Contingency Management for Smoking in Substance Abusers

药物滥用者吸烟的应急管理

• 批准号: 7558557
• 负责人: SHEILA MARIE ALESSI
• 金额: $ 18.5万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-02-01 至 2012-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7558557
• 关键词: Abstinence; Address; Admission activity; Aftercare; Alcohol or Other Drugs use; Alcohols; Behavior; Biochemical; Carbon Monoxide; Characteristics; Clinical Research; Cocaine; Cotinine; Counseling; Data; Dependence; Diagnostic; Dropout; General Population; Guidelines; Health; Incentives; Intake; Intervention; Literature; Marijuana; Measures; Mediating; Mediation; Methadone; Morbidity - disease rate; Motivation; National Institute on Alcohol Abuse and Alcoholism; Nicotine; Nicotine Withdrawal; Outcome; Participant; Patient Self-Report; Patients; Population; Preparation; Prize; Procedures; Publications; Randomized; Research; Safety; Sampling; Self Efficacy; Services; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Source; Substance Use Disorder; Substance abuse problem; Test Result; Testing; Time; Treatment outcome; United States; United States Public Health Service; United States Substance Abuse and Mental Health Services Administration; Urine; Validation; base; cigarette smoking; contingency management; depressive symptoms; design; fetal tobacco exposure; improved; meetings; mortality; opioid abuse; primary outcome; programs; psychosocial; smoking cessation; smoking prevalence; standard care; substance abuser; success; tool

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：吸烟是美国最常见的可预防发病率和死亡率的来源，与普通人群相比，滥用药物的不良健康后果更为普遍。应急管理（CM），其中提供了诸如禁欲之类的目标行为的有形激励措施，在改善药物滥用治疗结果方面非常有效，并且在这个困难人群中可能是一种有用的戒烟工具。我们有初步数据表明CM对戒烟的疗效。在此应用中，我们提出了一项更大的研究，以更严格地评估一种基于奖品的CM程序，以促进想要戒烟的住宅药物滥用治疗患者的戒烟。符合酒精，可卡因，大麻或阿片类药物滥用或依赖性诊断标准的患者（n = 102）将与研究人员相遇，进行两次戒烟准备课程，包括基于公共卫生服务（PHS）戒烟的指南，以戒烟，每天提交2个呼吸碳一氧化碳（CO）样本（CO）样本，并设置一个戒烟日期。完成这两个课程后，参与者将被随机分配给：（a）标准护理或（b）标准护理加上戒烟的奖品CM。所有参与者将每天两次对CO进行测试的呼吸样品，并每周一次测试Cotinine的尿液样本，持续4周。在CM条件下，参与者还将有机会赢得符合符合戒烟标准的样品（例如CO> 6ppm; Cotinine> 30ng/ml）的样品。尼古丁的戒断，烟气，抑郁症状和其他（非纽约定）的使用，将每周评估。此外，将在摄入量和退出日期后的1、2、3和6个月进行自我效能，改变动机，吸毒，社会心理问题和抑郁症状。主要结果将基于CO和可替宁测试结果吸烟。自我效能感和改变结果的动机的调解影响将进行测试。还将评估可能与条件内和跨条件内和跨条件的改善结果相关的参与者特征。假设与标准护理条件相比，在CM条件下，戒烟率将更高。吸烟率的吸烟率是滥用药物的两到三倍（Bobo，1989; Burling＆Ziff，1988; Kozlowski et al。，1989; Niaaa，1998），与吸烟相关的发病率和死亡率的增加相关（Blot，1992; Blot，1992; Hart et al an al an al an al and an al an。从历史上看，在治疗其他物质使用障碍的背景下，吸烟很少得到解决，但是最近的研究表明，对吸烟服务的需求（Ellingstad等，1999; Irving等，1994; Joseph et al。 Al。，2000）以及在药物滥用治疗患者中解决吸烟的安全性（Shoptaw等，2002; Kohn等，2003; Burling等，1991; Abrams等，1996; Bobo等，2001; Campbell等，2001; Campbell等，1995; Covey等，1993; Covey et al。参见，Stotts等，2003）。重要的是，同样的文献还表明，现有治疗方法在该人群中不是高效的，并且需要替代方案开始减轻与吸烟有关的对其他药物使用障碍患者健康的重大负担。