Over 80 percent of substance abusers smoke, with synergistic health risks. Smoking intervention studies with substance abusers have found that mandatory action-oriented treatment has not been beneficial. Most substance abusers in treatment are not considering quitting smoking in the near future, suggesting that action-oriented smoking treatment would not be of interest to them. Methods for increasing motivation have been developed that are powerful in changing drinking behavior, and these methods could be applied to increasing motivation to quit smoking among substance abusers. In a preliminary study of this brief approach, 30 percent have quit smoking, at a 1 month follow-up and 20 percent at a 3 month follow-up, showing strong promise. The proposed study will extend this approach to a larger sample and will try to improve the outcomes by making it easier for substance abusers to have an initial 2 weeks of tobacco abstinence (using extrinsic motivation) during which time their intrinsic motivation to quit can be bolstered.
Specific aims : a) To evaluate the effectiveness of Motivational Enhancement Treatment (MET) for tobacco use with substance abusers, as compared to standard (SC) care (access to smoking cessation groups and nicotine replacement therapy). b) To evaluate the hypothesis that contingency management (CM) to reinforce smoking abstinence early in treatment, combined with encouragement to remain abstinent, will increase the likelihood of tobacco abstinence among substance abusers during the 12-month follow-up period, as compared to a noncontingent payment condition (NR). c) To evaluate the hypothesis that the combination of both the CM (extrinsic motivation) and the MET (intrinsic motivation) will be more effective than will either intervention alone. d) A secondary aim is to improve patient-treatment matching strategies by examining how individual differences in motivationally relevant variables affect responsivity to each form of treatment. The study will recruit substance abusers who may or may not be interested in smoking cessation, by offering the chance to learn more about their smoking. The 200 patients will be randomly assigned to one of four conditions in a 2 X 2 between-groups factorial design while in inpatient treatment for substance abuse: MET vs. SC and CM vs. NR. Dependent variables include number of smoking quit attempts, reductions in nicotine dose delivery, continuous abstinence, smoking treatment attendance, substance use during the next 12 months. The study will provide significant information about methods of reducing smoking among substance abusers.
