Internet-based group contingency management to promote smoking abstinence
Cigarette smoking is the largest preventable risk factor for morbidity and mortality in developed countries. In addition to the need for novel pharmacotherapies, there is an urgent need for additional and complementary behavioral strategies to reduce smoking prevalence. Increasingly, the Internet and related information technologies are providing unprecedented access to powerful, science-based behavioral interventions. We developed and tested an innovative Internet-based contingency management intervention to promote smoking cessation, where contingencies for change were applied to individual smokers. Although the system generated high rates of initial abstinence in two randomized, controlled studies, some smokers did not quit or relapsed following withdrawal of the voucher-based contingencies. Given these findings, it is necessary to develop a strategy to enhance initial effects and to sustain long-term abstinence. In this project, we will develop and evaluate a potentially powerful addition to our existing treatment model: Internet-based group contingency management. Specifically, contingencies for change will be applied to groups of smokers – instead of individuals – where all smokers in a group must meet specified goals to receive either some or all of their vouchers during an initial treatment period. Group members can offer social support and guidance through a moderated discussion forum. We piloted the method, and a small group of smokers found the discussion forum to be highly valuable and effective. Indeed, a growing literature suggests that social factors may be critical in promoting and maintaining smoking cessation. The group model can be maintained much longer than financial incentives without an increase in treatment costs. We will evaluate maintenance of social support and cessation for three months following a main treatment phase where both financial incentives and group support will be available. A group contingency model would harness two powerful sources of influence over behavior change, financial incentives and social support, and it should lead to an affordable, practical, and sustainable strategy to promote cessation. Overall, the present study will yield a rich dataset on the promise of group contingencies to promote smoking cessation.