Contingency Management for Smoking Cessation Among Veterans With Psychotic Disorders

Schizophrenia and other psychotic disorders are highly prevalent in the VA population and
are associated with high rates of smoking. Although smoking cessations approaches that work
for non-schizophrenic patients such as behavioral counseling and medications appear to be
efficacious for schizophrenic smokers, a major obstacle in providing adequate treatment is
poor attendance at treatment sessions. Contingency management has been shown to shape
treatment behavior in non-schizophrenic smokers and to shape other behaviors such as cocaine
use and exercise in schizophrenics.

The intention of this project is to examine the use of contingent incentives to increase
attendance at smoking cessation treatment sessions by smokers with schizophrenia and other
psychoses and to compare two different approaches to providing contingent incentives in this
context. Subjects in the experimental condition draw from a fishbowl to obtain tokens when
they attend a smoking cessation treatment session. The number of draws will be based upon
attendance at consecutive sessions. Subjects in the experimental condition receive a set
reward that will not change regardless of attendance at consecutive sessions. We hypothesize
that the participants in the experimental condition will attend more smoking cessation group
therapy sessions than those in the control condition because they will have the possibility,
although not the likelihood, to obtain contingent reinforcement of greater value.

Inclusion Criteria:

- All subjects must be diagnosed with schizophrenia or any other psychotic disorder,
bipolar disorder with psychotic features, or major depression with psychotic features
according to the electronic medical record.

- Current nicotine use, defined as smoking 5 or more cigarettes/day for at least 16 of
the past 30 days prior to study screening.

- Prospective subjects must indicate willingness to attend smoking cessation group
therapy.

Exclusion Criteria:

- Imminent risk for suicide or violence.

- Severe psychiatric symptoms or psychosocial instability likely to prevent
participation in the study protocol (i.e., attendance at scheduled sessions, ability
to read study materials, and/or ability to comprehend interventions).

- Clinically apparent, gross cognitive impairment.