title: A Randomized Trial of Contingency Management for Smoking Cessation During Intensive Outpatient Alcohol Treatment.
abstract: This randomized clinical trial was designed to evaluate the efficacy of contingency management (CM) for smoking cessation for smokers with alcohol abuse or dependence delivered concurrently with intensive outpatient alcohol treatment. The study also explored the indirect effects of CM smoking treatment and smoking cessation on alcohol and drug use outcomes.
  
  
  
  Alcohol abuse/dependent smokers were randomized to cognitive behavioral therapy plus nicotine replacement therapy plus contingency management (CBT+NRT+CM) or to cognitive behavior therapy plus nicotine replacement therapy (CBT+NRT) delivered concurrent with a three-week intensive outpatient alcohol treatment program.
  
  
  
  Participants in the CBT+NRT+CM condition were significantly more likely to be cigarette abstinent at the end of treatment (χ2(1)=8.48, p=.004) with approximately double the carbon monoxide confirmed quit rate (60%) compared with the CBT+NRT condition (29%). At the one-month and six-month time-points there were nonsignificant differences in smoking abstinence outcomes by condition. Smoking treatment condition did not directly affect alcohol abstinence outcomes, but we observed an indirect effect of smoking treatment on alcohol and drug abstinence at one-month follow-up that was mediated by smoking cessation at the end of treatment.
  
  
  
  Adding CM to an evidence-based smoking cessation treatment that included medication and behavioral counseling doubled the quit rate at the end of treatment. This finding provides strong evidence for the efficacy of CM for helping alcohol dependent smokers reach the milestone of initial smoking abstinence.
authors.affiliation: Veterans Affairs Connecticut Healthcare System, Newington, CT 06111, USA; University of Connecticut School of Medicine, Farmington, CT 06030, USA. Electronic address: judith.cooney@va.gov.
authors.forename: Judith L
authors.initials: JL
authors.lastname: Cooney
authors.affiliation: Veterans Affairs Connecticut Healthcare System, Newington, CT 06111, USA; University of Connecticut School of Medicine, Farmington, CT 06030, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Cooper
authors.affiliation: Veterans Affairs Connecticut Healthcare System, Newington, CT 06111, USA; University of Connecticut School of Medicine, Farmington, CT 06030, USA.
authors.forename: Christoffer
authors.initials: C
authors.lastname: Grant
authors.affiliation: Veterans Affairs Connecticut Healthcare System, Newington, CT 06111, USA; Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Sevarino
authors.affiliation: Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Suchitra
authors.initials: S
authors.lastname: Krishnan-Sarin
authors.affiliation: University of Connecticut, Storrs, CT 06269, USA.
authors.forename: Ian A
authors.initials: IA
authors.lastname: Gutierrez
authors.affiliation: Veterans Affairs Connecticut Healthcare System, Newington, CT 06111, USA; Yale University School of Medicine, New Haven, CT 06510, USA.
authors.forename: Ned L
authors.initials: NL
authors.lastname: Cooney
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D012201:Reward; D016540:Smoking Cessation / Q000379:methods*; D061485:Tobacco Use Cessation Devices
keywords: Alcohol use disorder; Contingency management; Randomized clinical trial; Smoking cessation; Tobacco use disorder