1
|
Notley C, Gentry S, Livingstone-Banks J, Bauld L, Perera R, Conde M, Hartmann-Boyce J. Incentives for smoking cessation. Cochrane Database Syst Rev 2025; 1:CD004307. [PMID: 39799985 PMCID: PMC11725379 DOI: 10.1002/14651858.cd004307.pub7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2025]
Abstract
BACKGROUND Financial incentives (money, vouchers, or self-deposits) can be used to positively reinforce smoking cessation. They may be used as one-off rewards, or in various schedules to reward steps towards sustained smoking abstinence (known as contingency management). They have been used in workplaces, clinics, hospitals, and community settings, and to target particular populations. This is a review update. The previous version was published in 2019. OBJECTIVES Primary To assess the long-term effects of incentives and contingency management programmes for smoking cessation in mixed and pregnant populations. Secondary To assess the long-term effects of incentives and contingency management programmes for smoking cessation in mixed populations, considering whether incentives were offered at the final follow-up point. To assess the difference in outcomes for pregnant populations, considering whether rewards were contingent on abstinence or guaranteed. SEARCH METHODS For this update, we searched CENTRAL, MEDLINE, Embase, PsycINFO, and two trials registers on 2 November 2023, and the Cochrane Tobacco Addiction Group Specialised Register on March 2023, together with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA We considered only randomised controlled trials (RCTs), allocating individuals, workplaces, groups within workplaces, or communities to smoking cessation incentive schemes or control conditions. We included studies in a mixed-population setting (e.g. community-, work-, clinic- or institution-based), studies with specific populations (e.g. those with diagnosed mental health conditions), and studies in pregnant people who smoke. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. The primary outcome measure in the mixed-population studies was abstinence from smoking at longest follow-up (at least six months from the start of the intervention). In the trials of pregnant people, we used abstinence from smoking measured at the longest follow-up, and at least to the end of the pregnancy. Where available, we pooled outcome data using a Mantel-Haenszel random-effects model, with results reported as risk ratios (RRs) and 95% confidence intervals (CIs), using adjusted estimates for cluster-randomised trials. We analysed studies carried out in mixed populations separately from those carried out in pregnant populations. MAIN RESULTS Forty-eight mixed-population studies met our inclusion criteria, recruiting more than 21,924 participants; 15 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. We judged eight studies to be at low risk of bias, and 16 to be at high risk of bias, with the remaining 24 studies at unclear risk. Thirty-three of the trials were run in the USA, two in Thailand, one in the Philippines, one in Hong Kong, and one in South Africa. The rest were European. Incentives offered included cash payments, self-deposits, or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow-up (six months or more) compared with controls was 1.52 (95% CI 1.33 to 1.74; I2 = 23%; 39 studies, 18,303 participants; high-certainty evidence). Results were not sensitive to the exclusion of seven studies that offered an incentive for cessation at long-term follow-up (result excluding those studies: RR 1.46, 95% CI 1.23 to 1.73; I2 = 26%; 32 studies, 15,082 participants), suggesting the impact of incentives continues for at least some time after incentives cease (at least six months). For this update, we included an adjusted analysis incorporating three cluster-RCTs. The pooled odds ratio was 1.57 (95% CI 1.37 to 1.79; I2 = 30%; 43 studies, 23,960 participants; high-certainty evidence). Although not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self-deposits), to a range of between 45 US dollars (USD) and USD 1185. There was no clear difference in effect between trials offering low or high total value of incentives, nor those encouraging redeemable self-deposits. We ran an updated exploratory meta-regression and found no significant association between the outcome and the total value of the financial incentive (P = 0.963). Any such indirect comparison is particularly crude in this context, due to differences in the cultural significance of financial amounts (e.g. USD 50 might have different significance in different contexts). We included 14 studies of 4314 pregnant people (11 conducted in the USA, one in France, and two in the UK). We judged four studies to be at low risk of bias, two at high risk of bias, and eight at unclear risk. When pooled, the 13 trials with usable data delivered a risk ratio at longest follow-up (up to 48 weeks postpartum) of 2.13 (95% CI 1.58 to 2.86; I2 = 31%; 13 studies, 3942 participants; high-certainty evidence), in favour of incentives. AUTHORS' CONCLUSIONS Overall, our conclusion from this latest review update remains that there is high-certainty evidence that incentives improve smoking cessation rates at long-term follow-up in mixed population studies. The evidence demonstrates that the effectiveness of incentives is sustained even when the last follow-up occurs after the withdrawal of incentives. There is also now high-certainty evidence that incentive schemes conducted amongst pregnant people who smoke improve smoking cessation rates, both at the end of pregnancy and postpartum. This represents a change from the previous update in which we rated this evidence as moderate certainty. Current and future research might more precisely explore differences between trials offering low or high cash incentives and self-incentives (deposits), within a variety of smoking populations, focusing on low- and middle-income countries where the burden of tobacco use remains high.
Collapse
Affiliation(s)
- Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sarah Gentry
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Linda Bauld
- Usher Institute and Behavioural Research UK, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Monserrat Conde
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA, USA
| |
Collapse
|
2
|
Gray JC, Larson MJ, Moresco N, Dufour S, Ritter GA, DeLeon PD, Milliken CS, Vest N, Adams RS. Healthcare utilization and readiness outcomes among soldiers with post-deployment at-risk drinking, by multimorbidity class. Alcohol 2024; 114:31-39. [PMID: 37619959 PMCID: PMC10881892 DOI: 10.1016/j.alcohol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/08/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023]
Abstract
Although alcohol use disorder (AUD) regularly co-occurs with other conditions, there has not been investigation of specific multimorbidity classes among military members with at-risk alcohol use. We used latent class analysis (LCA) to cluster 138,929 soldiers with post-deployment at-risk drinking based on their co-occurring psychological and physical health conditions and indicators of alcohol severity. We examined the association of these multimorbidity classes with healthcare utilization and military readiness outcomes. Latent class analysis was conducted on 31 dichotomous indicators capturing alcohol use severity, mental health screens, psychological and physical health diagnoses, and tobacco use. Longitudinal survival analysis was used to examine the relative hazards of class membership regarding healthcare utilization (e.g., emergency department visit, inpatient stay) and readiness outcomes (e.g., early separation for misconduct). Latent class analysis identified five classes: Class 1 -Relatively Healthy (51.6 %); Class 2 - Pain/Tobacco (17.3 %); Class 3 - Heavy Drinking/Pain/Tobacco (13.1 %); Class 4 - Mental Health/Pain/Tobacco (12.7 %); and Class 5 - Heavy Drinking/Mental Health/Pain/Tobacco (5.4 %). Musculoskeletal pain and tobacco use were prevalent in all classes, though highest in Classes 2, 4, and 5. Classes 4 and 5 had the highest hazards of all outcomes. Class 5 generally exhibited slightly higher hazards of all outcomes than Class 4, demonstrating the exacerbation of risk among those with heavy drinking/AUD in combination with mental health conditions and other multimorbidity. This study provides new information about the most common multimorbidity presentations of at-risk drinkers in the military so that targeted, individualized care may be employed. Future research is needed to determine whether tailored prevention and treatment approaches for soldiers in different multimorbidity classes is associated with improved outcomes.
