Contingency management for behavior change: applications to promote brief smoking cessation among opioid-maintained patients

Abstract

Cigarette smoking is highly prevalent among patients who are being treated for opioid-dependence, yet there have been limited scientific efforts to promote smoking cessation in this population. Contingency management (CM) is a behavioral treatment that provides monetary incentives contingent upon biochemical evidence of drug abstinence. This paper discusses the results of two studies that utilized CM to promote brief smoking cessation among opioid-maintained patients. Participants in a pilot study were randomly assigned for a 2-week period to a Contingent group that earned monetary vouchers for providing biochemical samples that met criteria for smoking abstinence, or a Noncontingent group that earned monetary vouchers independent of smoking status (Dunn et al., 2008). Results showed Contingent participants provided significantly more smoking-negative samples than Noncontingent participants (55% vs. 5%, respectively). A second randomized trial that utilized the same 2-week intervention and provided access to the smoking cessation pharmacotherapy bupropion replicated the results of the pilot study (55% and 17% abstinence in Contingent and Noncontingent groups, respectively; Dunn et al, 2010). Relapse to illicit drug use was also evaluated prospectively and no association between smoking abstinence and relapse to illicit drug use was observed (Dunn et al., 2009). It will be important for future studies to evaluate participant characteristics that might predict better treatment outcome, to assess the contribution that pharmacotherapies might have alone or in combination with a CM intervention on smoking cessation and to evaluate methods for maintaining the abstinence that is achieved during this brief intervention for longer periods of time.

Figure 1

Total smoking abstinence (top panel) and longest duration continuous smoking abstinence (bottom panel) for 20 opioid-maintained patients. Bars represent group means and circles represent individual data. Asterisk represents significance at p<05 level, vertical bar represents SEM. Reprinted with permission from: Dunn, K.E., Sigmon, S.C. Thomas, C.S., Heil, S.H., & Higgins, S.T. (2008). Voucher-based contingent reinforcement of smoking abstinence among methadone-maintained patients: A pilot study. Journal of Applied Behavior Analysis, Vol. 41 (4), pp 527-538.

Figure 2

Total smoking abstinence (top panel) and longest duration continuous smoking abstinence (bottom panel) for 40 opioid-maintained patients. Bars represent group means and circles represent individual data. Asterisk represents significance at p<05 level, vertical bar represents SEM. Reprinted with permission from: Dunn, K.E., Sigmon, S.C., Reimann, E.R., Badger, G.J., Heil, S.H., & Higgins, S.T. (2010). A contingency-management intervention to promote initial smoking cessation among opioid-maintained patients. Experimental and Clinical Psychopharmacology, Vol. 18 (1), pp 37-50.

Figure 3

Total smoking abstinence (top panel) and longest duration continuous smoking abstinence (bottom panel) for 40 opioid-maintained patients, as a function of bupropion (gray bars) or no bupropion (white bars). Bars represent group means and circles represent individual data. Vertical bars represent SEM.