A multicomponent smoking cessation program for adults with Type 2 Diabetes Mellitus (DiMe-SALUD2 project): A study protocol of a randomized controlled trial.

Background: Tobacco use represents a significant public health burden, being especially harmful for smokers with Type 2 Diabetes Mellitus (T2DM). Effective smoking cessation interventions are required for this vulnerable population. The goal is to describe a study protocol of a randomized controlled trial (RCT) aimed at analyzing the effectiveness and efficiency of a multicomponent smoking cessation intervention for T2DM smokers, including a training protocol on healthy lifestyle habits and self-management of T2DM (DiMe-SALUD2 project). Methods: This RCT will assign participants to: (1) Control Group (n = 30), including a brief psychoeducation advice about smoking cessation; (2) Cognitive-behavioral treatment (CBT) for smoking cessation (n = 30), based on a multicomponent program implemented in group-based sessions over an eight-week period; and (3) CBT plus DiMeSALUD2 protocol (n = 30), which will develop an additional psychoeducational protocol specifically designed to improve healthy lifestyle habits. Participants will be assessed at baseline, post-treatment and several follow-ups (1-, 6- and 12-months). Primary outcomes will include smoking abstinence (24-h point prevalence abstinence at post-treatment and 7-day point prevalence at follow-ups) and smoking continuous abstinence. Secondary outcomes will include treatment retention, changes in smoking patterns and nicotine dependence, as well as the impact on T2DM clinical variables, mental health, and quality of life. Discussion: The DiMeSALUD2 program could assist T2DM smokers in quitting tobacco use and improving their overall quality of life. This project will help incorporating improvements in routine clinical practice with T2DM patients, offering a smoking cessation program adapted to their specific needs. Trial registration: ClinicalTrials.gov. Identifier: NCT05885659. Date of registration: June 2nd, 2023.

High-Risk Cannabis Use: A Proposal of an Operational Definition through Delphi Methodology for Scientific Consensus.

INTRODUCTION: Cannabis ranks as one of the most widely used psychoactive substances worldwide. Its usage has been reported as a risk factor for developing a variety of physical and mental health issues, alongside social and economic problems. According to the World Health Organization (WHO), hazardous (or high-risk) substance use is defined as "a pattern of substance use that increases the risk of harmful consequences for the user." The primary objective of this study was to achieve a consensus on an operational definition of high-risk cannabis use suitable for a European jurisdiction (Spain). METHODS: A three round Delphi study was conducted. The Delphi technique entails group decision-making and iterative forecasting by consulting a panel of experts and conducting systematic feedback rounds. An online survey was distributed among a diverse expert panel comprising professionals from Spain working on fields related to cannabis use (research, policy planning, and clinical professionals). One-hundred ninety-nine invitations were sent to experts, of which forty-five (22.6%) accepted to participate. All participants were provided the option to revise a background document with the latest compiled scientific evidence and guidelines related to health and social conditions associated to cannabis usage. This background document also proposed the quantification of dose using a standardized unit established for the population of Spain (the Standard Joint Unit or SJU) based on quantity of cannabis main psychoactive constituent, 9-tetrahydrocannabinol (9-THC) (1 SJU = 1 joint = 0.25 g of cannabis = 7 mg of 9-THC). Three rounds of Likert scale and open-ended questions were administered until consensus, defined as ≥75% agreement, was attained. RESULTS: Consensus was reached on defining high-risk cannabis use as the usage of more than 4 SJU (>28 mg THC) per week or any use of cannabis with potency >10% THC. Concurrent use of cannabis with other drugs was also considered high risk, while the smoked route was considered the riskiest administration route. It was also agreed that vulnerable groups for high-risk cannabis use (for whom any pattern of cannabis use represents high risk of harm) include individuals under the age of 21, pregnant or breastfeeding women, individuals with psychiatric history, those with medical health issues related to cannabis use, professional drivers and heavy machine operators. CONCLUSION: This operational definition of high-risk cannabis use for Spain elucidates usage patterns and individual vulnerability factors predictive of heightened harm. Its adoption holds potential to inform decision-making among individuals, professionals, and policy-makers, facilitating evidence-based interventions aimed at prevention and risk reduction.

Effectiveness of Contingency Management in Tobacco Smokers with Depressive Symptoms: A Systematic Review.

