit attempt than noncontingent participants, respectively. Bupropion did not significantly influence abstinence outcomes. Results from this randomized clinical trial support the efficacy of contingency management interventions in promoting initial smoking abstinence in this challenging population.

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Figures

Figure 1
Figure 1
Smoking abstinence for contingent (filled symbols) and noncontingent (open symbols) participants. Data are collapsed across 14-day intervention. Bars represent group mean; symbols represent individual data. Top panel: Total percentage smoking-abstinent samples. Bottom panel: Mean longest duration of smoking abstinence. Error bars on bottom panel represent SEM. Asterisks indicate significant group effects between contingent and noncontingent groups.
Figure 2
Figure 2
Daily smoking abstinence across the 14-day intervention for contingent (filled symbols) and noncontingent (open symbols) participants. Error bars represent SEM. Top panel: Self-report of cigarettes per day at each study visit. Middle panel: Mean breath carbon monoxide (CO) levels. Bottom panel: Mean urine cotinine levels. Asterisks indicate significant group effects between contingent and noncontingent groups.
Figure 3
Figure 3
Nicotine withdrawal across the 14-day intervention for responders in the contingent group. Data presented are from the Minnesota Nicotine Withdrawal Questionnaire (MNWQ). Mean total score (left panels) and desire to smoke (right panels) are presented. Top panels: MNWQ data from all contingent responders (collapsed across bupropion groups). Bottom panels: MNWQ data as a function of bupropion (filled symbols) or no bupropion (open symbols). Error bars represent SEM.
Figure 4
Figure 4
Smoking abstinence among contingent (left bars) and noncontingent (right bars) participants as a function of bupropion (solid bars) or no bupropion (open bars) administration. Data are collapsed across the 14-day intervention. Top panel: Total percentage smoking-abstinent samples. Bottom panel: Mean longest duration of smoking abstinence. Bars represent group mean; error bars represent SEM.
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