Collapse
Affiliation(s)
- Joshua C Gray
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, Bethesda, MD 20814, United States.
| | - Mary Jo Larson
- Brandeis University, Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA 02453, United States
| | - Natalie Moresco
- Brandeis University, Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA 02453, United States
| | - Steven Dufour
- Uniformed Services University of the Health Sciences, Department of Medical and Clinical Psychology, Bethesda, MD 20814, United States; Naval Medical Center Portsmouth, Portsmouth, VA 23708, United States
| | - Grant A Ritter
- Brandeis University, Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA 02453, United States
| | - Patrick D DeLeon
- Walter Reed National Military Medical Center, Bethesda, MD 20814, United States
| | - Charles S Milliken
- Army's Substance Use Disorder Clinical Care, Office of the Army Surgeon General, Defense Health Headquarters, 7700 Arlington Blvd., Falls Church, VA 22042, United States
| | - Noel Vest
- Boston University School of Public Health, Department of Community Health Sciences, Boston, MA 02118, United States
| | - Rachel Sayko Adams
- Brandeis University, Heller School for Social Policy and Management, Institute for Behavioral Health, Waltham, MA 02453, United States; Boston University School of Public Health, Department of Health Law, Policy & Management, Boston, MA 02118, United States; Veterans Health Administration, Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, CO 80045, United States
| |
Collapse
|
3
|
Non-Pharmacologic Approaches to Tobacco Cessation. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
|
4
|
Secades-Villa R, Aonso-Diego G, González-Roz A. A randomized controlled trial of contingency management for smoking cessation in substance use treatment patients. Int J Clin Health Psychol 2022; 22:100314. [PMID: 35662791 PMCID: PMC9157212 DOI: 10.1016/j.ijchp.2022.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/03/2022] [Indexed: 12/04/2022] Open
Abstract
Background/Objective Contingency management (CM) is one of the most effective interventions for smokers with substance use disorder (SUD), and no empirical assessment of its long-term efficacy has been conducted so far in a real-world context. The objectives were: (1) examine the additive effectiveness of CM on cognitive-behavioral treatment (CBT) for smoking cessation, and (2) examine the relationship between smoking cessation and substance use abstinence. Method A total of 80 participants (75.8% males; Mage = 45.31; SD = 9.64) were assigned to two smoking cessation treatments: CBT or CBT+CM. A set of generalized estimating equations were conducted to examine the effect of treatment condition on smoking outcomes, as well as the effect of smoking status on substance abstinence. Results Adding CM to CBT for smoking cessation improved tobacco abstinence rates at the end-of-treatment (p = .049). Tobacco abstinence rates declined over time (p = .012), but no significant effects of treatment condition were observed across follow-ups (p = .260). Smoking cessation was not significantly related to substance abstinence (p ≥ .488). Conclusions CM facilitates early abstinence in smokers with SUD, although effects subside after treatment termination. The lack of association between smoking abstinence and substance use suggests no jeopardizing effects as a result of quitting smoking.
Collapse
Affiliation(s)
- Roberto Secades-Villa
- Addictive Behaviors Research Group, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
| | - Gema Aonso-Diego
- Addictive Behaviors Research Group, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
- Corresponding author.
| | - Alba González-Roz
- Addictive Behaviors Research Group, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
| |
Collapse
|
5
|
van Amsterdam J, van den Brink W. Smoking As an Outcome Moderator In the Treatment of Alcohol Use Disorders. Alcohol Alcohol 2022; 57:664-673. [PMID: 35589093 DOI: 10.1093/alcalc/agac027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/15/2022] Open
Abstract
AIMS To clarify whether smoking interferes with successful treatment of alcohol use disorder (AUD). METHODS The current systematic review investigates the potential moderating effect of smoking on behavioural and pharmacological treatment of AUD. In addition, this review summarizes the results of randomized controlled trials investigating the effect of smoking cessation treatments in subjects with AUD on drinking outcomes. RESULTS Overall, the results show that 16 out of the 31 pharmacological and psychotherapeutic alcohol treatment studies showed that being a non-smoker or decreased tobacco consumption during AUD treatment is associated with beneficial drinking outcomes, including reduced drinking, later relapse and prolonged alcohol abstinence. As such, smoking predicts poorer drinking outcomes in alcohol treatments. In the stop-smoking studies in patients with AUD, reduced smoking had virtually no effect on drinking behaviours. The inverse association between smoking and drinking outcome observed here indicates that non-smokers may be more successful to attain alcohol abstinence than smokers do. However, this association does not imply per se that smoking triggers alcohol consumption, since it can also mean that alcohol consumption promotes smoking. CONCLUSIONS It is concluded that (continued) tobacco smoking may have a negative moderating effect on the treatment outcome of AUD treatments. To optimize treatment outcome of AUD one may consider informing and counselling patients with AUD about the risks of smoking for treatment outcomes and offering support for smoking cessation.
Collapse
Affiliation(s)
- Jan van Amsterdam
- Department of Psychiatry, Academic Medical Center University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| |
Collapse
|
6
|
Effects of episodic future thinking on reinforcement pathology during smoking cessation treatment among individuals with substance use disorders. Psychopharmacology (Berl) 2022; 239:631-642. [PMID: 35020047 PMCID: PMC8799566 DOI: 10.1007/s00213-021-06057-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/28/2021] [Indexed: 02/04/2023]
Abstract
RATIONALE Reinforcer pathology (RP) is a theoretical model based on two processes: delay discounting (DD) and drug demand. Given that RP has been shown to have a predictive value on smoking behaviors, several studies have explored which interventions can reduce RP. Consistent with the RP framework, episodic future thinking (EFT) has shown effects on treatment outcomes and RP processes. The vast majority of studies that assess the effects of EFT on RP consist of experimental studies, and no previous research has tested these effects in a clinical sample of smokers. OBJECTIVES The primary aim of this study was to assess the effects of EFT on RP throughout the course of a smoking cessation intervention in smokers with substance use disorders (SUDs). METHODS Participants were randomized to cognitive behavior therapy (CBT) + EFT (n = 39) or CBT + EFT + contingency management (n = 33). Cotinine, frequency of EFT practices, cigarette purchase task (CPT), and DD were evaluated in treatment sessions. Mixed-effects model repeated measures analysis was used to explore DD and CPT in-treatment changes as a function of EFT practices and cotinine levels. RESULTS Greater practice of the EFT component significantly reduced cigarette demand (p < .020) as well as DD (p = .003). Additionally, a greater reduction in cotinine levels coupled with greater EFT practice led to a greater decrease in cigarette demand (p < .014). CONCLUSIONS EFT reduced the two facets of RP in treatment-seeking smokers with SUDs.
