Abstinence Reinforcement Therapy (ART) for Rural Veteran Smokers

农村老烟民的戒断强化治疗 (ART)

• 批准号: 8485369
• 负责人: PATRICK S. CALHOUN
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8485369
• 关键词: Abstinence; Aftercare; Alcohol abuse; Attention; Behavior Therapy; Behavioral; Biological Assay; Bypass; Carbon Monoxide; Caring; Cigarette; Clinic; Cognitive; Cotinine; Counseling; Data; Development; Drug usage; Economic Burden; Effectiveness; Effectiveness of Interventions; Evidence based treatment; Funding; Goals; Guidelines; Health; Health behavior change; Individual; Inpatients; Internet; Intervention; Life; Measures; Mediating; Mediator of activation protein; Medicine; Mental Depression; Methods; Monitor; Morbidity - disease rate; Outpatients; Pain; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Population; Positive Reinforcer; Post-Traumatic Stress Disorders; Psychological reinforcement; Quality-Adjusted Life Years; Randomized; Randomized Controlled Trials; Relative (related person); Risk; Rural; Secure; Self Efficacy; Services; Smoker; Smoking; Smoking Cessation Intervention; Substance Use Disorder; Surveys; Symptoms; Technology; Telephone; Therapeutic Intervention; Time; Treatment outcome; United States; Veterans; Withholding Treatment; arm; base; cigarette smoking; comparative effectiveness; contingency management; cost effective; cost effectiveness; design; effective intervention; effectiveness trial; evidence base; follow-up; high risk; improved; innovation; medical specialties; mortality; nicotine replacement; primary outcome; programs; rural area; smoking cessation; smoking intervention; telehealth; therapy design; treatment program; voucher

DESCRIPTION (provided by applicant): Project Background. Cigarette smoking is the most lethal substance use disorder in the United States in terms of morbidity and mortality. Unfortunately, smoking cessation treatment including smoking cessation aids such as nicotine replacement therapy are greatly underutilized. There is a special need to develop effective interventions that target rural Veterans. Veterans living in rural areas are at particular high risk for smoking related morbidity and mortality. Rural Veterans are significantly less likely to access intensive clinic-based smoking cessation care. While the efforts of our group and others have expanded reach of smoking cessation treatment options beyond the clinic to include tele-medicine, cognitive- behavioral telephone counseling, and internet based interventions, it has been suggested that there is a need of more innovative and intensive approaches to smoking cessation in order to improve quit rates, particularly in settings where treatment options are limited such as rural areas. The use of intensive behavioral therapies, such as contingency management (CM), may be a useful component for smoking cessation interventions among rural Veterans. CM has shown efficacy for reducing smoking in other difficult-to-treat populations. Project Objectives. The primary goal of the current study is o evaluate the effectiveness of an intervention that combines evidenced based treatment for smoking cessation with smart-phone based, portable contingency management on smoking rates compared to a contact control intervention in a randomized controlled trial among rural Veteran smokers. Specifically, Veterans will be randomized to receive Abstinence Reinforcement Therapy (ART) which combines evidenced based cognitive-behavioral telephone counseling (TC), a tele-medicine clinic for access to nicotine replacement (NRT), and mobile contingency management (mCM) or a control condition (i.e., TC and NRT alone) that will provide controls for therapist, medication, time and attention effects. The specific aims and hypotheses are: AIM 1: To evaluate the impact of ART on rates of abstinence from cigarettes at 3-month, 6- month, and 12-month post-treatment follow-ups. Hypothesis 1: Abstinence rates will be significantly higher among Veterans randomized to the ART-based intervention than those randomized to the control arm. AIM 2: To evaluate the relative cost-effectiveness of the ART intervention. Hypothesis 2: ART based treatment will result in greater cost-effectiveness compared to the control condition as measured by the incremental cost-effectiveness ratio. AIM 3: To evaluate potential treatment mediators including self-efficacy-related mechanisms. Hypothesis 3: Increased abstinence associated with ART will be partially mediated by increased self-efficacy compared to the contact-control condition. Project Methods. Proposed is a four year project in which 300 Veteran smokers will be randomized to receive either a multi-component Abstinence Reinforcement Therapy or a contact control intervention. Participating patients will be surveyed at 3-months, 6-months and 12-months post-randomization. The primary outcome of the trial is prolonged self-reported abstinence at the 6 month follow-up verified by cotinine assay.

描述（由申请人提供）：