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Member Research & Reports

Member Research & Reports

Brown: Treating Smokers in Substance Treatment with Contingent Vouchers, Nicotine Replacement and Brief Advice Adapted for Sobriety Settings

Smokers with substance abuse disorders smoke at higher rates than the general population, and have little success in quitting smoking early in recovery with traditional smoking treatments. Current clinical practice guidelines suggest providing smokers with nicotine replacement therapy. However, contingent vouchers to incentivize smoking abstinence on a platform of brief counselling can encourage initial abstinence in unmotivated smokers and provide a foundation for longer term abstinence.

[Photo: Dr. Damaris Rohsenow]

The purpose of this study, led by Dr. Damaris Rohsenow, professor of behavioral and social sciences and associate director of the Center for Alcohol and Addiction Studies, was to evaluate a randomized, controlled trial comparing contingent vouchers for smoking abstinence to noncontingent vouchers, when all received counselling and nicotine replacement therapy. The study sample included smokers who had not previously sought smoking treatment in residential substance use disorder treatment. Vouchers were for monetary rewards, and were either contingent on providing negative abstinence tests (i.e., the participant had not smoked; the contingent voucher group), or not contingent on tests (the noncontingent voucher group).

Within treatment, 20 percent had complete abstinence with contingent vouchers, while only 5 percent of the noncontingent voucher group achieved complete abstinence. Across one, three, six, and 12 months after randomization, contingent vouchers resulted in significantly fewer cigarettes per day. However, not differences in substance use were seen across the groups.

The results of this study suggest that within-treatment effects are stronger when counselling and nicotine replacement therapy are paired with contingent vouchers. Based on the findings, future efforts related to voucher-based treatment could include investigating effects when combined with stronger smoking medications, and the potential effects of motivational interviewing.

This study was published in Journal of Substance Abuse Treatment.

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