Contingency management (CM) treatments can reduce smoking. This study will evaluate the efficacy of a short-term CM technique for initiating abstinence in conjunction with the nicotine receptor agonist/antagonist varenicline. While efficacious in reducing smoking rates, about half of patients do not respond to this pharmacotherapy, and most of the response (or lack thereof) occurs in the first month. CM is especially effective in engendering initial abstinence;if CM can improve early response to varenicline;more patients may remain on the drug and achieve abstinence, which in turn should be associated with long-term benefits. This drug may be particularly amenable for use with CM because it is purported to attenuate nicotine craving and withdrawal, two effects that do not occur with CM alone. Further, by providing CM with varenicline in a high cardiovascular risk population (patients with hypertension who smoke), benefits may outweigh costs. In total, 260 patients with pre- and stage I hypertension who smoke >10 cigarettes per day will be randomized to: varenicline alone or varenicline plus CM. Patients in both conditions will receive varenicline (titrated to a maximal dose of 1.0 mg twice daily) for 12 weeks along with standard smoking cessation therapy and regular carbon monoxide (CO) and cotinine monitoring. Patients assigned to CM will earn chances to win prizes ranging in value from $1 to $100 for each CO negative (<6 ppm) sample provided, and samples negative for cotinine will result in even greater chances to earn prizes. Main outcomes will be 7-day point prevalence rates of objectively confirmed abstinence at weeks 5, 12, 24, 36, and 52, longest duration of continuous abstinence, and percent continuously abstinent. A significantly higher proportion of CM patients are expected to achieve and maintain long durations of abstinence than patients receiving varenicline alone. Although some relapse is likely to occur after treatment, slopes of the relapse curves are not expected to differ between groups, such that the group that receives CM early on should have a higher proportion of patients abstinent at week 52. Clinic and 24-hour blood pressure (BP) and heart rate (HR) will be additional outcomes. We expect that BP and HR will decrease more among CM than non-CM patients and reductions in smoking may mediate decreases in these indices.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA024667-05
Application #
8308556
Study Section
Special Emphasis Panel (ZDA1-RXL-E (03))
Program Officer
Grossman, Debra
Project Start
2008-09-30
Project End
2014-07-31
Budget Start
2012-08-01
Budget End
2014-07-31
Support Year
5
Fiscal Year
2012
Total Cost
$476,354
Indirect Cost
$154,493
Name
University of Connecticut
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
022254226
City
Farmington
State
CT
Country
United States
Zip Code
06030
Petry, Nancy M; Alessi, Sheila M; Byrne, Shannon et al. (2015) Reinforcing adherence to antihypertensive medications. J Clin Hypertens (Greenwich) 17:33-8
Abraham, Hazel Mae A; White, C Michael; White, William B (2015) The comparative efficacy and safety of the angiotensin receptor blockers in the management of hypertension and other cardiovascular diseases. Drug Saf 38:33-54
Weiss, Lindsay M; Petry, Nancy M (2014) Substance abuse treatment patients with early onset cocaine use respond as well to contingency management interventions as those with later onset cocaine use. J Subst Abuse Treat 47:146-50
Andrade, Leonardo F; Petry, Nancy M (2014) White problem gamblers discount delayed rewards less steeply than their African American and Hispanic counterparts. Psychol Addict Behav 28:599-606
Alessi, Sheila M; Petry, Nancy M (2014) Smoking reductions and increased self-efficacy in a randomized controlled trial of smoking abstinence-contingent incentives in residential substance abuse treatment patients. Nicotine Tob Res 16:1436-45
White, William B; Marfatia, Ravi; Schmidt, Julia et al. (2013) INtensive versus standard ambulatory blood pressure lowering to prevent functional DeclINe in the ElderlY (INFINITY). Am Heart J 165:258-265.e1
Sobieraj, Diana M; White, William B; Baker, William L (2013) Cardiovascular effects of pharmacologic therapies for smoking cessation. J Am Soc Hypertens 7:61-7
Andrade, Leonardo F; Alessi, Sheila M; Petry, Nancy M (2013) The effects of alcohol problems and smoking on delay discounting in individuals with gambling problems. J Psychoactive Drugs 45:241-8
Gulati, Vinay; White, William B (2013) Novel Approaches for the Treatment of the Patient with Resistant Hypertension: Renal Nerve Ablation. Curr Cardiovasc Risk Rep 7:
Weiss, Lindsay; Petry, Nancy M (2013) Older methadone patients achieve greater durations of cocaine abstinence with contingency management than younger patients. Am J Addict 22:119-26

Showing the most recent 10 out of 39 publications