Background: Effective interventions are required to address tobacco smoking in people with depressive symptomatology. In this context, contingency management could be one useful therapeutic strategy. Objectives: This study is a systematic review of tobacco cessation interventions for smokers with depressive symptomatology including a contingency management component, evaluating their efficacy with regards to tobacco abstinence, depressive symptomatology, adherence to treatment and other variables related to tobacco use. For this purpose, a search was carried out in Pubmed, PsycINFO, Cochrane, Web of Science and ClinicalTrials.gov in September 2022. The quality of the studies was assessed using the Cochrane Risk of Bias tool. Results: Of the 208 articles identified, six were included in this review. Results: For the most part, the research included suggests that contingency management is an effective strategy for improving abstinence outcomes, adherence, and other smoking-related variables such as delay discounting and intensity of cigarette demand in smokers with depressive symptomatology. Conclusions: Although contingency management could be a promising intervention in tobacco smokers with depressive symptomatology, further research in this area is still required.

Reduction in Depressive Symptoms in People who Inject Drugs who Are Cured of Hepatitis C Virus Infection: The HERO Study.

Background: Depressive symptoms are prevalent among people who inject drugs (PWID) and people with hepatitis C virus (HCV). We examined changes in depressive symptoms among HCV-infected PWID following direct-acting antiviral treatments to evaluate whether these changes differed by history of depressive symptoms, substance use, or HCV treatment outcome. Methods: We conducted a secondary analysis of the HERO Study (NCT02824640), a pragmatic randomized clinical trial among PWID, to test the effectiveness of HCV care models. Depressive symptoms (primary outcome) were measured using the Patient Health Questionnaire (PHQ-9) at baseline, end of treatment (EOT), and at follow-up 12 and 24 weeks after EOT. Sustained virologic response (SVR) was defined as undetectable HCV RNA at ≥12 weeks following EOT. Baseline drug use was defined as having a positive urine screening test for amphetamine, methamphetamine, benzodiazepine, cocaine, cannabis, opiate, or oxycodone. Results: The sample (n = 498) was 72.3% male, 64.2% White, and on average 43.9 years old. In patients who achieved SVR (F(3432) = 4.58; P = .004) and those with drug use at baseline (F(3478) = 5.11; P < .01), PHQ-9 scores significantly declined over time, with scores lower at EOT and both follow-ups as compared with baseline. Mean PHQ-9 scores at EOT and follow-ups were significantly lower than at baseline, except for those with no depression or mild depression at baseline. Conclusions: This study showed that HCV treatment in PWID is associated with sustained declines in depression up to 24 weeks post-treatment among those who achieve SVR and that drug use does not interfere with improvement in depressive symptoms.

Psychometric properties and factor structure of the brief Wisconsin Inventory of Smoking Dependence Motives among Spanish smokers from the general population.

INTRODUCTION: The brief version of the Wisconsin Inventory of Smoking Dependence Motives (B-WISDM) is a well-established instrument to measure the multidimensional nature of nicotine dependence. However, no previous research has assessed its psychometric properties in the Spanish context. The aim of the present study was to analyze the factor structure and measurement invariance across gender of this instrument among Spanish smokers from the general population. METHODS: This cross-sectional study assessed 480 smokers through an online questionnaire including information on tobacco use and several nicotine dependence measures. Confirmatory Factor Analysis was used to assess the factorial structure of the Spanish B-WISDM, its internal consistency, measurement invariance across gender and convergent validity with the Fagerström Test for Nicotine Dependence (FTND) and the Glover-Nilsson Smoking Behavioral Questionnaire (GN-SBQ) scores. RESULTS: Results indicate that the eleven correlated factors solution had a better fit when compared to the other tested models (two correlated factors and two second-order factors with eleven first-order correlated factors solution), remaining such structure invariant across gender. Internal consistency of the scale was high (α = 0.950; dimension α values ranged between 0.657 and 0.921). Overall scores and dimensions of the scale significantly and positively correlated with other nicotine dependence measures (except for Social/Environmental Goads and FTND). CONCLUSIONS: This is the first version of the B-WISDM validated to assess nicotine dependence with a multidimensional perspective within the Spanish culture. Results show adequate psychometric properties regarding its factor structure and measurement invariance across gender, supporting its utility to evaluate the motives driving tobacco use among Spanish smokers from the general population.

Preliminary Evidence of the Association between Time on Buprenorphine and Cognitive Performance among Individuals with Opioid Use Disorder Maintained on Buprenorphine: A Pilot Study.