Collapse
|
7
|
Pisinger C, Toxværd CG, Rasmussen M. Are financial incentives more effective than health campaigns to quit smoking? A community-randomised smoking cessation trial in Denmark. Prev Med 2022; 154:106865. [PMID: 34740676 DOI: 10.1016/j.ypmed.2021.106865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/20/2021] [Accepted: 10/30/2021] [Indexed: 11/18/2022]
Abstract
The aim of this community-randomised smoking cessation (SC) trial was to investigate both recruitment and SC-rates in three municipalities offering financial incentives (FIM) to smokers who stop smoking when attending a municipal SC-program and compare these with three municipalities investing in a campaign (CAM) that should encourage smokers to use the SC-program. Furthermore, in a non-randomised matched control design we investigated whether there was a difference in recruitment and SC-rates in the three FIM and the three CAM, comparing each with three matched control municipalities (MCM). Each municipality received approx. $16,000. The FIM rewarded persons who were abstinent when attending the municipal SC-program. The CAM spent the money on a campaign recruiting smokers to the SC-program. Two of three FIM were only partly active in recruiting smokers in the intervention year 2018. An intention-to-treat (ITT) approach was used in analyses. Complete case analyses and multiple imputation were used to address loss to follow-up. No difference in recruitment was found between the CAM and the FIM (p = 0.954), in adjusted analyses. In ITT analyses, FIM achieved significantly higher odds of validated abstinence from smoking at one-year follow-up (OR (95%CI): 1.63(1.1-2.4)), but not of self-reported continuous abstinence after six months than CAM. Compared with no intervention, campaigns increased the recruitment of smokers to the SC-program while financial incentives increased six months abstinence rates. In a randomised trial, no difference was demonstrated in the effect of financial incentives and campaigns to recruit smokers to a SC-program and financial incentives seemed superior to help smokers staying smoke-free for a year. TRIAL REGISTRATION: ClinicalTrials.Gov ID: NCT03849092.
Collapse
Affiliation(s)
- Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark; University of Copenhagen, Faculty of Health Sciences, Department of Public Health, Denmark; Danish Heart Foundation, Copenhagen, Denmark.
| | - Cecilie Goltermann Toxværd
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark.
| | - Mette Rasmussen
- WHO-CC, Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, The Capital Region of Denmark, Denmark; Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden.
| |
Collapse
|
8
|
Medenblik AM, Calhoun PS, Maisto SA, Kivlahan DR, Moore SD, Beckham JC, Wilson SM, Blalock DV, Dedert EA. Pilot Cohorts for Development of Concurrent Mobile Treatment for Alcohol and Tobacco Use Disorders. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:11782218211030524. [PMID: 34552330 PMCID: PMC8451000 DOI: 10.1177/11782218211030524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022]
Abstract
Alcohol and tobacco are the 2 most frequently used drugs in the United States and represent the highest co-occurrence of polysubstance use. The objective of this study was to refine an intervention combining mobile contingency management with cognitive-behavioral telephone counseling for concurrent treatment of alcohol and tobacco use disorders. Two cohorts (n = 13 total, n = 5 women) of participants were enrolled, with 10/13 completing treatment and 7/13 completing the 6-month follow-up. At enrollment, participants were drinking a mean of 28.9 drinks per week (SD = 14.1), with a mean of 14.7 heavy drinking days in the past month (SD = 9.9), and a mean of 18.1 cigarettes per day (SD = 11.7). Treatment included a mobile application that participants used to record carbon monoxide and breath alcohol content readings to bioverify abstinence. Participants received up to 4 sessions of phone cognitive-behavioral therapy and monetary reinforcement contingent on abstinence. In cohort 1, 4/6 participants reported abstinent or low-risk drinking post-monitoring. Six weeks post quit-date, 2/6 participants were CO-bioverified abstinent from tobacco use, with 2/6 in dual remission. These results were maintained at 6-months. In cohort 2, 6/7 reported abstinent or low-risk drinking post-monitoring, 5 weeks post quit-date. At the post-monitoring visit, 5/7 were CO-bioverified abstinent from smoking, with 5/7 in dual remission. At 6-months, 3/7 reporting abstinent or low-risk drinking, 1/7 had bioverified abstinence from smoking, with 1/7 in dual remission. Observations suggest that it is possible to develop a concurrent mobile treatment for alcohol and tobacco use disorders.
Collapse
Affiliation(s)
- Alyssa M Medenblik
- Psychology Department, University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Stephen A Maisto
- Veterans Affairs Center for Integrated Health Care, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Daniel R Kivlahan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Scott D Moore
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jean C Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Sarah M Wilson
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Eric A Dedert
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
9
|
Aonso-Diego G, González-Roz A, Krotter A, García-Pérez A, Secades-Villa R. Contingency management for smoking cessation among individuals with substance use disorders: In-treatment and post-treatment effects. Addict Behav 2021; 119:106920. [PMID: 33798921 DOI: 10.1016/j.addbeh.2021.106920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/18/2021] [Accepted: 03/18/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Smokers with substance use disorders (SUDs) show elevated tobacco prevalence, and smoking abstinence rates are considerably low. This randomized controlled trial sought to compare the effect of a cognitive behavioral treatment (CBT) that includes an episodic future thinking (EFT) component with the same treatment protocol plus contingency management (CM). This study aims to examine the effect of CM on smoking outcomes and in-treatment behaviors (i.e., retention, session attendance and adherence to nicotine use reduction guidelines), and to analyze whether these in-treatment variables predicted days of continuous abstinence at end-of-treatment. METHOD A total of 54 treatment-seeking participants (75.9% males, M = 46.19 years old) were allocated to CBT + EFT (n = 30) or CBT + EFT + CM (n = 24). Intervention consisted of eight weeks of group-based sessions. Tobacco abstinence was verified biochemically by testing levels of carbon monoxide (≤4ppm) and urine cotinine (≤80 ng/ml). RESULTS CM intervention increased 24-hour tobacco abstinence (50% vs. 20%, χ2(1) = 5.4; p = .021) and days of continuous abstinence (M = 5.92 ± 7.67 vs. 5.53 ± 12.42; t(52) = -0.132; p = 0.89) at end-of-treatment in comparison with CBT + EFT intervention. Although not statistically significant, CBT + EFT + CM enhanced in-treatment behaviors, in terms of retention (83.3% vs. 70%; χ2(1) = 0.255; p = .208), sessions attended (12.29 ± 3.22 vs. 10.93 ± 3.26; t(52) = -1.527; p = .133) and adherence to weekly nicotine use reduction targets (41.07% ± 31.96 vs. 35% ±2 6.28; t(52) = -0.766; p = .447). A higher percentage of samples meeting reduction guidelines (β = 0.609; p<.001) predicted days of continuous abstinence at end-of-treatment. CONCLUSION Combining CM with CBT + EFT improves short-term quitting rates. Findings suggest the need to incorporate strategies for improving adherence to nicotine reduction guidelines.
