Sandra J Japuntich1, Lewina O Lee2, Suzanne L Pineles3, Kristin Gregor2, Celina M Joos4, Samantha C Patton4, Suchitra Krishnan-Sarin5, Ann M Rasmusson3. 1. Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Coro West, Suite 309, 164 Summit Ave., Providence, RI 02906, United States; Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, United States; VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA 02130, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States. Electronic address: sandra.japuntich@lifespan.org. 2. VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA 02130, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States. 3. VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA 02130, United States; Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States; National Center for PTSD, Women's Health Sciences Division, Department of Veterans Affairs, United States. 4. VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA 02130, United States; National Center for PTSD, Women's Health Sciences Division, Department of Veterans Affairs, United States. 5. Department of Psychiatry, Yale University School of Medicine, Boston, MA, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06519, United States.
Abstract
INTRODUCTION: Trauma-exposed individuals with and without posttraumatic stress disorder (PTSD) are more likely to smoke and less successful in quit attempts than individuals without psychopathology. Contingency management (CM) techniques (i.e., incentives for abstinence) have demonstrable efficacy for smoking cessation in some populations with psychopathology, but have not been well tested in PTSD. This pilot study examined the feasibility of CM plus brief cognitive behavioral therapy (CBT) in promoting smoking cessation among trauma-exposed individuals with and without PTSD. METHODS: Fifty trauma-exposed smokers (18 with PTSD) were asked to abstain from tobacco and nicotine replacement therapy for one month. During week one of cessation, CBT was provided daily and increasing CM stipends were paid for each continuous day of biochemically-verified abstinence; CM stipends were withheld in response to smoking lapses and reset to the initial payment level upon abstinence resumption. CBT and fixed payments for study visits were provided during the subsequent three weeks. RESULTS: Of the 50 eligible participants who attended at least one pre-quit visit (49% female, 35% current PTSD), 43 (86%) attended the first post-quit study visit, 32 (64%) completed the first week of CM/CBT treatment, and 26 (52%) completed the study. Post-quit seven-day point prevalence abstinence rates for participants with and without PTSD, respectively, were similar: 39% vs. 38% (1 week), 33% vs. 28% (2 weeks), 22% vs. 19% (3 weeks), and 22% vs. 13% (4 weeks). CONCLUSIONS: Use of CM + CBT to support tobacco abstinence is a promising intervention for trauma-exposed smokers with and without PTSD.
INTRODUCTION:Trauma-exposed individuals with and without posttraumatic stress disorder (PTSD) are more likely to smoke and less successful in quit attempts than individuals without psychopathology. Contingency management (CM) techniques (i.e., incentives for abstinence) have demonstrable efficacy for smoking cessation in some populations with psychopathology, but have not been well tested in PTSD. This pilot study examined the feasibility of CM plus brief cognitive behavioral therapy (CBT) in promoting smoking cessation among trauma-exposed individuals with and without PTSD. METHODS: Fifty trauma-exposed smokers (18 with PTSD) were asked to abstain from tobacco and nicotine replacement therapy for one month. During week one of cessation, CBT was provided daily and increasing CM stipends were paid for each continuous day of biochemically-verified abstinence; CM stipends were withheld in response to smoking lapses and reset to the initial payment level upon abstinence resumption. CBT and fixed payments for study visits were provided during the subsequent three weeks. RESULTS: Of the 50 eligible participants who attended at least one pre-quit visit (49% female, 35% current PTSD), 43 (86%) attended the first post-quit study visit, 32 (64%) completed the first week of CM/CBT treatment, and 26 (52%) completed the study. Post-quit seven-day point prevalence abstinence rates for participants with and without PTSD, respectively, were similar: 39% vs. 38% (1 week), 33% vs. 28% (2 weeks), 22% vs. 19% (3 weeks), and 22% vs. 13% (4 weeks). CONCLUSIONS: Use of CM + CBT to support tobacco abstinence is a promising intervention for trauma-exposed smokers with and without PTSD.