Contingency Management for Smoking Cessation

Overseen by Benjamin Toll, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Medical University of South Carolina

Must be taking: Nicotine patch

Disqualifiers: Unstable psychiatric, Non-English, Pregnant, others

No Placebo Group

Approved in 2 Jurisdictions

Trial Summary

What is the purpose of this trial?

This is a smoking cessation treatment study. Patients who have a cancer or a suspected cancer who will undergo surgical removal of their cancer are eligible to participate in this study. A novel smoking cessation treatment will be provided to half of the participants in the study. All study participants will receive standard smoking cessation therapy including counseling and the nicotine patch.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

What data supports the effectiveness of the treatment Contingency Management for smoking cessation?

Research shows that using financial incentives, like prizes or vouchers, can help people quit smoking by rewarding them for not smoking. Studies found that people are more likely to stop smoking when they receive rewards for staying smoke-free, and this approach has been effective in various settings, including with pregnant women and socioeconomically disadvantaged individuals. ^{1 2 3 4 5}

Is contingency management for smoking cessation safe for humans?

Contingency management, which includes methods like prize-based incentives, has been used safely in various settings, including with pregnant women and socioeconomically disadvantaged adults, without reported safety concerns. ^{1 2 6 7 8}

How does the contingency management treatment for smoking cessation differ from other treatments?

Contingency management for smoking cessation is unique because it uses incentives, like money or prizes, to encourage people to quit smoking. This approach is different from traditional methods as it directly rewards individuals for maintaining abstinence, which can increase motivation and participation. ^{1 2 3 9 10}

Research Team

Benjamin Toll, PhD

Principal Investigator

Medical University of South Carolina

Eligibility Criteria

This trial is for adult smokers diagnosed with or suspected to have operable cancer, who are about to undergo surgery. Participants must smoke at least one cigarette daily and speak English. Those using alternative nicotine products, pregnant women, or individuals with unstable psychiatric/medical conditions cannot join.

Inclusion Criteria

I am 18 years old or older.

I have been diagnosed with or suspected to have a type of cancer that can be operated on.

You smoke at least one cigarette every day.

Exclusion Criteria

You use electronic cigarettes, snus, or other similar products that deliver nicotine.

I do not speak English.

I do not have any severe mental health issues like thoughts of suicide, psychosis, or dementia.

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive standard smoking cessation therapy including counseling and the nicotine patch. Half of the participants receive a novel smoking cessation treatment.

6 weeks

Follow-up

Participants are monitored for smoking abstinence through self-report, Carbon Monoxide Breath Monitoring, and Anabasine testing.

6 months

Treatment Details

Interventions

• Contingency Management (Behavioural Intervention)

Trial Overview The study tests a new smoking cessation treatment against standard care in cancer patients facing surgery. Half will receive the novel treatment plus counseling and nicotine patches; the other half will get only the standard therapy.

Participant Groups

Group I: Contingency Management Experimental Treatment 1 Intervention

Group II: Standard Care Active Control 1 Intervention

Who Is Running the Clinical Trial?

Medical University of South Carolina

Lead Sponsor

Trials

994

Recruited

7,408,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Findings from Research

In a study involving 81 nicotine-dependent smokers, the addition of prize-based contingency management (CM) to standard care significantly reduced smoking during treatment compared to standard care alone.

However, these reductions in smoking did not persist after the treatment ended, indicating that while prize CM can be effective in the short term, it may not lead to long-term cessation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prize contingency management for smoking cessation: a randomized trial. Ledgerwood, DM., Arfken, CL., Petry, NM., et al.[2022]

Incentive and contingency management strategies have shown effectiveness in modifying smoking behavior, particularly in controlled settings, suggesting they can be beneficial for smoking cessation efforts.

Quit-and-win programs, which use incentives to encourage quitting, attract many participants and have produced modest quit rates, although the quality of evaluations varies and more rigorous studies are needed to confirm their effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Incentives in smoking cessation: status of the field and implications for research and practice with pregnant smokers. Donatelle, R., Hudson, D., Dobie, S., et al.[2006]

A contingency management procedure that rewards participants with accumulating money for abstaining from smoking led to a significantly higher likelihood of achieving a 48-hour period of abstinence compared to a procedure that deducted money for smoking.

Participants who earned money for continued abstinence were also less likely to miss appointments, indicating better engagement and adherence to the treatment program.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The relative contribution of economic valence to contingency management efficacy: a pilot study. Roll, JM., Howard, JT.[2021]

Monetary incentives based on group performance significantly promoted brief abstinence from cigarette smoking, with 53% of participants submitting negative breath carbon monoxide samples when vouchers were contingent on team performance.

