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Dunn, Kelly

Psychology

2009

PhD

Methadone and buprenorphine maintenance are the most widely used and effective treatments for opioid dependence. Prevalence of cigarette smoking among opioid-maintained patients is more than 3-fold that of the general population and associated with increased morbidity and mortality. Relatively few studies have aimed to develop or evaluate smoking-cessation interventions among opioid-maintained patients. The most promising work on this topic to date has used contingency management (CM), in which monetary-based incentives are delivered contingent upon biochemical evidence of drug abstinence. A recent pilot study by our group demonstrated the initial efficacy of a CM intervention for promoting smoking abstinence in a sample of methadone-maintained smokers (Dunn, Sigmon, Thomas, Heil & Higgins, 2008). The next step in this line of research was to conduct a larger-scale random ized trial to replicate and extend our pilot findings. Toward this end, in the present trial 40 methadone-or buprenorphinemaintained smokers were enrolled and visited the clinic daily for the 14-day intervention.
Participants were randomly assigned to a Contingent (n=20) or Noncontingent (n=20) experimental group. Contingent participants received vouchers based on breath carbon monoxide (CO) values during Study Days 1-5 and urinary cotinine values during Days 6-14. Voucher values began at $9.00 and increased by $1.50 with each subsequent negative sample, for maximum possible earnings of $362.50. Noncontingent participants earned vouchers independent of smoking status. While not a primary focus, those interested in and eligible for pharmacotherapy could also receive bupropion (Zyban®), a commonly-used pharmacotherapy for smoking cessation. Contingent participants achieved significantly more smoking abstinence, as evidenced by a greater percent of smoking-negative samples (55% vs. 17%) and longer duration of continuous abstinence (7.7 vs. 2.4 days) than Noncontingent participants, respectively.
There were no significant group differences in smoking abstinence at a 30-,60-or 90-day follow-up assessments, nor was there a significant contribution of bupropion on abstinence outcomes. Results from this randomized clinical trial provide further support for the efficacy of CM in promoting smoking abstinence in this hard-to-treat population. Furthermore, considering that opioid treatment clinics throughout the country adhere to a relatively uniform set of guidelines, there is potential for wide dissemination of this intervention to treatment programs nationwide.