Prize Reinforcement for Smoking Cessation

描述(由申请人提供)：应急管理(CM)治疗在减少药物使用方面是有效的。一种相对较新的方法被称为基于奖品的CM，它使用奖品来加强物质戒断，在减少某些类型的物质使用方面是有效的，但其在治疗吸烟方面的有效性尚未被评估。本研究的目的之一是评估奖励强化干预措施在减少吸烟方面的效果。第二个目的是以吸烟为样本，测试两种强化方案的不同疗效。我们将110名患者随机分配到三种情况之一：1)标准治疗；2)传统奖品强化；或3)早期治疗强化奖品强化。根据目前的护理指南标准，每种情况下的患者都将接受吸烟咨询。所有患者将参加为期一周的基准期，然后进行为期四周的干预。在这两个阶段，每个患者每天将会见两次研究助理，以提供一氧化碳(CO)样本。在奖品强化条件下的患者，当他们提供CO阴性样本(即=6ppm)时，将有机会获奖。如果他们在周末后提供的唾液可替宁样本为阴性(即=10 ng/毫升)，他们还将获得奖金抽奖。处于传统CM状态的患者将有至少50%的机会在每个阴性样本中获奖，而连续阴性样本的获奖机会会不断增加。处于增强状态的患者将有机会获得相同的抽签总数和增援幅度，但增援计划将有所不同。在CM阶段的第一周，这些患者将有100%的机会获奖，但在后3周，总体强化的可能性将降至34%。患者还将接受为期2个月和6个月的随访评估。主要结果衡量标准将是持续禁欲的最长持续时间和平均禁欲天数。我们预测，与标准治疗相比，奖励强化措施将在更大程度上减少吸烟。我们还预测，与传统的CM条件相比，增强的CM条件将导致吸烟的更大程度的减少，并且这些变化可能导致在整个研究期间更长时间地持续戒烟。

DESCRIPTION (provided by applicant): Contingency management (CM) treatments are efficacious in reducing substance use. A relatively new approach, called prize-based CM, which uses prizes to reinforce substance abstinence, is effective in decreasing certain types of substance use, but its efficacy has not been evaluated in the treatment of cigarette smoking. One purpose of the current study is to assess the efficacy of a prize reinforcement intervention for reducing cigarette smoking. A second purpose is to test the differential efficacy of two schedules of reinforcement, using cigarette smoking as an exemplar. We will randomly assign 110 patients to one of three conditions: 1) Standard treatment; 2) Traditional prize reinforcement; or 3) Early-treatment enhanced prize reinforcement. Patients in each condition will receive counseling for their smoking based on current standard of care guidelines. All patients will participate in a one-week baseline period, followed by a four-week intervention. Throughout both phases, each patient will meet with a research assistant twice daily to provide carbon monoxide (CO) samples. Patients in the prize reinforcement conditions will earn the chance to win prizes when they provide negative CO samples (i.e., = 6ppm). They will also earn bonus draws if they provide negative salivary cotinine samples (i.e., =10ng/ml) after weekends. Patients in the Traditional CM condition will have at least a 50% chance of winning a prize for each negative sample with escalating chances for successive negative samples. Patients in the Enhanced condition will have the opportunity to earn the same overall number of draws and magnitude of reinforcement, but the schedule of reinforcement will differ. For the first week of the CM phase, these patients will have a 100% chance of winning prizes, but in the latter 3 weeks, overall probability of reinforcement will be decreased to 34%. Patients will also undergo 2- and 6-month follow- up assessments. Primary outcome measures will be longest duration of continuous abstinence and mean number of days of abstinence. We predict that the prize reinforcement will reduce cigarette smoking to a greater extent than standard treatment. We also predict that the Enhanced CM condition will lead to greater reductions in cigarette smoking relative to the Traditional CM condition, and that these changes may result in longer sustained abstinence from smoking throughout the study period.