Contingency management and cognitive behavioral therapy for trauma-exposed smokers with and without posttraumatic stress disorder. (March 2019)

• Record Type: Journal Article
• Authors: Japuntich, Sandra J.; Lee, Lewina O.; Pineles, Suzanne L.; Gregor, Kristin; Joos, Celina M.; Patton, Samantha C.; Krishnan-Sarin, Suchitra; Rasmusson, Ann M.
• Is Part Of: Addictive behaviors. Volume 90(2019)
• Page Start: 136
• Page End: 142
• Publication Date: 2019-03
• Subjects: Stress disorders -- Post-traumatic -- Psychological trauma -- Tobacco use disorder -- Contingency management -- Tobacco use cessation; Substance abuse -- Periodicals; Alcoholism -- Periodicals; Drug addiction -- Periodicals; Nicotine addiction -- Periodicals; Smoking -- Periodicals; Gambling -- Psychological aspects -- Periodicals; Electronic journals; 362.29
• DOI: 10.1016/j.addbeh.2018.10.042
• Languages: English
• ISSNs: 0306-4603

Abstract

Abstract: Introduction: Trauma-exposed individuals with and without posttraumatic stress disorder (PTSD) are more likely to smoke and less successful in quit attempts than individuals without psychopathology. Contingency management (CM) techniques (i.e., incentives for abstinence) have demonstrable efficacy for smoking cessation in some populations with psychopathology, but have not been well tested in PTSD. This pilot study examined the feasibility of CM plus brief cognitive behavioral therapy (CBT) in promoting smoking cessation among trauma-exposed individuals with and without PTSD. Methods: Fifty trauma-exposed smokers (18 with PTSD) were asked to abstain from tobacco and nicotine replacement therapy for one month. During week one of cessation, CBT was provided daily and increasing CM stipends were paid for each continuous day of biochemically-verified abstinence; CM stipends were withheld in response to smoking lapses and reset to the initial payment level upon abstinence resumption. CBT and fixed payments for study visits were provided during the subsequent three weeks. Results: Of the 50 eligible participants who attended at least one pre-quit visit (49% female, 35% current PTSD), 43 (86%) attended the first post-quit study visit, 32 (64%) completed the first week of CM/CBT treatment, and 26 (52%) completed the study. Post-quit seven-day point prevalence abstinence rates for participants with and without PTSD, respectively, were similar: 39% vs. 38% (1 week), 33% vs. 28% (2 weeks), 22% vs. 19% (3 weeks), and 22% vs. 13% (4 weeks). Conclusions: Use of CM + CBT to support tobacco abstinence is a promising intervention for trauma-exposed smokers with and without PTSD. Highlights: Contingency management is feasible to use with trauma exposed smokers. Contingency management is a promising treatment for trauma exposed smokers. Effects of contingency management abated when contingencies were removed.