Contingency management for smoking cessation among individuals with substance use disorders: In-treatment and post-treatment effects

Introduction: Smokers with substance use disorders (SUDs) show elevated tobacco prevalence, and smoking abstinence rates are considerably low. This randomized controlled trial sought to compare the effect of a cognitive behavioral treatment (CBT) that includes an episodic future thinking (EFT) component with the same treatment protocol plus contingency management (CM). This study aims to examine the effect of CM on smoking outcomes and in-treatment behaviors (i.e., retention, session attendance and adherence to nicotine use reduction guidelines), and to analyze whether these in-treatment variables predicted days of continuous abstinence at endof-treatment. Method: A total of 54 treatment-seeking participants (75.9% males, M = 46.19 years old) were allocated to CBT + EFT (n = 30) or CBT + EFT + CM (n = 24). Intervention consisted of eight weeks of group-based sessions. Tobacco abstinence was verified biochemically by testing levels of carbon monoxide (<4ppm) and urine cotinine (<80 ng/ml). Results: CM intervention increased 24-hour tobacco abstinence (50% vs. 20%, chi 2(1) = 5.4; p = .021) and days of continuous abstinence (M = 5.92 +/- 7.67 vs. 5.53 +/- 12.42; t(52) = -0.132; p = 0.89) at end-of-treatment in comparison with CBT + EFT intervention. Although not statistically significant, CBT + EFT + CM enhanced intreatment behaviors, in terms of retention (83.3% vs. 70%; chi 2(1) = 0.255; p = .208), sessions attended (12.29 +/- 3.22 vs. 10.93 +/- 3.26; t(52) = -1.527; p = .133) and adherence to weekly nicotine use reduction targets (41.07% +/- 31.96 vs. 35% +/- 2 6.28; t(52) = -0.766; p = .447). A higher percentage of samples meeting reduction guidelines (beta = 0.609; p<.001) predicted days of continuous abstinence at end-of-treatment. Conclusion: Combining CM with CBT + EFT improves short-term quitting rates. Findings suggest the need to incorporate strategies for improving adherence to nicotine reduction guidelines.