Monetary incentives promote smoking abstinence in adults with attention deficit hyperactivity disorder (ADHD)

Abstract

Individuals with attention deficit hyperactivity disorder (ADHD) smoke at rates significantly higher than the general population and have more difficulty quitting than nondiagnosed individuals. Currently, there are no evidence-based approaches for reducing smoking specifically in individuals with ADHD. Adult regular smokers with or without ADHD participated in a study of extended smoking withdrawal where monetary incentives were used to promote abstinence. Participants were paid according to an escalating schedule for maintaining abstinence measured as self-report of no smoking and an expired air carbon monoxide (CO) level of <or=4 parts per million. Sixty-four percent (14/22) of smokers with ADHD and 50% (11/22) of smokers without ADHD maintained complete abstinence for the 2-week duration of the study. Twenty-two percent (5/22) and 9% (2/22) of smokers with ADHD and without ADHD, respectively, maintained continued abstinence for up to 10 days following the removal of the contingencies. Though abstinence rates were higher for the smokers with ADHD, the group differences were not statistically significant. Results suggest that monetary incentives may be a useful approach for promoting abstinence in adult smokers with ADHD, perhaps owing to altered reinforcement processes in these individuals.

Figure 1

Disposition of participants throughout study. cigs = cigarettes; ADHD = attention deficit hyperactivity disorder; CO = carbon monoxide.

Figure 2

Proportion of smokers in attention deficit hyperactivity disorder (ADHD; (n = 22) and non-ADHD (n = 22) groups maintaining smoking abstinence throughout the study. First 2 weeks were daily, carbon monoxide- (CO) verified assessment of smoking; and the second 2 weeks were not CO-verified and only assessed once at Day 19. Dollar values along x-axis signify the amount available for compliance with abstinence requirement on each day of the contingency management (CM) intervention. Dotted line indicates the point at which contingencies were removed.