A randomized controlled trial of contingency management for smoking cessation in substance use treatment patients

Abstract

Background/objective: Contingency management (CM) is one of the most effective interventions for smokers with substance use disorder (SUD), and no empirical assessment of its long-term efficacy has been conducted so far in a real-world context. The objectives were: (1) examine the additive effectiveness of CM on cognitive-behavioral treatment (CBT) for smoking cessation, and (2) examine the relationship between smoking cessation and substance use abstinence.

Method: A total of 80 participants (75.8% males; M _age = 45.31; SD = 9.64) were assigned to two smoking cessation treatments: CBT or CBT+CM. A set of generalized estimating equations were conducted to examine the effect of treatment condition on smoking outcomes, as well as the effect of smoking status on substance abstinence.

Results: Adding CM to CBT for smoking cessation improved tobacco abstinence rates at the end-of-treatment (p = .049). Tobacco abstinence rates declined over time (p = .012), but no significant effects of treatment condition were observed across follow-ups (p = .260). Smoking cessation was not significantly related to substance abstinence (p ≥ .488).

Conclusions: CM facilitates early abstinence in smokers with SUD, although effects subside after treatment termination. The lack of association between smoking abstinence and substance use suggests no jeopardizing effects as a result of quitting smoking.

Keywords: Contingency management; Longitudinal study; Relapse; Smoking cessation; Substance use disorder.

Figure 1

Consort flow diagram of study participants.

Figure 2

Risk estimates for cigarette smoking across follow-ups (3-, 6-, and 12-month) in the whole sample and by treatment arm. Note. Risk estimates (RR) are provided for each follow-up assessment in comparison to the end-of-treatment smoking status. * p ≤ 0.05. CBT = cognitive-behavioral treatment; CM = contingency management.