Collapse
|
10
|
Karelitz JL, McClure EA, Wolford-Clevenger C, Pacek LR, Cropsey KL. Cessation classification likelihood increases with higher expired-air carbon monoxide cutoffs: a meta-analysis. Drug Alcohol Depend 2021; 221:108570. [PMID: 33592559 PMCID: PMC8026538 DOI: 10.1016/j.drugalcdep.2021.108570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Expired-air carbon monoxide (CO) is commonly used to biochemically verify smoking status. The CO cutoff and CO monitor brand may affect the probability of classifying smokers as abstinent, thus influencing conclusions about the efficacy of cessation trials. No systematic reviews have tested this hypothesis. Therefore, we performed a meta-analysis examining whether the likelihood of smoking cessation classification varied due to CO cutoff and monitor brand. METHODS Eligible studies (k = 122) longitudinally assessed CO-verified cessation in adult smokers in randomized trials. Primary meta-regressions separately assessed differences in quit classification likelihood due to continuous and categorical CO cutoffs (Low, 3-4 parts per million [ppm]; [SRNT] Recommended, 5-6 ppm; Moderate, 7-8 ppm; and High, 9-10 ppm); exploratory analyses compared likelihood outcomes between monitor brands: Bedfont and Vitalograph. RESULTS The likelihood of quit classification increased 18% with each 1 ppm increase above the lowest cutoff (3 ppm). Odds of classification as quit significantly increased between each cutoff category and High: 261% increase from Low; 162% increase from Recommended; and 150% increase from Moderate. There were no differences in cessation classification between monitor brands. CONCLUSIONS As expected, higher CO cutoffs were associated with greater likelihood of cessation classification. The lack of CO monitor brand differences may have been due to model-level variance not able to be followed up in the present dataset. Researchers are advised to report outcomes using a range of cutoffs-including the recommended range (5-6 ppm)-and the CO monitor brand/model used. Using higher CO cutoffs significantly increases likelihood of quit classification, possibly artificially elevating treatment strategies.
Collapse
Affiliation(s)
- Joshua L Karelitz
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, 5150 Centre Ave, Suite 4C, Pittsburgh, PA, 15232, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 5150 Centre Ave, Suite 4C, Pittsburgh, PA, 15232, USA.
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 67 President St, MSC 861, Charleston, SC, 29425, USA; Hollings Cancer Center, Medical University of South Carolina, 67 President St, MSC 861, Charleston, SC, 29425, USA
| | - Caitlin Wolford-Clevenger
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1670 University Blvd Birmingham, AL, 35233, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2068 Erwin Road, Room 3038, Durham, NC, 27705, USA
| | - Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1670 University Blvd Birmingham, AL, 35233, USA
| |
Collapse
|
11
|
Aonso-Diego G, González-Roz A, Martínez-Loredo V, Krotter A, Secades-Villa R. Episodic future thinking for smoking cessation in individuals with substance use disorder: Treatment feasibility and acceptability. J Subst Abuse Treat 2021; 123:108259. [PMID: 33612193 DOI: 10.1016/j.jsat.2020.108259] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/09/2020] [Accepted: 12/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Smokers with substance use disorders (SUD) smoke approximately four times more than the general population. Current efforts are focused on improving smoking cessation treatments for this population. Episodic future thinking (EFT), a novel intervention aimed at decreasing impulsive choice, has shown promising results for reducing cigarette demand in experimental settings. This feasibility study sought to examine the feasibility and preliminary EFT effects on delay discounting (DD) and nicotine intake reductions throughout treatment. METHOD Smokers in substance use treatment (N = 29; 75.9% males) received an 8-week cognitive-behavioral treatment (CBT) + EFT for smoking cessation. The study assessed feasibility through successful recruitment rates, retention, and adherence to treatment. Participants' satisfaction acted as our acceptability measure. We computed nonparametric range tests to analyze changes in continuous variables. RESULTS Among interested individuals, 42 (43.75%) met the inclusion criteria, and 29 entered the treatment program. Rate of treatment completion was 65.5% (19/29). Mean (SD) sessions attended were 7(1.11), and mean patient satisfaction rating with treatment was 8.83/10. The study observed low compliance with EFT, with 15.8% (3/19) of patients practicing at least 50% of the requested times. CONCLUSIONS CBT + EFT is acceptable for the SUD population. However, future studies should implement some adjustments to improve the adherence and feasibility of EFT, such as reducing the number of practices and temporal intervals in EFT events. Given the small sample size, and the absence of a control group, future larger scale trials are needed to elucidate EFT effects on DD and smoking cessation.
Collapse
Affiliation(s)
- Gema Aonso-Diego
- Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain.
| | - Alba González-Roz
- Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | | | - Andrea Krotter
- Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | - Roberto Secades-Villa
- Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| |
Collapse
|
12
|
Philibert R, Mills JA, Long JD, Salisbury SE, Comellas A, Gerke A, Dawes K, Vander Weg M, Hoffman EA. The Reversion of cg05575921 Methylation in Smoking Cessation: A Potential Tool for Incentivizing Healthy Aging. Genes (Basel) 2020; 11:E1415. [PMID: 33260961 PMCID: PMC7760261 DOI: 10.3390/genes11121415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 02/06/2023] Open
Abstract
Smoking is the largest preventable cause of mortality and the largest environmental driver of epigenetic aging. Contingency management-based strategies can be used to treat smoking but require objective methods of verifying quitting status. Prior studies have suggested that cg05575921 methylation reverts as a function of smoking cessation, but that it can be used to verify the success of smoking cessation has not been unequivocally demonstrated. To test whether methylation can be used to verify cessation, we determined monthly cg05575921 levels in a group of 67 self-reported smokers undergoing biochemically monitored contingency management-based smoking cessation therapy, as part of a lung imaging protocol. A total of 20 subjects in this protocol completed three months of cotinine verified smoking cessation. In these 20 quitters, the reversion of cg05575921 methylation was dependent on their initial smoking intensity, with methylation levels in the heaviest smokers reverting to an average of 0.12% per day over the 3-month treatment period. In addition, we found suggestive evidence that some individuals may have embellished their smoking history to gain entry to the study. Given the prominent effect of smoking on longevity, we conclude that DNA methylation may be a useful tool for guiding and incentivizing contingency management-based approaches for smoking cessation.
Collapse
Affiliation(s)
- Robert Philibert
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA; (J.A.M.); (J.D.L.); (K.D.)
- Behavioral Diagnostics LLC, Coralville, IA 52241, USA
| | - James A. Mills
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA; (J.A.M.); (J.D.L.); (K.D.)
| | - Jeffrey D. Long
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA; (J.A.M.); (J.D.L.); (K.D.)