People on buprenorphine maintenance treatment (BMT) commonly present cognitive deficits that have been associated with illicit drug use and dropout from buprenorphine treatment. This study has compared cognitive responses to the Stroop Task and the Continuous Performance Task (CPT) among individuals on BMT, with recent drug use, and healthy controls and explored the associations between cognitive responses and drug use, craving, and buprenorphine use among participants on BMT. The participants were 16 individuals on BMT and 23 healthy controls. All participants completed a 60 min laboratory session in which they completed the Stroop Task and the CPT, a saliva drug test, a brief clinical history that collected substance-use- and treatment-related information, and the Opioid Craving Scale. The results showed that the BMT participants presented more commission errors (MBMT participants = 2.49; Mhealthy controls = 1.38; p = 0.048) and longer reaction times (MBMT participants = 798.09; Mhealthy controls = 699.09; p = 0.047) in the Stroop Task than did the healthy controls. More days on buprenorphine were negatively associated with reaction time in the CPT (-0.52) and the number of commission errors (-0.53), simple reaction time (-0.54), and reaction time correct (-0.57) in the Stroop Task. Neither drug use nor craving was significantly associated with the results for the cognitive tasks. Relative to the control participants, the BMT individuals performed worse in terms of longer reaction times and more commission errors in the Stroop Task. Within the BMT participants, longer times on buprenorphine were associated with better cognitive results in terms of faster reaction times for both tasks and lower commission errors for the Stroop Task.

New Validity Evidence of the Global Appraisal of Individual Needs-Short Screener for Evaluating Internalizing/Externalizing Behaviors in Spanish Adolescents.

OBJECTIVE: The Global Appraisal of Individual Needs (GAIN-SS) is a screening instrument evaluating internalizing/externalizing behaviors. This study examines the validity evidence of the GAIN-SS in Spanish adolescents and explores sex differences in its performance. METHOD: Participants were 1,547 Spanish adolescents from the community (females = 48.2%, mean [SD] age = 15.20 [0.74]). A cross-sectional online assessment was used to evaluate past-month substance use and gambling involvement. Problems associated to these behaviors were assessed using the GAIN-SS, the South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA), and the Rutgers Alcohol Problem Index (RAPI). Factor analyses were conducted to examine the internal structure of the GAIN-SS. RESULTS: Results revealed four subscales accounting for 47.03% of the variance related to externalizing (EDScr), internalizing (IDScr), substance use disorders (SDScr), and crime/violence problems (CVScr). Concurrent validity was supported through significant correlations between the GAIN-SS subscales, alcohol-related problems, and gambling behavior, with the exception of the IDScr. Past-month gamblers or substance users evidenced higher scores in the CVScr. Females reported more internalizing symptoms, whereas males reported higher scores in CVScr. CONCLUSIONS: The GAIN-SS is a valid screener for substance use and gambling in Spanish adolescents. Sensitivity of the GAIN-SS to sex differences suggests that it may be useful to design gender-sensitive interventions.

Analyzing the Behavior of Cannabis Users during the COVID-19 Confinement in Spain.

The impact of the COVID-19 pandemic on our lives is unquestionable, including in the area of substance consumption. This study aimed to evaluate the changes in the pattern of cannabis use during the Spanish COVID-19 lockdown and confinement, and to analyze the variations in the reported motives for cannabis use and withdrawal symptoms. A cross-sectional retrospective study was conducted between April and May 2020, using an instrument that included two time points. Time 1 collected retrospective information on the participants' habits (N = 89; 73% male; mean age = 29.01) prior to confinement and Time 2 collected the same information during the confinement. Sociodemographic data were collected, as well as the frequency of substance use, cannabis use patterns, sources of cannabis, perceived availability of drugs and cannabis price, and the Marijuana Motives Measure questionnaire and the Cannabis Withdrawal Scale were used. Results showed a decrease in both cannabis use and consumption due to enhancement and social motives. All reported sources of cannabis experienced a reduction except for the Internet, which experienced a significant increase. There was a positive correlation between withdrawal symptoms and coping motives before and during the lockdown. These findings will allow professionals to better develop both prevention and intervention strategies.

Sex Differences in Comorbidity Between Substance Use and Mental Health in Adolescents: Two Sides of the Same Coin.

