Contingent Vouchers for Smoking in Substance Abusers as Adjunct to Nicotine Patch

描述(申请人提供)：吸烟者吸烟率和吸烟率很高，但戒烟成功率很低，因此需要采取更有力的方法来鼓励尝试戒烟。基于NCI指南(BA)的简短建议，一种旨在激励戒烟尝试的方法，已经显示出对酗酒吸烟者合并药物使用的一些好处，但总体戒断率很低。在BA中增加或有货币支持是增加初始戒酒作为长期戒酒基础的一种方式。在先前的一项研究中，在凭证阶段使用以戒烟为条件的即时凭证(CM)的应急管理相对于非或有凭证强化(NR)增加了戒烟率，但此后效果甚微。尝试了提高有效性的可能方法：增加NRT大大增加了CM期间和之后的戒断率，而高额支付几乎没有额外的好处。然而，由于NRT加咨询是戒烟护理的基本标准，需要知道的是吸烟CM是否会增加NRT加药物滥用者咨询的效果。本研究的目的是确定与非偶然戒烟相比，临时戒烟强化是否增加了短暂咨询和尼古丁替代对住院治疗中药物滥用者戒烟的有效性。这项拟议的研究将是一个两组设计，其中340名每天吸烟15支或更多的药物滥用者接受BA(4个疗程)和NRT(8周)，并被随机分为19天(5个减少天数以形成初始戒断+14个戒断强化天数)与匹配的NR条件(设计以适应药物滥用计划的长度)。NRT将免费提供给所有人。BA(动机信息和认知-行为应对技能援助)通过直接解决物质滥用者表达的障碍和担忧，略微适用于戒酒环境。在开始治疗后的1、3、6和12个月将评估戒毒和药物使用的时点流行率。次要目的是评估CM对影响结果的潜在中介因素的影响，包括治疗内的禁欲、动机水平和对吸烟不适的耐受性。以前没有研究比较成年吸烟者的CM和NR，当所有人都被提供NRT加上旨在激励人们戒烟的简短建议时。潜在的意义是增加关于在药物滥用者中最有效地戒烟的知识，这一点很重要，因为目前还没有已知的方法来应对这些困难的人群。

DESCRIPTION (provided by applicant): Substance abusers have a high prevalence and rate of smoking with little success in quitting, so stronger approaches are needed to encourage attempts to quit smoking. Brief advice based on the NCI guidelines (BA), an approach designed to motivate cessation attempts, has shown some benefit for alcoholic smokers with comorbid drug use yet overall abstinence rates are low. Adding contingent monetary reinforcement to BA is one way to increase initial abstinence as a foundation for longer term abstinence. In a previous study, contingency management using immediate vouchers contingent on smoking abstinence (CM) increased abstinence relative to noncontingent voucher reinforcement (NR) during the voucher phase with little effect afterwards. Possible methods to increase effectiveness were piloted: Adding NRT greatly increased abstinence during and after CM while high payments had little additional benefit. However, since NRT with counseling is the basic standard of care for smoking cessation, what needs to be known is whether CM for smoking would increase the effectiveness of NRT plus counseling with substance abusers. The aim of this study is to determine whether contingent reinforcement for smoking abstinence, compared to noncontingent reinforcement, increases the effectiveness of brief counseling and nicotine replacement on smoking abstinence of substance abusers in residential treatment. The proposed study will be a 2-group design in which 340 substance abusers who smoke 15 or more cigarettes per day receive BA (4 sessions) and NRT (8 weeks), and are randomized to 19 days (5 reduction days to shape initial abstinence + 14 abstinent reinforcement days) of CM for smoking vs. a matched NR condition (length designed to fit in the substance abuse program). NRT will be provided free to all. The BA (motivation message and cognitive-behavioral coping skills assistance) is adapted slightly for sobriety settings by directly addressing barriers and concerns expressed by substance abusers. Point-prevalence abstinence and substance use will be assessed at 1, 3, 6 and 12 months after starting treatment. Secondary aims evaluate effects of CM on potential mediators of effects on outcome including within-treatment abstinence, motivation level and tolerance for smoking discomfort. No previous study compared CM to NR for adult smokers when all have been provided NRT plus brief advice designed to motivate people to quit smoking. The potential significance is to add to knowledge about the most effective ways to maximize smoking cessation among substance abusers, important given that no methods are known to work with this difficult population.