Cigarette smoking, the most common source of preventable morbidity and mortality in the United States, is more prevalent and has more serious adverse health consequences in substance abusers compared to the general population. Contingency management (CM), in which tangible incentives are provided contingent on a target behavior like abstinence, is highly efficacious in improving substance abuse treatment outcomes and may be a useful smoking cessation tool in this difficult population. We have preliminary data suggesting the efficacy of CM for smoking abstinence. In this application, we propose a larger study to more rigorously evaluate a prize-based CM procedure for initiating smoking abstinence in residential substance abuse treatment patients who want to quit smoking. Patients (n=102) who meet diagnostic criteria for alcohol, cocaine, marijuana, or opiate abuse or dependence will meet with research staff for two quit preparation sessions consisting of counseling based on Public Health Service (PHS) guidelines for quitting smoking, submit 2 breath carbon monoxide (CO) samples each day, and set a quit date. Following completion of these two sessions, participants will be randomly assigned to: (a) standard care or (b) standard care plus prize CM for smoking abstinence. All participants will submit breath samples tested for CO twice daily and urine samples tested for cotinine once weekly for 4 weeks. In the CM condition, participants will also have the opportunity to win prizes ($1-$100 in value) for submitting samples that meet smoking abstinence criteria (e.g., CO >6ppm;cotinine >30ng/mL). Nicotine withdrawal, urges to smoke, depressive symptoms, and other (non-nicotine) substance use will be assessed weekly. In addition, self-efficacy, motivation to change, substance use, psychosocial problems, and depressive symptoms will be assessed at intake and 1, 2, 3 and 6 months following the quit date. Primary outcomes will be smoking abstinence based on CO and cotinine test results. Mediation effects of self-efficacy and motivation to change on outcomes will be tested. Participant characteristics that may be associated with improved outcomes within and across conditions will also be assessed. It is hypothesized that smoking abstinence rates will be higher in the CM condition compared to the standard care condition. Cigarette smoking prevalence rates are two to three times higher in substance abusers than in the general population (Bobo, 1989;Burling &Ziff, 1988;Kozlowski et al.,1989;NIAAA, 1998), with associated increases in smoking-related morbidity and mortality in this population (Blot, 1992;Hurt et al., 1996). Historically, cigarette smoking has rarely been addressed in the context of treatment for other substance use disorders, but recent research indicates a demand for smoking cessation services (Ellingstad et al., 1999;Irving et al., 1994;Joseph et al., 2003;Orleans &Hutchinson, 1993;Richter et al., 2001;Sees &Clark, 1993;Seidner et al., 1996;Zullino et al., 2000) and the safety of addressing smoking in substance abuse treatment patients (Shoptaw et al., 2002;Kohn et al., 2003;Burling et al., 1991;Abrams et al., 1996;Bobo et al., 2001;Campbell et al., 1995;Covey et al., 1993;Gariti et al., 2002;Hurt et al., 1994;Martin et al., 1997;cf., Stotts et al., 2003). Importantly, that same literature also suggests that existing treatments are not highly efficacious in this population and that alternatives are needed to begin to lessen the substantial burden of smoking-related consequences on the health of patients with other substance use disorders.
