Contingency Management for Smoking Cessation Among Veterans With Psychotic Disorders

• Number of treatment sessions attended [ Time Frame: 11 weeks ]
  

• Reduction in cigarettes per day [ Time Frame: 3 and 6 months ]
  
• 7- and 30-day point prevalence abstinence [ Time Frame: 3 and 6 months ]
  
• Continuous abstinence from quit date [ Time Frame: 3 and 6 months ]
  
• Days to relapse from quit date [ Time Frame: Up to 6 months ]
  
• Change in BPRS scores [ Time Frame: 3 and 6 months ]
  
• Change in PHQ-9 scores [ Time Frame: 3 and 6 months ]
  

Schizophrenia and other psychotic disorders are highly prevalent in the VA population and are associated with high rates of smoking. Although smoking cessations approaches that work for non-schizophrenic patients such as behavioral counseling and medications appear to be efficacious for schizophrenic smokers, a major obstacle in providing adequate treatment is poor attendance at treatment sessions. Contingency management has been shown to shape treatment behavior in non-schizophrenic smokers and to shape other behaviors such as cocaine use and exercise in schizophrenics.

The intention of this project is to examine the use of contingent incentives to increase attendance at smoking cessation treatment sessions by smokers with schizophrenia and other psychoses and to compare two different approaches to providing contingent incentives in this context. Subjects in the experimental condition draw from a fishbowl to obtain tokens when they attend a smoking cessation treatment session. The number of draws will be based upon attendance at consecutive sessions. Subjects in the experimental condition receive a set reward that will not change regardless of attendance at consecutive sessions. We hypothesize that the participants in the experimental condition will attend more smoking cessation group therapy sessions than those in the control condition because they will have the possibility, although not the likelihood, to obtain contingent reinforcement of greater value.