Both individual and team-based incentives were effective in increasing abstinence rates compared to a no-voucher condition, suggesting that interdependent contingencies can be a cost-effective strategy for smoking cessation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Investigating group contingencies to promote brief abstinence from cigarette smoking. Meredith, SE., Dallery, J.[2023]

In a study involving 146 participants from a smoking cessation program, those who received financial incentives for abstinence (contingency management) had significantly higher smoking abstinence rates compared to those who received usual care, with rates of 49.3% versus 25.4% at 4 weeks post-quit date.

The financial incentives, averaging $63.40 earned by participants, proved effective in encouraging abstinence, particularly among socioeconomically disadvantaged individuals, suggesting that such strategies could enhance smoking cessation efforts in similar populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Financial incentives for abstinence among socioeconomically disadvantaged individuals in smoking cessation treatment. Kendzor, DE., Businelle, MS., Poonawalla, IB., et al.[2022]

In a study involving 75 socioeconomically disadvantaged adults, those who placed greater importance on earning financial incentives for smoking cessation were significantly more likely to achieve continuous abstinence during the four-week intervention (OR = 3.95) and up to 12 weeks post-quit day (OR = 4.71).

The results indicate that an individual's perception of the importance of financial incentives can predict their success in quitting smoking, suggesting that tailoring incentive programs to enhance perceived value may improve outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Greater perceived importance of earning abstinence-contingent incentives is associated with smoking cessation among socioeconomically disadvantaged adults. Alexander, AC., Hébert, ET., Businelle, MS., et al.[2022]

The Internet-based contingency management intervention led to a higher rate of negative breath carbon monoxide samples (66.7%) in the contingent group compared to the noncontingent group (25%), indicating that the incentive system effectively promoted smoking cessation during treatment.

Both groups showed a significant reduction in carbon monoxide levels (15.6 ppm), suggesting that elements like feedback and goal-setting contributed to reduced smoking, even though there were no significant differences in long-term abstinence rates at 3- and 6-month follow-ups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-based contingency management to promote smoking cessation: a randomized controlled study. Dallery, J., Raiff, BR., Grabinski, MJ.[2022]

Internet-based deposit contracts for smoking cessation were effective in increasing the number of breath samples meeting the carbon monoxide criterion, with 47% success in Experiment 1 and 41.5% in Experiment 2, compared to virtually no success during baseline measurements.

Participants found the deposit contract interventions acceptable and feasible, indicating a positive reception that could support further research into their long-term effectiveness for smoking cessation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Internet-based self-tailored deposit contracts to promote smoking reduction and abstinence. Jarvis, BP., Dallery, J.[2018]

In a study involving 74 cocaine-dependent methadone outpatients over 12 weeks, both voucher and prize-based contingency management (CM) interventions led to longer durations of abstinence compared to standard treatment.

The study found no significant differences in outcomes between the voucher and prize systems, indicating that both methods are effective in promoting abstinence during treatment, which is linked to better long-term recovery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. Petry, NM., Alessi, SM., Hanson, T., et al.[2021]

In a study involving 142 outpatients with cocaine or heroin dependence, both voucher and prize-based contingency management (CM) interventions led to longer treatment retention and greater durations of confirmed abstinence compared to standard treatment.

While there were no significant differences in abstinence rates at 6- and 9-month follow-ups, the duration of abstinence achieved during treatment was the strongest predictor of continued abstinence after treatment ended.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vouchers versus prizes: contingency management treatment of substance abusers in community settings. Petry, NM., Alessi, SM., Marx, J., et al.[2016]

References

1. Ireland pubmed.ncbi.nlm.nih.gov

Prize contingency management for smoking cessation: a randomized trial. [2022]

2. England pubmed.ncbi.nlm.nih.gov

Incentives in smoking cessation: status of the field and implications for research and practice with pregnant smokers. [2006]

3. United States pubmed.ncbi.nlm.nih.gov

The relative contribution of economic valence to contingency management efficacy: a pilot study. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Investigating group contingencies to promote brief abstinence from cigarette smoking. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Financial incentives for abstinence among socioeconomically disadvantaged individuals in smoking cessation treatment. [2022]

6. England pubmed.ncbi.nlm.nih.gov

Greater perceived importance of earning abstinence-contingent incentives is associated with smoking cessation among socioeconomically disadvantaged adults. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Internet-based contingency management to promote smoking cessation: a randomized controlled study. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Internet-based self-tailored deposit contracts to promote smoking reduction and abstinence. [2018]

9. United States pubmed.ncbi.nlm.nih.gov

Randomized trial of contingent prizes versus vouchers in cocaine-using methadone patients. [2021]

10. United States pubmed.ncbi.nlm.nih.gov

Vouchers versus prizes: contingency management treatment of substance abusers in community settings. [2016]