Center for Alcohol and Addiction Studies, Brown University, USA.
Center for Alcohol and Addiction Studies, Brown University, USA.
Addict Behav. 2018 May;80:95-101. doi: 10.1016/j.addbeh.2018.01.017. Epub 2018 Jan 31.
Contingency management (CM) is effective for promoting smoking abstinence; however, moderators and mediators of CM treatment efficacy in young adult populations are under-explored. We leveraged fine-grained data from a large randomized controlled trial: 1) to determine whether early attainment of sustained abstinence mediated the effect of treatment on abstinence; 2) to test whether heavy drinking moderated the effect of treatment on abstinence; and 3) to test a serial mediation model of the effects of drinking during early treatment on sustained smoking abstinence.
College student smokers (N=110) were randomized to receive either CM treatment or noncontingent reinforcement (NR) over a 21-day treatment period. All participants received $5 for providing twice-daily breath carbon monoxide (CO) samples. In CM, additional money was provided for samples that indicated smoking reduction (Initial Phase; first 7days), and for samples ≤5ppm (Abstinence Phase; following 14days).
CM treatment led to greater sustained abstinence relative to NR. Longer sustained abstinence in the Initial Phase partially mediated the effect of treatment on sustained abstinence in the Abstinence Phase. Heavier pretreatment drinkers had shorter periods of sustained abstinence in the Abstinence Phase; this effect was greater in CM. A serial mediation model determined that increased drinking during the Initial Phase led to decreased sustained abstinence, which then led to decreased sustained abstinence in the Abstinence Phase.
These data provide a greater understanding of how heavy drinking and early sustained abstinence may affect success during treatment in young adults undergoing contingency management treatment for smoking.
应急管理（CM）对促进戒烟是有效的；然而，在年轻成人人群中，CM 治疗效果的调节因素和中介因素仍未得到充分探索。我们利用一项大型随机对照试验的详细数据：1）确定早期持续戒烟是否介导了治疗对戒烟的影响；2）检验重度饮酒是否调节了治疗对戒烟的影响；3）检验治疗早期饮酒对持续吸烟戒断的影响的序列中介模型。
大学生吸烟者（N=110）被随机分配接受 CM 治疗或非条件强化（NR），治疗期为 21 天。所有参与者均因提供两次每日呼气一氧化碳（CO）样本而获得 5 美元。在 CM 中，对于表明吸烟量减少的样本（初始阶段；前 7 天）和≤5ppm 的样本（戒断阶段；接下来的 14 天），会提供额外的钱。
CM 治疗与 NR 相比，导致更高的持续戒烟率。初始阶段更长的持续戒烟部分介导了治疗对戒断阶段持续戒烟的影响。治疗前饮酒量较高的患者在戒断阶段的持续戒烟时间较短；CM 中的这种影响更大。序列中介模型确定，初始阶段饮酒量增加导致持续戒烟减少，进而导致戒断阶段持续戒烟减少。
这些数据提供了更深入的了解，即重度饮酒和早期持续戒烟如何影响年轻成年人接受吸烟 CM 治疗期间的治疗成功。
