Technological Innovations in a Behavioral Treatment for Cigarette Smoking
Cigarette smoking is the largest preventable risk factor for morbidity and mortality in developed countries. Although the United States Public Health Service endorses various pharmacotherapies and counseling for smoking cessation, the majority of patients relapse within six months, even when both treatments are used together. The limitations of current interventions highlight the urgent need for innovative, powerful, and community-friendly treatments. Abstinence reinforcement therapy is one such treatment. We developed and tested an internet-based monitoring system to verify and reinforce smoking abstinence by breath carbon monoxide (CO) output. By using this simple yet innovative method, we found that patients were highly engaged with the treatment, and that voucher reinforcement produced high rates of sustained abstinence in a group of heavy smokers (over 65% of the 400 CO samples were negative during treatment).
In the current project, we are evaluating a broadly applicable, sustainable, and clinically feasible abstinence reinforcement intervention. The treatment delivery model integrates the reach and convenience of the internet with a state-of-the-art, empirically-derived behavioral treatment for cigarette smoking. Smokers are being randomly assigned to an abstinence reinforcement group or to a control group, and smoking status is measured during treatment and at a 6-month follow-up. We are able to sustain treatment on an uninterrupted basis during the initial weeks of a quit attempt, which growing evidence suggests is a critical period to promote long-term cessation. To complement our individualized user-friendly CO measurement technology and make the treatment even more personally salient to participants, we have incorporated a deposit contract procedure. Participants contribute a specified amount of money that they can recoup based on evidence of abstinence. This method holds promise as a way to substantially offset the costs associated with treatment. Finally, we are employing a remote treatment delivery model such that distance is no longer a barrier to treatment. The treatment can be disseminated to any qualified smoker in the United States. The project is innovative and directly addresses some of the major limitations (cost, sustainability, access) inherent in traditional abstinence reinforcement delivery models, and it has the potential to be appealing and feasible for widespread dissemination. If the promise of the intervention is realized, it will reduce the high rates of morbidity and mortality associated with smoking.