Incentives Plus Bupropion for Smoking in Schizophrenics

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DESCRIPTION (provided by applicant): There is a high prevalence of cigarette smoking among people with schizophrenia, but few smoking treatments have been developed for these patients. Laboratory and clinical studies have begun to delineate environmental and biological factors that affect smoking in schizophrenics. Recent laboratory feasibility studies have shown promising results with contingent monetary reinforcement for smoking reductions. Similarly, several smoking treatment studies in schizophrenics have shown promising results with bupropion- SR. Our long-term goal is to develop an effective, feasible, research-based smoking cessation program for smokers with schizophrenia. In this laboratory-based feasibility study, we will evaluate 128 male and female smokers with schizophrenia who are interested in quitting smoking in the future, using a 2 x 2 between groups factorial design. The primary aims are: (1) to evaluate the efficacy of a novel contingency management procedure for shaping smoking abstinence by reinforcing salivary cotinine reductions, compared to non-contingent reinforcement; (2) to evaluate the efficacy of 300 mg/day bupropion-SR, compared to placebo; (3) to evaluate the efficacy of combining contingent reinforcement for smoking reductions with bupropion, versus either intervention alone. Secondary aims are (1) to evaluate whether gender or individual differences in nicotine dependence and motivation moderate responsivity to each intervention; (2) to evaluate whether abstinence is related to changes in psychiatric symptoms, extrapyramidal symptoms or cognitive functioning. This study will provide significant information regarding the efficacy and feasibility of using a combination of contingency management and smoking pharmacotherapy to treat smoking in schizophrenics.