Contingent Vouchers for Smoking in Substance Abusers as Adjunct to Nicotine Patch

描述（由申请人提供）：药物滥用者的吸烟率和患病率很高，但戒烟成功率很低，因此需要更强有力的方法来鼓励尝试戒烟。基于NCI指南（BA）的简短建议，一种旨在激励戒烟尝试的方法，已显示出对合并药物使用的酒精吸烟者的一些益处，但总体戒烟率较低。在BA中加入应急货币强化是增加初始禁欲作为长期禁欲基础的一种方法。在以前的研究中，应急管理，使用即时凭证特遣队戒烟（CM）增加戒烟相对于noncontingent凭证加固（NR）在凭证阶段之后几乎没有影响。可能的方法，以提高有效性进行了试点：添加NRT大大增加了禁欲期间和之后的CM，而高支付几乎没有额外的好处。然而，由于NRT与咨询是戒烟护理的基本标准，需要知道的是，吸烟的CM是否会增加NRT与物质滥用者咨询的有效性。本研究的目的是确定是否有条件的加强戒烟，相比非条件的加强，增加了短期咨询和尼古丁替代物质滥用者在住宅治疗戒烟的有效性。拟定的研究将是一项2组设计，其中340名每天吸烟15支或以上的物质滥用者接受BA（4个疗程）和NRT（8周），并随机接受19天（5个减少日以形成初始戒烟+14个戒烟强化日）的CM吸烟与匹配的NR条件（设计的长度适合物质滥用计划）。NRT将免费提供给所有人。BA（动机信息和认知行为应对技能援助）通过直接解决物质滥用者表达的障碍和担忧而稍微适应清醒环境。将在开始治疗后1、3、6和12个月评估禁欲和物质使用的点患病率。次要目的评价CM对结果影响的潜在介质的影响，包括治疗内戒烟，动机水平和吸烟不适的耐受性。以前没有研究比较了成年吸烟者的CM和NR，所有人都被提供了NRT加上旨在激励人们戒烟的简短建议。潜在的意义是增加关于最有效的方法的知识，以最大限度地减少药物滥用者的吸烟，重要的是，考虑到没有方法已知的工作与这个困难的人群。

DESCRIPTION (provided by applicant): Substance abusers have a high prevalence and rate of smoking with little success in quitting, so stronger approaches are needed to encourage attempts to quit smoking. Brief advice based on the NCI guidelines (BA), an approach designed to motivate cessation attempts, has shown some benefit for alcoholic smokers with comorbid drug use yet overall abstinence rates are low. Adding contingent monetary reinforcement to BA is one way to increase initial abstinence as a foundation for longer term abstinence. In a previous study, contingency management using immediate vouchers contingent on smoking abstinence (CM) increased abstinence relative to noncontingent voucher reinforcement (NR) during the voucher phase with little effect afterwards. Possible methods to increase effectiveness were piloted: Adding NRT greatly increased abstinence during and after CM while high payments had little additional benefit. However, since NRT with counseling is the basic standard of care for smoking cessation, what needs to be known is whether CM for smoking would increase the effectiveness of NRT plus counseling with substance abusers. The aim of this study is to determine whether contingent reinforcement for smoking abstinence, compared to noncontingent reinforcement, increases the effectiveness of brief counseling and nicotine replacement on smoking abstinence of substance abusers in residential treatment. The proposed study will be a 2-group design in which 340 substance abusers who smoke 15 or more cigarettes per day receive BA (4 sessions) and NRT (8 weeks), and are randomized to 19 days (5 reduction days to shape initial abstinence + 14 abstinent reinforcement days) of CM for smoking vs. a matched NR condition (length designed to fit in the substance abuse program). NRT will be provided free to all. The BA (motivation message and cognitive-behavioral coping skills assistance) is adapted slightly for sobriety settings by directly addressing barriers and concerns expressed by substance abusers. Point-prevalence abstinence and substance use will be assessed at 1, 3, 6 and 12 months after starting treatment. Secondary aims evaluate effects of CM on potential mediators of effects on outcome including within-treatment abstinence, motivation level and tolerance for smoking discomfort. No previous study compared CM to NR for adult smokers when all have been provided NRT plus brief advice designed to motivate people to quit smoking. The potential significance is to add to knowledge about the most effective ways to maximize smoking cessation among substance abusers, important given that no methods are known to work with this difficult population.