Contingency management for smokers with mental health disorders and smoking-sensitive conditions caused or exacerbated by tobacco use: A review of existing studies, intervention parameters, and research priorities.

Abstract

Cigarette smoking is highly prevalent in people with smoking-sensitive conditions and mental health disorders. As early as the 1960s, evidence indicated the efficacy of contingency management (CM) for smoking cessation in various populations. This invited review is a critical appraisal of existing CM studies on smoking cessation in populations presenting smoking-sensitive conditions. It is particularly focused on examining the differences between two populations: smokers presenting health-related conditions and smokers with mental health disorders. Smoking abstinence is discussed in relation to treatment parameters (duration of interventions, schedules of reinforcement, and adjunctive therapies). A systematic review was conducted using PubMed, PsycINFO, and Scopus databases in December 2021. A total of 18 studies (N = 1,697; weighted age: 48.66 (8.57); Mdn % females: 41) were included in this review. Populations included hospitalized patients, smokers with chronic obstructive pulmonary disease (COPD), overweight, cancer, mood disorders, attentional deficits, psychosis, and posttraumatic stress disorder. CM abstinence rates were 43.04% at the earliest follow-up assessment (i.e., end of treatment—15 weeks) and 23.28% at subsequent follow-ups (10 days to 1-year posttreatment). Virtually all of the CM studies used cash as a reinforcer and were in place for an average of 5.53 weeks. Incremental versus fixed reinforcement schedules are more commonly used to promote smoking abstinence, but there are still not enough sufficiently powered and well-designed (active vs. control) studies to clarify the optimal magnitude and frequency of incentives. Dismantling studies are needed to refine the CM parameters most likely to produce enduring abstinence.

Extending contingency management for smoking cessation to patients with or at risk for cardiovascular disease: A preliminary trial of a home-based intervention.

“…Contingency management (CM) for smoking cessation (i.e., using financial incentives to reinforce biochemically verified smoking abstinence) may be a promising intervention for patients with CVD who smoke as it can be delivered by nonclinical staff and may help alleviate the need for clinicians to comprehensively address smoking cessation with their patients. Controlled studies have demonstrated that CM effectively promotes smoking abstinence in medically vulnerable populations such as pregnant women, patients with chronic obstructive pulmonary disease (COPD), and patients with comorbid psychiatric conditions and other substance use disorders (Bolívar et al, 2021; González-Roz & Secades-Villa, 2022; Secades-Villa et al, 2020; Streck et al, 2018; Tidey et al, 2011; Wilson et al, 2018). We know of no published research examining CM for smoking cessation in patients with or at risk for developing CVD; thus, clinical trials examining the efficacy of CM for smoking cessation in this patient population are sorely needed (Barth et al, 2015; Prochaska & Benowitz, 2015; Suissa et al, 2017).…”