Effects of contingency management and bupropion on cigarette smoking in smokers with schizophrenia

Abstract

Rationale: Individuals with schizophrenia have high smoking-related morbidity and mortality rates and need powerful and innovative smoking cessation interventions.

Objectives: This proof-of-concept study investigated the feasibility and initial efficacy of combining a contingency management intervention with bupropion to reduce smoking in people with schizophrenia.

Methods: Using a double-blind, placebo-controlled, between-groups design, 57 non-treatment-seeking participants were randomized to receive 300 mg/day bupropion or placebo. One week later, participants were randomized to a contingency management (CM) intervention in which reductions in urinary cotinine levels were reinforced, or a non-contingent reinforcement (NR) condition in which session attendance was reinforced, regardless of cotinine level. Over the 22-day study period, participants visited the laboratory approximately three times per week to provide urine samples for analysis of cotinine levels, to give breath samples for analysis of carbon monoxide (CO) levels, and to report number of cigarettes smoked per day, nicotine withdrawal symptoms, cigarette craving, and psychiatric symptoms.

Results: Cotinine and CO levels significantly decreased during the study period in participants randomized to the CM condition, but not the NR condition. Bupropion did not reduce cotinine levels or increase the efficacy of CM. Cigarette craving and psychiatric symptom levels significantly decreased during the study in all groups.

Conclusions: The results of this study indicate the efficacy and feasibility of this CM intervention for reducing smoking in individuals with schizophrenia.

Figure 1

Urinary cotinine levels (top), breath carbon monoxide levels (middle) and self-reported number of cigarettes smoked per day (bottom) in participants randomized to CM + BUP (solid circles), CM + PLA (open circles), NR + BUP (solid triangles) and NR + PLA (open triangles) conditions across study weeks. Error bars indicate SEM. Asterisks indicate significant differences from Week 1 (p < .05).