- Department of Biostatistics, University of Iowa, Iowa City, IA 52242, USA
| | - Sue Ellen Salisbury
- Department of Radiology, University of Iowa, Iowa City, IA 52242, USA; (S.E.S.); (E.A.H.)
| | - Alejandro Comellas
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA; (A.C.); (A.G.); (M.V.W.)
| | - Alicia Gerke
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA; (A.C.); (A.G.); (M.V.W.)
| | - Kelsey Dawes
- Department of Psychiatry, University of Iowa, Iowa City, IA 52242, USA; (J.A.M.); (J.D.L.); (K.D.)
- Molecular Medicine Program, University of Iowa, Iowa City, IA 52242, USA
| | - Mark Vander Weg
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242, USA; (A.C.); (A.G.); (M.V.W.)
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA 52242, USA
| | - Eric A. Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA 52242, USA; (S.E.S.); (E.A.H.)
| |
Collapse
|
13
|
Hovhannisyan K, Rasmussen M, Adami J, Wikström M, Tønnesen H. Evaluation of Very Integrated Program: Health Promotion for Patients With Alcohol and Drug Addiction-A Randomized Trial. Alcohol Clin Exp Res 2020; 44:1456-1467. [PMID: 32424821 DOI: 10.1111/acer.14364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Compared to the general population, patients with alcohol and drug addiction have an increased risk of additional hazardous lifestyles and suffer from more chronic diseases, adding to their already significantly higher morbidity and mortality. The objective of this study was to test the efficacy of the Very Integrated Program (VIP) on treatment and health outcomes for patients diagnosed with alcohol and drug addiction. METHODS Parallel randomized clinical trial with intervention as add-on to addiction care as usual. A total of 322 patients aged 18 years or older were identified, and the study requirements were fulfilled by 219 patients, 7 of whom participated in a pilot. The intervention was a 6-week intensive, tailored, educational program that included motivational interviewing, a smoking cessation program, dietary and physical activity counseling, and patient education. The main outcome measures were substance-free days, time to relapse, and treatment adherence assessed after 6 weeks and 12 months. Secondary outcomes were lifestyle factors, symptoms of comorbidity, and quality of life. Missing data were imputed conservatively by using data closest to the follow-up date and baseline values in patients with no follow-up. RESULTS The 212 patients (intervention, n = 113; control, n = 99) were randomized, and 202 had complete data for primary outcomes. After 6 weeks, there were no significant differences between the groups regarding primary or secondary outcomes. At the 12-month follow-up, the patients in the control group had significantly more total substance-free days (139 days; ranging 0 to 365 vs. 265; 0 to 366, p = 0.021)-specifically among the patients with drug addiction-and higher physical and mental quality of life (45 vs. 58, p = 0.049 and 54 vs. 66, p = 0.037), but not in the per-protocol analysis (60 vs. 46, p = 0.52 and 70 vs. 66, p = 0.74). The sensitivity analyses did not support significant differences between the groups. CONCLUSION Overall, adding VIP intervention did not improve outcome of the alcohol or drug addiction care or the lifestyle compared to the addiction care alone. This patient group is still in need of effective programs, and new intervention research is required to develop that.
Collapse
Affiliation(s)
- Karen Hovhannisyan
- From the, Department of Health Science, (KH, MR, MW, HT), Clinical Health Promotion Centre, WHO-CC, Region Skåne, Lund University, Lund, Sweden
| | - Mette Rasmussen
- From the, Department of Health Science, (KH, MR, MW, HT), Clinical Health Promotion Centre, WHO-CC, Region Skåne, Lund University, Lund, Sweden.,Clinical Health Promotion Centre, (MR, HT), WHO-CC, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Maria Wikström
- From the, Department of Health Science, (KH, MR, MW, HT), Clinical Health Promotion Centre, WHO-CC, Region Skåne, Lund University, Lund, Sweden
| | - Hanne Tønnesen
- From the, Department of Health Science, (KH, MR, MW, HT), Clinical Health Promotion Centre, WHO-CC, Region Skåne, Lund University, Lund, Sweden.,Clinical Health Promotion Centre, (MR, HT), WHO-CC, The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
14
|
Fine DR, Bearnot BI, Rigotti NA, Baggett TP. Smoking status and quit behaviors among health center patients with substance use disorders: A national study. Drug Alcohol Depend 2019; 202:6-12. [PMID: 31279257 DOI: 10.1016/j.drugalcdep.2019.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite a high prevalence of smoking among individuals with substance use disorders, tobacco dependence in this vulnerable population is undertreated. METHODS We analyzed data from 5592 adult (≥18 years old) respondents to the 2014 Health Center Patient Survey, a nationally representative cross-sectional survey of individuals who receive care at U.S. Federally Qualified Health Centers. We evaluated self-reported smoking status, smoking-related quit behaviors (having quit, wanting or attempting to quit in the past year, and planning to quit in the next 6 months), and receipt of advice to quit smoking among participants with and without alcohol use disorder (AUD) and drug use disorder (DUD). RESULTS Current smoking was common among individuals with AUD (64.3%) and DUD (55.0%). Few patients with AUD or DUD had quit smoking (16.7% and 24.0%, respectively). Smokers with AUD had higher odds of wanting to quit smoking in the past year (adjusted odds ratio = 2.88; 95% confidence interval = 1.19, 7.05), but were not more likely to have made a past-year quit attempt. DUD was not significantly associated with smoking-related quit behaviors. Smokers with AUD or DUD, as well as those who engaged in treatment for AUD or DUD, did not differ significantly from other smokers in receipt of advice to quit smoking. CONCLUSIONS Smokers with AUD and DUD were unlikely to have quit smoking despite interest in quitting. Our findings suggest a need for individualized tobacco treatment approaches in patients with AUD and DUD and missed opportunities to provide tobacco cessation counseling during addiction treatment.
Collapse
Affiliation(s)
- Danielle R Fine
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16thfloor, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Benjamin I Bearnot
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16thfloor, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Nancy A Rigotti
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16thfloor, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
| | - Travis P Baggett
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16thfloor, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, 780 Albany Street, Boston, MA, 02118, USA.
