Alcohol misuse and smoking constitute two of the three leading preventable causes of death in the United States. Reluctance to treat tobacco dependence among those with AUD is misguided as recent research suggests smoking cessation treatment can be effective, does not increase risk of relapse to alcohol, and may even improve rates of sobriety. There is strong evidence for the short-term efficacy for alcohol misuse and smoking of contingency management (CM). It is an intensive behavioral therapy that provides incentives (vouchers, money) to individuals misusing substances contingent upon objective evidence from drug use. Implementation of CM has been limited because of the need to verify abstinence multiple times daily using clinic based monitoring. Our group recently developed a smart-phone application which allows a patient to video themselves several times daily while using a small CO monitor and to transmit the data to a secure server which has made the use of CM for outpatient smoking cessation portable and feasible. Our mobile CM (mCM) approach paired with cognitive-behavioral counseling and pharmacological smoking cessation aids has been effective in reducing smoking. Thus, the purpose of this project is to develop and pilot-test a combined alcohol and smoking mCM intervention. Our long term goal is to develop mCM procedures that will be used as part of a multi-component intervention to concurrently and effectively treat both alcohol misuse and smoking. As part of this project, we will develop a multi-component telehealth alcohol and smoking mCM intervention. It will include mCM, cognitive-behavioral phone counseling, and standard smoking cessation pharmacotherapy. Three cohorts will provide data. The first cohort (n = 5) will yield primarily qualitative data from participants and therapists, which will be utilized to modify the treatment components including the therapist manual, participant workbook, mCM apps, and data collection procedures. The second cohort (n = 5) will yield qualitative and quantitative data to guide the focus of the intervention to components most valued by participants and linked with achieving outcome benchmarks. The third cohort will be a pilot clinical trial comparing the multi-component mCM intervention (n = 30) to a comparison condition (n = 15) that differs only in that reinforcement will not be contingent on abstinence. The work proposed in these aims will provide the first step toward implementation of an innovative approach that builds upon the power of mHealth technology to reduce the prevalence of both alcohol misuse and smoking.
The purpose of this project is to develop and pilot-test a multi-component alcohol and smoking intervention that can be conducted by mobile phone to promote accessibility by a greater proportion of the population. The work proposed in these aims will provide the first step toward implementation of an innovative approach that utilizes the innovation and accessibility of mobile Health technology to reduce the prevalence of both alcohol misuse and smoking.