BACKGROUND: This study aims to evaluate sex differences in alcohol and cannabis use and mental health disorders (MHD) in adolescents, and to evaluate the predictive role of mental health disorders for alcohol and cannabis use disorders (AUD and CUD respectively). METHOD: A sample of 863 adolescents from the general population (53.7% girls, Mage = 16.62, SD = 0.85) completed a computerized battery including questions on substance use frequency, the Brief Symptom Inventory, the Cannabis Problems Questionnaire for Adolescents - Short version, the Rutgers Alcohol Problem Index and the DSM-IV-TR criteria for AUD and CUD. Bivariate analyses and binary logistic regressions were performed. RESULTS: Girls presented significantly more mental health problems and a higher prevalence of comorbidity between SUD and MHD. Obsessive-compulsive symptoms and phobic anxiety indicated a higher risk of AUD, whereas depression and interaction between hostility and obsessive-compulsive disorder indicated a higher risk of CUD. CONCLUSIONS: Comorbidity between SUD and MHD is high among adolescents, and significantly higher among girls.

The Effect of Prescription Drugs and Alcohol Consumption on Intimate Partner Violence Victim Blaming.

Intimate Partner Violence (IPV) is a public health problem with harsh consequences for women's well-being. Social attitudes towards victims of IPV have a big impact on the perpetuation of this phenomenon. Moreover, specific problems such as the abuse of alcohol and drugs by IPV victims could have an effect on blame attributions towards them. The aim of this study was to evaluate whether the external perception (Study 1) and self-perception (Study 2) of blame were influenced by the victims' use and abuse of alcohol or by the victims' use of psychotropic prescription drugs. Results of the first study (N = 136 participants) showed a significantly higher blame attribution towards female victims with alcohol abuse compared to those without it. No significant differences were found on blame attributed to those with psychotropic prescription drugs abuse and the control group. Results of the second study (N = 195 female victims of interpersonal violence) showed that alcohol consumption is associated with higher self-blame and self-blame cognitions among IPV victims. However, results did not show significant differences on self-blame associated to the victims' use of psychotropic prescription drugs. Our findings indicate that alcohol consumption, but not prescription drugs use, plays a relevant role in the attribution of blame by general population and self-blame by victims of IPV.

Victimization and substance use among adolescents in residential child care.

BACKGROUND: Adolescents in Residential Child Care (RCC) report high levels of victimization. This has been linked to mental health problems and a higher risk of substance use and substance use problems. The present study aimed to evaluate the specific impact of different forms of victimization on alcohol and cannabis use problems among adolescents in RCC, attending to sex differences. METHODS: 321 adolescents from 38 residential therapeutic care facilities in Spain participated in the study. Thirty-six different forms of victimization were evaluated, as well as alcohol and cannabis use problems. Impact of polyvictimization and specific forms of victimization on alcohol and cannabis use problems and disorders were calculated using Analysis of Variance (ANOVA) and logistic regression models. RESULTS: Girls in RCC reported significantly more experiences of victimization. Polyvictimization was associated with alcohol use problems but not cannabis use problems. Property, domestic and community victimization showed the highest predictive role regarding alcohol and cannabis use disorders, with significant interactions with sex and migrant family background. CONCLUSIONS: Adolescents in RCC reported considerably high levels of victimization and alcohol and cannabis use problems. In this population, property victimization, as well as indirect domestic and community victimization were predictors of further substance use problems, with girls being particularly sensitive to victimization. Migrant family backgrounds can also have an influence on the impact of some victimization forms on substance use. Victimization associated to high-risk environments and families could contribute to explain the high levels of substance use problems in this population.

Prevention of recurrent suicidal behavior: Case management and psychoeducation.

BACKGROUND: Development of effective programs for suicide prevention is a global priority. This study evaluated the differential effectiveness of the combination of several strategies to prevent repetition of suicide attempts. METHODS: Participants were patients who entered the Emergency Department after a non-fatal suicide attempt. A total of 163 participants (68.1% females, mean age = 41.39) met the inclusion criteria and were spread across three groups: One group received a passive strategy consisting of preventive information, a second group received the passive strategy combined with an active component of case management (MAC), and a third group received the passive strategy, case management and a psychoeducational programme (PSyMAC). Randomization of participants was not possible. The study included assessments at the beginning, and follow-ups every six months up to 30 months. RESULTS: The study showed no significant differences between groups in the number of re-attempts. Logistic regression showed a positive effect for MAC. CONCLUSIONS: The present study showed that the use of case management could be a promising strategy, but more research is needed.

Substance Use and Gambling Patterns Among Adolescents: Differences According to Gender and Impulsivity.