| |
Collapse
|
15
|
Notley C, Gentry S, Livingstone‐Banks J, Bauld L, Perera R, Hartmann‐Boyce J, Cochrane Tobacco Addiction Group. Incentives for smoking cessation. Cochrane Database Syst Rev 2019; 7:CD004307. [PMID: 31313293 PMCID: PMC6635501 DOI: 10.1002/14651858.cd004307.pub6] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Financial incentives, monetary or vouchers, are widely used in an attempt to precipitate, reinforce and sustain behaviour change, including smoking cessation. They have been used in workplaces, in clinics and hospitals, and within community programmes. OBJECTIVES To determine the long-term effect of incentives and contingency management programmes for smoking cessation. SEARCH METHODS For this update, we searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The most recent searches were conducted in July 2018. SELECTION CRITERIA We considered only randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to smoking cessation incentive schemes or control conditions. We included studies in a mixed-population setting (e.g. community, work-, clinic- or institution-based), and also studies in pregnant smokers. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. The primary outcome measure in the mixed-population studies was abstinence from smoking at longest follow-up (at least six months from the start of the intervention). In the trials of pregnant women we used abstinence measured at the longest follow-up, and at least to the end of the pregnancy. Where available, we pooled outcome data using a Mantel-Haenzel random-effects model, with results reported as risk ratios (RRs) and 95% confidence intervals (CIs), using adjusted estimates for cluster-randomised trials. We analysed studies carried out in mixed populations separately from those carried out in pregnant populations. MAIN RESULTS Thirty-three mixed-population studies met our inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. We judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty-four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow-up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long-term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease.Although not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self-deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self-deposits.We included 10 studies of 2571 pregnant women. We judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow-up (up to 24 weeks post-partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. AUTHORS' CONCLUSIONS Overall there is high-certainty evidence that incentives improve smoking cessation rates at long-term follow-up in mixed population studies. The effectiveness of incentives appears to be sustained even when the last follow-up occurs after the withdrawal of incentives. There is also moderate-certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post-partum. Current and future research might explore more precisely differences between trials offering low or high cash incentives and self-incentives (deposits), within a variety of smoking populations.
Collapse
Affiliation(s)
- Caitlin Notley
- University of East AngliaNorwich Medical SchoolNorwichUK
| | - Sarah Gentry
- University of East AngliaNorwich Medical SchoolNorwichUK
| | | | - Linda Bauld
- University of EdinburghUsher Institute, College of Medicine and Veterinary MedicineEdinburghUK
| | - Rafael Perera
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
| | | | | |
Collapse
|
16
|
Exploring patterns of alcohol misuse in treatment-seeking UK veterans: A cross-sectional study. Addict Behav 2019; 92:14-19. [PMID: 30572207 DOI: 10.1016/j.addbeh.2018.11.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/05/2018] [Accepted: 11/28/2018] [Indexed: 11/22/2022]
Abstract
AIMS To explore patterns of alcohol misuse in a sample of treatment-seeking veterans compared to the UK Armed Forces personnel population and the general public. Furthermore, the present study investigated which variables were associated with alcohol misuse in this sample, and in particular what factors were associated with increased or decreased severity of alcohol misuse. METHOD The present study investigated alcohol misuse in treatment-seeking veterans and compared it with the UK Armed Forces and the general public. In addition, it explored associations between sociodemographic, physical health and mental health variables and alcohol misuse. RESULTS Results suggested that treatment-seeking veterans report different patterns of alcohol misuse compared to the UK Armed Forces and the general public. This group was more likely to report alcohol dependence and alcohol-related harm. They also reported higher levels of overall alcohol misuse than the general public. Mental health problems including PTSD, anxiety and depression, as well as anger, functional impairment and being single were all related to greater alcohol misuse. Being older and not in work were related to reduced alcohol misuse. CONCLUSIONS These findings add further weight to the importance of ensuring appropriate support is provided to personnel leaving the Armed Forces. Treatment-seeking veterans have specific patterns of alcohol-related needs that should be addressed. Knowing more about the common alcohol-related problems in this group can help inform and improve mental health interventions. Findings on related variables will help in identifying those individuals who may be at most risk of alcohol-related problems.
Collapse
|
17
|
Sloas L, Murphy A, Wooditch A, Taxman FS. Assessing the Use and Impact of Points and Rewards across Four Federal Probation Districts: A Contingency Management Approach. VICTIMS & OFFENDERS 2019; 14:811-831. [PMID: 33041726 PMCID: PMC7545962 DOI: 10.1080/15564886.2019.1656691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Contingency management (CM) is a well-acknowledged behavioral approach for incentivizing changes in behavior and attitudes. A version of CM was piloted in four federal probation districts to determine whether systematically awarding points and rewards for key behaviors could be implemented and impact recidivism rates. A case controlled match design was conducted with a CM sample (referred to as Justice Steps (JSTEPS)) (n=128) who were individually matched to a comparison sample (n=128) on six variables related to recidivism. Analyses compared the number of technical violations and new arrests between JSTEPS participants and a historical comparison sample. Using Kaplan-Meier survival analysis, results indicate JSTEPS sites using early CM rewarding strategies tend have delayed recidivism than others. A research agenda is outlined.
Collapse
Affiliation(s)
- Lincoln Sloas
- College for Design and Social Inquiry, School of Criminology and Criminal Justice, Florida Atlantic University, 777 Glades Road, SO 221, Boca Raton, FL 33431
| | - Amy Murphy
- Center for Advancing Correctional Excellence, George Mason University, Fairfax, VA 22030
| | - Alese Wooditch
- Temple University, Department of Criminal Justice, 529 Gladfelter Hall | 1115 Polett Walk, Philadelphia, PA 19122
| | - Faye S Taxman
- Criminology, Law & Society, Center for Advancing Correctional Excellence!, 4087 University Drive, 4100, MSN 6D3, Fairfax, VA 22030
| |
Collapse
|
18
|
Lee DC, Walker DD, Hughes JR, Brunette MF, Scherer E, Stanger C, Etter JF, Auty S, Budney AJ. Sequential and simultaneous treatment approaches to cannabis use disorder and tobacco use. J Subst Abuse Treat 2018; 98:39-46. [PMID: 30665602 DOI: 10.1016/j.jsat.2018.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 12/15/2022]
Abstract
Tobacco smoking among those seeking treatment for cannabis use disorder (CUD) is common and is a negative predictor of cannabis outcomes. Quitting tobacco may be beneficial for those seeking to quit cannabis use. This initial proof of concept, controlled trial was designed to compare a simultaneous versus sequential tobacco intervention among those seeking treatment for CUD. Sixty-seven adults received either a simultaneous (SIM) or sequential (SEQ) approach to tobacco cessation in the context of outpatient treatment for CUD. A tobacco intervention (TI) that combined web-based counseling with nicotine replacement therapy (NRT) was provided during weeks 1-12 for SIM and was delayed until weeks 13-24 for SEQ. During weeks 1-12, no between-condition significant differences were observed on treatment participation or cannabis use outcomes. The majority of SIM participants initiated TI counseling (62%), 50% made at least one quit attempt and 41% initiated NRT. Interestingly, 39% in SEQ made tobacco quit attempts and 18% initiated NRT on their own before the TI was offered to them. However, only 30% of those in SEQ continued treatment during weeks 13-24, which compromised between-condition comparisons following the TI, but illustrated a potential clinical concern with delaying the TI. Tobacco cessation outcomes generally were poor and did not differ between conditions. This initial controlled trial suggests that addressing tobacco use during CUD treatment is acceptable and generates action towards tobacco cessation. Additional trials testing more intensive TI models may be necessary to identify more efficacious interventions for co-use of cannabis and tobacco.
