Internet-based group contingency management to promote abstinence from cigarette smoking: a feasibility study

Abstract

Background: In contingency management (CM) interventions, monetary consequences are contingent on evidence of drug abstinence. Typically, these consequences are contingent on individual performance. Consequences contingent on group performance may promote social support (e.g., praise).

Methods: Thus, to combine social support with the monetary incentives of CM, we integrated independent and interdependent group contingencies of reinforcement into an Internet-based intervention to promote smoking abstinence. Breath carbon monoxide (CO) measures were compared between treatment conditions and a baseline control condition. Thirteen participants were divided into 5 groups or "teams" (n=2-3 per team). Each participant submitted video recordings of CO measurement twice daily via the Internet. Teammates could monitor each other's progress and communicate with one another through an online peer support forum. During a 4-day tapering condition, vouchers exchangeable for goods were contingent on gradual reductions in breath CO. During a 10-day abstinence induction condition, vouchers were contingent on abstinence (CO≤4ppm). In both treatment conditions, concurrent independent and interdependent group contingencies were arranged (i.e., a mixed contingency arrangement).

Results: Less than 1% of CO samples submitted during baseline were≤4ppm, compared to 57% submitted during abstinence induction. Sixty-five percent of participants' comments on the online peer support forum were rated as positive by independent observers. Participants rated the intervention favorably on a treatment acceptability questionnaire.

Conclusion: The results suggest that the intervention is feasible and acceptable for promoting abstinence from cigarette smoking.

Fig. 1

Individual participant (N = 13) data showing breath CO level (ppm) for each sample across all study conditions. Dashed vertical lines represent condition change lines (A = baseline, B = tapering, and C = abstinence induction). Dashed horizontal lines represent the abstinence criterion used during abstinence induction (4 ppm); therefore, data points at or below this line are indicative of abstinence. Baseline duration increases from 2 to 6 days across teams from left to right (i.e., Team 1 experienced a 2-day baseline, Team 2 experienced a 3-day baseline, etc.). Note the different scale on the y-axis for T47.

Fig. 2

Mean percentage of negative breath CO samples (CO ≤4 ppm). Each bar represents the mean for all participants (N = 13) during each condition. Circles represent individual participant means during each condition.