Although alcohol, tobacco and cannabis are the most prevalent drugs used by adolescents, gambling is a growing concern due to its increasing popularity. To date there have been few studies exploring the existing patterns of concurrent use of drugs and gambling in adolescents. This study aims to identify subpopulations of adolescents using different substances and gambling activities, to explore gender differences and to examine impulsivity as a predictor of class membership. A cross-sectional survey was carried out in 22 high-schools, and 1644 adolescents were assessed (54.1% males; mean age = 15.21 years, SD = .75). Participants reported their last-year frequency of using alcohol, tobacco and cannabis, as well as bingo, poker, other casino games, sports betting, lottery, scratch tickets and electronic gaming machines. Problem drinking was evaluated with the Rutgers Alcohol Problems Index, and gambling severity with the South Oaks Gambling Scale for Adolescents. Impulsivity was assessed using a Delay Discounting task, the Barratt Impulsiveness Scale and the Impulsive Sensation-Seeking Scale. Based on a latent class model of drugs and gambling activities, four subpopulations of males and five of females were found. General impulsivity and sensation seeking were the most consistent predictors of class membership. These novel findings support the need to consider specific groups of adolescents engaging in different patterns of addictive behaviors when implementing selective prevention strategies.

Polydrug use trajectories and differences in impulsivity among adolescents.

Background/Objective: Although alcohol, tobacco and cannabis are the most widely consumed drugs, sparse data exist regarding polydrug use in adolescents and its relationship with impulsivity. This study aims to identify trajectories of polydrug use and analyze differences in impulsivity between them. Method: A total of 1,565 adolescents (54.4% males; mean age = 13.02, SD = 0.57) were annually assessed over three years using the Barratt Impulsiveness Scale, the Zuckerman Impulsive Sensation Seeking Scale, a Stroop Test and a Delay Discounting Task. Frequency of alcohol, tobacco, and cannabis use, intoxication episodes and problem drinking were also assessed. Polydrug trajectories were identified using latent class mixed modelling. To examine differences in self-reported and behavioral impulsivity two mixed multivariate analyses of covariance were used. Results: Three trajectories of substance use were found. The 'Experimental use' and the 'Early use' trajectories presented the lowest and highest impulsivity, respectively. Substance use increases in the 'Telescoped used' trajectory were associated with parallel increases in impulsivity. Conclusions: individuals with divergent patterns of substance use during adolescence differ in their impulsiveness, primarily in general impulsivity and sensation seeking. Present findings suggest the relevance of these facets as possible targets for interventions preventing the onset and escalation of substance use.

Antecedentes/Objetivo: A pesar de que el alcohol, tabaco y cánnabis son las drogas más utilizadas, existen pocos estudios sobre policonsumo y su relación con la impulsividad en adolescentes. Los objetivos de este estudio son identificar trayectorias de policonsumo y analizar diferencias en impulsividad. Método: Se evaluaron anualmente 1.565 adolescentes (54,4% hombres; edad media = 13,02, DT = 0,57) durante tres años usando la Escala de Impulsividad de Barratt, la Escala de Búsqueda de Sensaciones de Zuckerman y las Tareas de Stroop y Descuento por Demora. Se evaluó el uso de alcohol, tabaco, cannabis, uso problemático de alcohol y borracheras. Se usaron modelos mixtos de clases latentes y análisis mixtos multivariados de covarianza. Resultados: Se encontraron tres trayectorias de policonsumo. Las trayectorias de "Uso experimental" y "Uso temprano" presentaron los menores y mayores niveles de impulsividad, respectivamente. Los incrementos en el consumo de la trayectoria de "Escalamiento" se asociaron con incrementos paralelos en la impulsividad. Conclusiones: Las personas con distintos patrones de consumo de sustancias durante la adolescencia difieren en sus niveles de impulsividad, principalmente en impulsividad general y búsqueda de sensaciones. Los resultados sugieren la relevancia de estas facetas como dianas para prevenir el inicio y escalamiento del consumo.

What Predicts What? Self-Reported and Behavioral Impulsivity and High-Risk Patterns of Alcohol Use in Spanish Early Adolescents: A 2-Year Longitudinal Study.

