Prize Reinforcement for Smoking Cessation

Contingency management (CM) treatments are efficacious in reducing substance use. A
relatively new approach, called prize-based CM, which uses prizes to reinforce substance
abstinence, is effective in decreasing certain types of substance use, but its efficacy has
not been evaluated in the treatment of cigarette smoking. One purpose of the current study
is to assess the efficacy of a prize reinforcement intervention for reducing cigarette
smoking. A second purpose is to test the differential efficacy of two schedules of
reinforcement, using cigarette smoking as an exemplar. We will randomly assign 110 patients
to one of three conditions: 1) Standard treatment; 2) Traditional prize reinforcement; or 3)
Early-treatment enhanced prize reinforcement. Patients in each condition will receive
counseling for their smoking based on current standard of care guidelines. All patients
will participate in a one-week baseline period, followed by a four-week intervention.
Throughout both phases, each patient will meet with a research assistant twice daily to
provide carbon monoxide (CO) samples. Patients in the prize reinforcement conditions will
earn the chance to win prizes when they provide negative CO samples (i.e., < 6ppm). They
will also earn bonus draws if they provide negative cotinine samples (i.e., <100ng/ml) after
weekends. Patients in the Traditional CM condition will have at least a 50% chance of
winning a prize for each negative sample with escalating chances for successive negative
samples. Patients in the Enhanced condition will have the opportunity to earn the same
overall number of draws and magnitude of reinforcement, but the schedule of reinforcement
will differ. For the first week of the CM phase, these patients will have a 100% chance of
winning prizes, but in the latter 3 weeks, overall probability of reinforcement will be
decreased to 34%. Patients will also undergo 2- and 6-month follow-up assessments. Primary
outcome measures will be longest duration of continuous abstinence and mean number of days
of abstinence. We predict that the prize reinforcement will reduce cigarette smoking to a
greater extent than standard treatment. We also predict that the Enhanced CM condition will
lead to greater reductions in cigarette smoking relative to the Traditional CM condition,
and that these changes may result in longer sustained abstinence from smoking throughout the
study period.