Collapse
Affiliation(s)
- Dustin C Lee
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, United States of America
| | - Denise D Walker
- Innovative Programs Research Group, University of Washington, United States of America
| | - John R Hughes
- Departments of Psychiatry and Psychological Science, University of Vermont, United States of America
| | - Mary F Brunette
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, United States of America
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, United States of America
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, United States of America
| | - Jean-Francois Etter
- Institute of Social and Preventive Medicine, Faculty of Medicine, University of Geneva, Switzerland
| | - Samantha Auty
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, United States of America
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, United States of America.
| |
Collapse
|
19
|
Poghosyan H, Moen EL, Kim D, Manjourides J, Cooley ME. Social and Structural Determinants of Smoking Status and Quit Attempts Among Adults Living in 12 US States, 2015. Am J Health Promot 2018; 33:498-506. [PMID: 30071738 DOI: 10.1177/0890117118792827] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study examined the relationships among intermediary determinants, structural determinants, and adult smoking status and quit attempts. DESIGN Secondary data analysis of cross-sectional data. SETTING Data come from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), Social Context module. A national, representative sample from 12 US states (Alabama, Arkansas, Delaware, District of Columbia, Georgia, Louisiana, Minnesota, Mississippi, Missouri, Rhode Island, Tennessee, and Utah). PARTICIPANTS A total of 64 053 noninstitutionalized US adults aged ≥18 years. MEASURES Smoking status and quit attempts were outcome variables. Individual-level structural determinants (age, sex, race/ethnicity, marital status, education, and employment status) and intermediary determinants (housing insecurity, food insecurity, health insurance, binge drinking, and general health mental health) from BRFSS. ANALYSIS Weighted multivariate, multinomial logistic regression. RESULTS Current smoking was greater among men, respondents aged between 35 to 64 and 55 to 64, adults who reported food insecurity, housing insecurity, frequent mental distress, binge drinking, and who were unemployed. Current smokers had higher odds of making quit attempts in the past 12 months if they were non-Hispanic Black, graduated college, and reported food and housing insecurity. CONCLUSION Multifaceted smoking cessation interventions that address food and housing needs also incorporate screening for potential comorbidities such as mental distress and/or hazardous alcohol use and may be needed to enhance smoking cessation rates among racially diverse adults.
Collapse
Affiliation(s)
- Hermine Poghosyan
- 1 Northeastern University, Bouve College of Health Sciences, Boston, MA, USA
| | - Erika L Moen
- 2 The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth Colleague, Lebanon, NH, USA
| | - Daniel Kim
- 3 Department of Health Sciences, Northeastern University, Bouve College of Health Sciences, Boston, MA, USA
| | - Justin Manjourides
- 3 Department of Health Sciences, Northeastern University, Bouve College of Health Sciences, Boston, MA, USA
| | | |
Collapse
|
20
|
Cassidy RN, Jackson KM, Rohsenow DJ, Tidey JW, Tevyaw TOL, Barnett NP, Monti PM, Miller ME, Colby SM. Contingency management for college student smokers: The role of drinking as a moderator and mediator of smoking abstinence during treatment. Addict Behav 2018; 80:95-101. [PMID: 29367116 DOI: 10.1016/j.addbeh.2018.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 12/15/2017] [Accepted: 01/15/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION 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. METHODS 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). RESULTS 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. CONCLUSIONS 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.
Collapse
Affiliation(s)
- Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University, USA.
| | | | | | | | | | - Nancy P Barnett
- Center for Alcohol and Addiction Studies, Brown University, USA
| | - Peter M Monti
- Center for Alcohol and Addiction Studies, Brown University, USA
| | - Mollie E Miller
- Center for Alcohol and Addiction Studies, Brown University, USA
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University, USA
| |
Collapse
|
21
|
Ziser K, Resmark G, Giel KE, Becker S, Stuber F, Zipfel S, Junne F. The effectiveness of contingency management in the treatment of patients with anorexia nervosa: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2018; 26:379-393. [PMID: 29577487 DOI: 10.1002/erv.2590] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 11/08/2022]
Abstract
Contingency management in stipulating weight gain is routinely used in the treatment of anorexia nervosa, however, empirical investigations concerning its effectiveness have been scarce. This systematic review was conducted according to the PRISMA statement. Of N = 973 hits, 42 full-texts were included in the qualitative synthesis (11 theoretical texts, 19 case reports, 12 descriptive, cohort, and controlled trials). A central topic in the included publications concerns the enhancement of patients' autonomy through participation in the contingency management process. This heightened autonomy is achieved by using contingency contracts. Positive short-term effects on weight gain were shown, whereas follow-up results were heterogeneous. Although contingency contracts are widely used in clinical practice, our systematic review shows that empirical evidence on underlying mechanisms and efficacy is still scarce. Using an explicit treatment contract can enhance patients' motivation, compliance, and autonomy. Clinical practice should see further development including innovative motivation enhancing and conflict dissolving techniques in addressing the pronounced ambivalence often shown by patients with anorexia nervosa.
Collapse
Affiliation(s)
- Katrin Ziser
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Sandra Becker
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Felicitas Stuber
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany
| |
Collapse
|
22
|
Gass JC, Morris DH, Winters J, VanderVeen JW, Chermack S. Characteristics and clinical treatment of tobacco smokers enrolled in a VA substance use disorders clinic. J Subst Abuse Treat 2018; 84:1-8. [PMID: 29195588 DOI: 10.1016/j.jsat.2017.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022]
Abstract
Individuals with a substance use disorder (SUD) diagnosis are more than twice as likely to smoke cigarettes as the general population. Emerging research has suggested that treating a substance use disorder simultaneously with tobacco use leads to a higher rate of treatment success for both substances. Despite this, substance use treatment protocols tend not to focus on tobacco use; in fact, traditional substance use treatments often discourage patients from attempting to quit smoking. One rationale is that patients may not be motivated to quit smoking. In the current study, data from veterans enrolled in outpatient treatment for a SUD were examined to assess for general characteristics of smokers as compared to non-smokers as well as to examine motivation to quit smoking. Baseline (i.e., pre-treatment) data from 277 Veterans were used. Charts of smokers in the SUD clinic (SUDC) were reviewed to assess how smoking is handled by SUDC providers, and if smokers attempt cessation. Of 277, 163 (59%) SUDC patients reported that they currently smoke cigarettes (M=16.3 cigarettes per day, SD=11.1). Smokers in the clinic reported greater general impairment than nonsmokers on the Short Index of Problems, F(1248)=8.9, p=0.003, as well as greater specific impairment: Physical Problems, F(1258)=13.5, p=0.000; Interpersonal Problems, F(1262)=5.6, p=0.019; Intrapersonal Problems, F(1260)=6.5, p=0.011, and Social Responsibility, F(1262)=14.7, p=0.000. Smokers in the sample were marginally more anxious than their non-smoking counterparts as measured by the GAD-7, F(1254)=4.6, p=0.053, though they were not significantly more depressed (p=0.19). On a 1-10 scale, smokers reported moderate levels of importance (M=5.4, SD=3.1), readiness (M=5.6, SD=3.2), and confidence (M=5.0, SD=3.0) regarding quitting smoking. Review of smokers' medical records reveal that while SUDC providers assess tobacco use at intake (90%) and offer treatment (86.5%), a substantially small portion of smokers attempt cessation (41.1%) while enrolled in SUDC. Moreover, no patients were enrolled in smoking-specific behavioral interventions while in SUDC, though 78 patients did obtain nicotine replacement or another smoking cessation medication (41% were prescribed by a SUDC provider). Contrary to the belief that treatment-seeking substance users are not motivated to quit smoking, these preliminary analyses demonstrate that Veterans were at least contemplating quitting smoking while they were enrolled in substance use treatment. Further, there is evidence that cigarette smokers have greater impairment caused by substance use, suggesting that this subgroup is of particular high need. Specific treatment recommendations are discussed, including how behavioral health providers in SUD clinics may be better able to capitalize on patients' moderate motivation to quit at intake.