BACKGROUND: The directionality of the relationship between impulsivity and heavy drinking patterns remains unclear. Recent research suggests it could be reciprocal and depends on different facets of impulsivity and different patterns of drinking. The aim of this study was to analyze this potential reciprocal relationship between self-reported and behavioral measures of impulsivity and sensation seeking with specific patterns of heavy drinking in a sample of Spanish adolescents across 2 years. METHODS: The study has a cross-lagged prospective design in which participants were evaluated 3 times over 2 years (once a year). Participants were 1,430 adolescents (53.9% male; mean age at study commencement = 13.02, SD = 0.51) from 22 secondary schools in Spain. Computerized versions of the following instruments were used: 2 subscales of Impulsive Sensation Seeking, 2 behavioral measures (Stroop Test and Delay Discounting [DD] task), frequency of intoxication episodes (IE), and the Rutgers Alcohol Problem Index to evaluate alcohol-related problems (ARP). Random intercepts cross-lagged panel models of reciprocal relationships between impulsivity measures and alcohol use outcomes were used. RESULTS: Individual levels of self-reported impulsivity and sensation seeking significantly predicted prospective involvement in IE and ARP. Performance in behavioral measures (Stroop Test and DD) did not predict subsequent heavy drinking or alcohol problems. No measure of drinking was found to be a significant predictor of prospective changes in impulsivity. CONCLUSIONS: Within-person levels of self-reported impulsivity and sensation seeking significantly predicted further heavy drinking from as early as 13 years old, whereas behavioral measures were not predictive. In our study, neither IE nor ARP predicted prospective changes in impulsivity. Further studies should address additional specific relationships between facets of impulsivity and specific outcomes of heavy drinking.

Trajectories of impulsivity by sex predict substance use and heavy drinking.

Although impulsivity and sensation seeking have been consistently associated with substance use, few studies have analyzed the relationship between changes in these variables and substance use in early adolescents. The aim of this study was to identify trajectories of impulsivity and sensation seeking and explore their relationship with substance use and heavy drinking. A total of 1342 non-user adolescents (53.6% males; mean age = 12.98, SD = 0.50) annually completed the Barratt Impulsiveness Scale, the Zuckerman's Impulsive Sensation Seeking scale and a delay discounting task, over a total period of three years. Past alcohol, tobacco and cannabis use, drunkenness episodes (DE) and problem drinking were also assessed. Impulsivity trajectories were explored using latent class mixed modelling. To study their predictive power binary logistic regressions were used. Two trajectories of impulsivity were found in males and five were found in females. Males with an increasing impulsivity trajectory were more likely to report tobacco [odds ratio (OR) = 1.84] and cannabis (OR = 3.01) use, DE (OR = 2.44) and problem drinking (OR = 3.12). The early increasing trajectory in females predicted tobacco use (OR = 3.71), cannabis use (OR = 5.87) and DE (OR = 3.64). Lack of premeditation and delay discounting were the most relevant facets in high-risk trajectories. Selective intervention and more intense and tailored treatment might help these adolescents to reduce early increases in impulsivity and prevent escalation of substance use.

Long-term reliability and stability of behavioral measures among adolescents: The Delay Discounting and Stroop tasks.

Delay Discounting (DD) and the Stroop test are two fundamental tasks for the assessment of impulsivity and inhibitory control, core features of several behavioral disorders. Although the study of reliability and temporal stability is important, only studies with adults and small samples have been carried out. The aim of this study is to assess the one-year reliability and temporal stability of both tasks among adolescents. A total of 1375 adolescents (M = 13.08 years old, SD = 0.51) made up the final sample (53.5% males). The results showed moderate stability and good reliability for both DD (α = 0.90) and Stroop (α = 0.85). Indices based on the reaction times and not the number of errors are recommended when using the Stroop test. These results support the use of both behavioral tasks in longitudinal research among adolescents.

Income Levels and Response to Contingency Management for Smoking Cessation.

BACKGROUND: Contingency management (CM) has demonstrated its efficacy in treating many drug addictions, including nicotine. However, one of the most commonly perceived limitations with regard to its dissemination into community settings is whether this protocol could be equally effective for treating patients across different income levels. OBJECTIVE: This study aimed to examine whether individuals' income levels affect treatment success in a cognitive behavioral treatment (CBT) that included a voucher-based CM protocol for smoking cessation. METHODS: A total of 92 treatment-seeking smokers in a community setting were randomly assigned to a CBT group (N = 49) or to a CBT plus CM group (N = 43). The CM procedure included a voucher program through which smoking abstinence was reinforced on a schedule of escalating magnitude of reinforcement with a reset contingency. We analyzed the impact of self-reported monthly income, alone and in combination with treatment condition, on short-term (treatment retention) and long-term (self-reported number of days of continuous smoking abstinence at 6-month follow-up) results. RESULTS: Income had no effect on treatment retention and continuous abstinence outcomes at 6-month follow-up in either treatment condition. Treatment modality emerged as the only significant predictor of treatment success. CONCLUSIONS: Our findings suggest that treatment-seeking smokers from the general population respond equally well to CM regardless of their income levels. The results of this randomized controlled trial support the generalizability of this evidenced-based program into community settings.