Prize Reinforcement for Smoking Cessation

描述（由申请人提供）：应急管理（CM）治疗在减少物质使用方面是有效的。一种相对较新的方法，称为基于奖励的CM，它使用奖励来加强物质戒断，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效果尚未得到评估。本研究的目的之一是评估奖励强化干预对减少吸烟的效果。第二个目的是测试两种强化方案的不同效果，以吸烟为例。我们将随机将110名患者分配到以下三种情况之一：1)标准治疗；2)传统奖励强化；或3)早期处理增强奖品强化。每种情况下的患者都将根据当前的标准护理指南接受有关吸烟的咨询。所有患者将参加为期一周的基线期，随后是为期四周的干预期。在这两个阶段中，每位患者将每天两次与研究助理会面，以提供一氧化碳（CO）样本。在奖励强化条件下，患者提供阴性CO样品（即= 6ppm）即可获得获奖机会。如果他们在周末后提供唾液可替宁阴性样本（即=10ng/ml），他们也将获得奖金。在传统CM条件下，每个阴性样本的患者至少有50%的机会赢得奖品，连续阴性样本的机会不断增加。处于增强状态的患者将有机会获得相同的总次数和强度的强化，但强化的时间表将有所不同。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，总体强化概率将下降到34%。患者还将接受2个月和6个月的随访评估。主要结果测量将是持续禁欲的最长时间和平均禁欲天数。我们预测奖励强化将在更大程度上减少吸烟比标准治疗。我们还预测，与传统CM条件相比，增强CM条件将导致更大的吸烟减少，并且这些变化可能导致在整个研究期间更长时间的持续戒烟。

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.