? ? 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. ? ? ?
