title: Treating Smokers in Substance Treatment With Contingent Vouchers, Nicotine Replacement and Brief Advice Adapted for Sobriety Settings.
abstract: Treatment for substance use disorders (SUD) provides an opportunity to use voucher-based treatment for smoking. Nicotine replacement (NRT) could improve outcomes previously observed with vouchers without NRT.
  
  
  
  A randomized controlled trial compared contingent vouchers (CV) for smoking abstinence to noncontingent vouchers (NV), when all received counseling and NRT. Smokers who had not sought smoking treatment (n=340) in residential SUD treatment were provided 14days of vouchers for complete smoking abstinence per exhaled carbon monoxide (CO) after a 5-day smoking reduction period, or vouchers only for breath samples, plus brief advice (four sessions) and 8weeks of NRT.
  
  
  
  Within treatment, 20% had complete abstinence with CV, 5% with NV (p<.001), and participants showed 50% of days abstinent in CV compared to 22% in NV (p<.001). Across 1, 3, 6 and 12months after randomization, CV resulted in significantly fewer cigarettes per day (p<.01) and fewer days smoking (p<.01), but with small effects. Point-prevalence abstinence differences across follow-up (e.g., 4% CV, 2% in NV at 6 and 12months) were not significant. No differences in substance use were seen.
  
  
  
  Within-treatment effects on abstinence are stronger than in a prior study of the same CV with BA but without NRT, but NRT does not improve abstinence after vouchers end. Implications for voucher-based treatment include investigating effects when combined with stronger smoking medications and using motivational interviewing. Smoking treatment does not harm SUD recovery.
authors.affiliation: Providence Veterans Affairs Medical Center, Providence, RI 02908, USA; Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912, USA. Electronic address: Damaris_Rohsenow@Brown.edu.
authors.forename: Damaris J
authors.initials: DJ
authors.lastname: Rohsenow
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912, USA.
authors.forename: Rosemarie A
authors.initials: RA
authors.lastname: Martin
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912, USA.
authors.forename: Jennifer W
authors.initials: JW
authors.lastname: Tidey
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912, USA.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Colby
authors.affiliation: Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI 02912, USA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Monti
mesh_terms: D000328:Adult; D003376:Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012201:Reward; D012907:Smoking / Q000188:drug therapy / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D019966:Substance-Related Disorders / Q000628:therapy*; D061485:Tobacco Use Cessation Devices
keywords: Brief advice; Contingency management; Contingent vouchers; Financial incentives; Nicotine dependence; Nicotine replacement; Point-prevalence abstinence; Smoking cessation; Substance use disorders