Incentive-based smoking cessation for methadone patients

描述(由申请人提供)： 美沙酮维持性(MM)患者中吸烟的流行率是普通人群的三倍，并与发病率和死亡率的增加有关。尽管有这些统计数据，但关于如何有效减少多发性骨髓瘤患者吸烟的科学知识仍然缺乏。到目前为止有限的研究表明，应急管理(CM)干预可能在这一人群中有效。然而，现有研究的一个共同点是，没有一项研究能够在这一具有挑战性的人群中产生长期的戒烟效果。现有证据表明，迄今为止使用的CM干预措施的一个重大局限性是，它们未能在戒烟努力的最初几周建立戒断。事实上，越来越多的研究表明，早期禁欲(在前两周内)是未来持续禁欲的有力预测因素。鉴于多发性骨髓瘤患者对有效戒烟的巨大需求，我们认为必要的第一步是开发一种干预措施，产生持续的初始戒烟期。然而，虽然初步戒烟对于长期的成功可能是必要的，但仅针对初步戒烟的干预措施可能不足以在这一人群中实现长期戒烟。因此，我们将整合初步戒烟程序和长期戒烟程序，总体目标是促进在激励计划终止后持续存在的戒烟行为。在这个修订的行为疗法开发应用程序中，我们建议对MM吸烟者进行基于凭证的干预组件的程序化测试。这项干预措施是由我们小组开发的，在其他人群中已被证明有效，目的是在戒烟努力的最初几天最大限度地实现持续戒烟。提出了两项研究。首先，我们将开发和测试一种基于代金券的干预措施，以促进戒烟努力的最初两周内的戒烟。其次，我们将开发和测试基于代金券的干预措施的有效性，以在为期两周的强化计划结束后维持戒酒。这项建议的首要目标是产生一种有效的、以经验为基础的戒烟干预措施，可以很容易地传播到全国各地的美沙酮诊所。总体而言，拟议的研究使用了一种程序性的方法来增强我们对如何在MM患者中实现短期和长期戒烟的理解。这项拟议的研究还可能对总体公共健康状况产生重大影响，因为开发有效的戒烟治疗将有助于降低MM和非MM吸烟者与吸烟相关的巨大经济和社会成本。

DESCRIPTION (provided by applicant): Prevalence of cigarette smoking among methadone maintenance (MM) patients is three-fold that of the general population and is associated with increased morbidity and mortality. Despite these statistics, there is a dearth of scientific knowledge about how to effectively reduce smoking among MM patients. The limited research thus far suggests that contingency-management (CM) interventions may be effective in this population. However, one commonality across the existing studies is that none have been able to produce longer-term smoking abstinence in this challenging population. The existing evidence suggests that a significant limitation of the CM interventions used to date is that they failed to establish abstinence in the initial weeks of the cessation effort. Indeed, an increasing body of research has demonstrated that early abstinence (during the 1st 2 weeks) is a robust predictor of sustained abstinence later. Given the tremendous need for effective smoking cessation in MM patients, we believe that the necessary first step is to develop an intervention that produces a sustained period of initial abstinence. However, while initial abstinence may be necessary for longer-term success, aiming interventions exclusively at initial abstinence is likely to be insufficient for achieving longer-term smoking cessation in this population. Thus, we will integrate procedures for establishing initial abstinence with those designed for longer-term abstinence with the overarching goal of promoting smoking abstinence that persists after the incentive program is discontinued. In this revised Behavioral Therapies Development application, we propose to programmatically test components of a voucher-based intervention in MM smokers. This intervention was developed by our group, has been demonstrated efficacious in other populations, and aims to maximize continuous smoking abstinence in the initial days of the cessation effort. Two studies are proposed. First, we will develop and test a voucher-based intervention to promote smoking abstinence during the initial 2 weeks of the cessation effort. Second, we will develop and test the efficacy of a voucher-based intervention to sustain abstinence after the intensive 2-week program is discontinued. The overarching goal of this proposal is to produce an efficacious, empirically-based smoking cessation intervention that can be easily disseminated to methadone clinics throughout the country. Overall, the proposed studies use a programmatic approach to enhance our understanding of how to achieve short- and longer-term smoking abstinence in MM patients. The proposed research also holds significant potential for impacting the status of public health in general, as development of efficacious smoking-cessation treatments will help to reduce the vast economic and societal costs associated with cigarette smoking among MM and non-MM smokers alike.