Alessi Sheila M, Petry Nancy M
Department of Medicine, University of Connecticut Health Center, Farmington, CT
Department of Medicine, University of Connecticut Health Center, Farmington, CT.
Nicotine Tob Res. 2014 Nov;16(11):1436-45. doi: 10.1093/ntr/ntu095. Epub 2014 Jun 16.
Individuals with substance use disorders (SUDs) experience increased smoking-related morbidity and mortality but severely compromised smoking treatment benefits. Residential SUD treatment settings may be particularly positioned to target smoking, with ever-increasing smoking bans and culture shifts, but most smokers continue smoking. This study examined the effects of contingency management (CM) for increasing smoking abstinence in residential patients.
Smokers interested in quitting were recruited from a residential SUD program for men and were randomized to frequent smoking monitoring with behavioral support (monitoring; n = 21) or that plus smoking abstinence-contingent (expired carbon monoxide [CO] ≤ 6 ppm; urinary cotinine ≤ 30ng/ml) incentives (CM, n = 24) for 4 weeks. After setting a quit date, procedures included daily behavioral support and smoking self-reports, 2 CO samples (a.m./p.m.) Monday through Friday, and cotinine tests on Mondays. CM participants received escalating draws for prizes ($1, $20, and $100 values) for negative tests; positive and missed samples reset draws. Follow-ups involved samples, self-reported smoking, and self-efficacy (weeks 4, 8, 12, and 24).
Percent days CO-negative was higher with CM (median [interquartile range] 51.7% [62.8%]) compared to monitoring (0% [32.1%]) (p = .002). Cigarettes per day declined and point-prevalence abstinence increased through follow-up (p < .01), without significant group by time effects (p > .05). Abstinence self-efficacy increased overall during the intervention and more with CM compared to monitoring and was associated with abstinence across conditions through follow-up.
CM improved some measures of response to smoking treatment in residential SUD patients.
患有物质使用障碍（SUDs）的个体吸烟相关的发病率和死亡率增加，但吸烟治疗效果严重受损。随着吸烟禁令不断增加和文化转变，住院SUD治疗环境可能特别适合针对吸烟问题，但大多数吸烟者仍继续吸烟。本研究探讨了权变管理（CM）对提高住院患者戒烟率的效果。
从一个针对男性的住院SUD项目中招募有戒烟意愿的吸烟者，随机分为两组，一组接受频繁的吸烟监测并给予行为支持（监测组；n = 21），另一组在此基础上加上戒烟奖励（呼出一氧化碳[CO]≤6 ppm；尿可替宁≤30 ng/ml）（CM组，n = 24），为期4周。设定戒烟日期后，程序包括每日行为支持和吸烟自我报告、周一至周五每天两次CO样本采集（上午/下午）以及周一的可替宁检测。CM组参与者若检测结果为阴性可获得递增的抽奖奖品（价值1美元、20美元和100美元）；阳性和未检测样本则重置抽奖。随访包括样本采集、自我报告吸烟情况和自我效能评估（第4、8、12和24周）。
与监测组（0% [32.1%]）相比，CM组CO阴性天数百分比更高（中位数[四分位间距]为51.7% [62.8%]）（p = 0.002）。随访期间，每日吸烟量下降，点患病率戒烟率增加（p < 0.01），但无显著的组间时间交互效应（p > 0.05）。在干预期间，总体戒烟自我效能增加，与监测组相比，CM组增加更多，并且在随访期间，无论何种情况，戒烟自我效能都与戒烟相关。
CM改善了住院SUD患者对吸烟治疗的一些反应指标。