Collapse
Affiliation(s)
- Julie C Gass
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States.
| | - David H Morris
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jamie Winters
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Joseph W VanderVeen
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Stephen Chermack
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| |
Collapse
|
23
|
Petry NM, Alessi SM, Olmstead TA, Rash CJ, Zajac K. Contingency management treatment for substance use disorders: How far has it come, and where does it need to go? PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017; 31:897-906. [PMID: 28639812 PMCID: PMC5714694 DOI: 10.1037/adb0000287] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Contingency management (CM) interventions consistently improve substance abuse treatment outcomes, yet CM remains a highly controversial intervention and is rarely implemented in practice settings. This article briefly outlines the evidence base of CM and then describes 4 of the most often-cited concerns about it: philosophical, motivational, durability, and economic. Data supporting and refuting each of these issues are reviewed. The article concludes with suggestions to address these matters and other important areas for CM research and implementation, with the aims of improving uptake of this efficacious intervention in practice settings and outcomes of patients with substance use disorders. (PsycINFO Database Record
Collapse
Affiliation(s)
- Nancy M Petry
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Sheila M Alessi
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | | | - Carla J Rash
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| | - Kristyn Zajac
- Calhoun Cardiology Center, University of Connecticut School of Medicine
| |
Collapse
|
24
|
Moody LN, Poe LM, Bickel WK. Toward a laboratory model for psychotherapeutic treatment screening: Implementation intentions and incentives for abstinence in an analog of smoking relapse. Exp Clin Psychopharmacol 2017; 25:373-379. [PMID: 29048186 PMCID: PMC5657006 DOI: 10.1037/pha0000136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite reductions in cigarette smoking in the United States, approximately 40 million Americans are smokers. Innovative interventions are needed to help remaining smokers quit. To develop innovative interventions, precise and effective tools are needed. Here, a laboratory model of smoking relapse is assessed for its ability to detect increased resistance to smoking across 2 interventions and for its sensitivity to differing degrees of effectiveness. Nicotine-deprived participants (N = 36) completed, in randomized order, 4 smoking resistance sessions with and without implementation intentions and monetary incentives. A Cox proportional hazard mixed-effects model indicated significant differences between condition, χ²(3) = 64.87, p < .001, and the Questionnaire on Smoking Urges, χ²(1) = 4.86, p = .03. Comparisons between conditions were used to estimate the effect size of each condition on delay to smoking reinitiation. The implementation intentions intervention had a small effect (d = 0.32), the monetary incentives had a large effect (d = 0.89) and the combination of both interventions had a large effect size (d = 1.20). This initial investigation of the smoking resistance paradigm showed sensitivity to smoking reinitiation across intervention conditions. Individuals resisted smoking significantly more in the presence of monetary incentives and implementation intentions than without these interventions. These results provide support for further examination of these interventions in more translational settings and the use of this laboratory analog to screen future interventions and treatment packages. (PsycINFO Database Record
Collapse
Affiliation(s)
- Lara N. Moody
- Virginia Tech Carilion Research Institute, Roanoke, VA, USA
- Virginia Tech, Department of Psychology, Blacksburg, VA, USA
| | - Lindsey M. Poe
- Virginia Tech Carilion Research Institute, Roanoke, VA, USA
| | - Warren K. Bickel
- Virginia Tech Carilion Research Institute, Roanoke, VA, USA
- Virginia Tech, Department of Psychology, Blacksburg, VA, USA
| |
Collapse
|
25
|
Higgins ST, Davis DR, Kurti AN. Financial Incentives for Reducing Smoking and Promoting Other Health-Related Behavior Change in Vulnerable Populations. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2372732216683518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Substantial reductions in U.S. cigarette smoking and associated chronic diseases over the past 50 years have benefited health. Unfortunately, those reductions have distributed unevenly throughout the population. Smoking remains prevalent and even increasing among certain vulnerable populations: economically disadvantaged groups, those with other substance-use disorders or mental illness, certain ethnic and racial minorities, and gender and sexual minorities. Moreover, other unhealthy behavior patterns (physical inactivity, unhealthy food choices, risky sexual behavior, poor adherence to medical preventive regimens) and associated chronic diseases are also overrepresented in many of these same populations. Disparities in unhealthy behavior patterns contribute to health disparities and escalating health care costs, underscoring the need for more effective behavior-change strategies. This report reviews research on the efficacy of financial incentives for reducing smoking in vulnerable populations, while also touching on applications of that behavior-change strategy for promoting other health-related behavior changes in vulnerable populations.
Collapse
|
26
|
Rash CJ, Stitzer M, Weinstock J. Contingency Management: New Directions and Remaining Challenges for An Evidence-Based Intervention. J Subst Abuse Treat 2017; 72:10-18. [PMID: 27746057 PMCID: PMC5154900 DOI: 10.1016/j.jsat.2016.09.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/23/2016] [Indexed: 12/24/2022]
Abstract
This article introduces the special issue on contingency management (CM), an efficacious intervention for the treatment of substance use disorders with low uptake in clinical settings that is not commensurate with evidence for efficacy. In this special issue of the Journal of Substance Abuse Treatment, we present 16 articles representing the latest research in efficacy, implementation, and technological advances related to CM. Combined, this collection of articles highlights the diverse populations, settings, and applications of CM in the treatment of substance use disorders. We conclude by highlighting directions for future research, particularly those that may increase CM's appeal and uptake in routine clinical care.
Collapse
Affiliation(s)
- Carla J Rash
- Calhoun Cardiology Center - Behavioral Health, UConn Health Center, 263 Farmington Avenue (MC 3944), Farmington, CT 06030-3944.
| | - Maxine Stitzer
- Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Baltimore, MD 21224
| | - Jeremiah Weinstock
- Department of Psychology, Saint Louis University, 3700 Lindell Boulevard, Morrissey Hall Rm 2735, St. Louis, MO 63108
| |
Collapse
|