Incentive-based smoking cessation for methadone patients

描述（由申请人提供）： 美沙酮维持治疗（MM）患者中吸烟的患病率是一般人群的三倍，并与发病率和死亡率增加有关。尽管有这些统计数据，但关于如何有效减少MM患者吸烟的科学知识仍然缺乏。有限的研究表明，到目前为止，应急管理（CM）的干预措施可能是有效的，在这一人群。然而，现有研究的一个共同点是，没有一项研究能够在这个具有挑战性的人群中产生长期戒烟。现有的证据表明，迄今为止使用的CM干预措施的一个重要局限性是，它们未能在戒烟努力的最初几周内建立禁欲。事实上，越来越多的研究表明，早期禁欲（前两周）是后来持续禁欲的有力预测因素。鉴于MM患者对有效戒烟的巨大需求，我们认为必要的第一步是制定一种干预措施，以产生持续的初始戒烟期。然而，虽然初始戒烟可能是长期成功所必需的，但仅针对初始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，我们将整合建立初始戒烟的程序与长期戒烟的程序，其总体目标是促进在奖励计划停止后持续戒烟。在这个修订后的行为疗法开发应用程序中，我们建议以编程方式测试MM吸烟者中基于凭证的干预的组件。这种干预措施是由我们小组开发的，已在其他人群中证明有效，旨在最大限度地提高戒烟初期的持续戒烟率。提出了两项研究。首先，我们将开发和测试一种基于凭证的干预措施，以促进戒烟努力的最初2周内的戒烟。第二，我们将开发和测试基于凭证的干预措施的有效性，以维持禁欲后，密集的2周计划停止。该提案的总体目标是制定一个有效的，基于药物的戒烟干预措施，可以很容易地传播到全国各地的美沙酮诊所。总的来说，拟议的研究使用了一种程序化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。拟议的研究还具有影响一般公共卫生状况的重大潜力，因为有效戒烟治疗的开发将有助于降低MM和非MM吸烟者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.