Contingency Management, Quitting Smoking, and ADHD
| Status: | Recruiting |
|---|---|
| Conditions: | Smoking Cessation, Smoking Cessation, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - 55 |
| Updated: | 3/1/2019 |
| Start Date: | October 2014 |
| End Date: | October 2019 |
| Contact: | Scott H Kollins, Ph.D. |
| Email: | scott.kollins@duke.edu |
| Phone: | 919.681.0014 |
Smoking/Nicotine Dependence in Attention Deficit Hyperactivity Disorder (ADHD)
The overall goal of the study is to evaluate how motivation and readiness for change are
influenced in the context of a smoking cessation attempt. A total of 60 adult (i.e. age
18-55) smokers (N=40 with ADHD; N=20 without ADHD) who are interested in quitting will be
enrolled into a 3-arm trial allocated as follows. Twenty of the ADHD smokers and the 20
non-ADHD smokers will be assigned to a traditional 8-week contingency management intervention
in which monetary payments will be made contingent upon biologically verified evidence of
smoking abstinence. The 20 additional ADHD smokers will be assigned to a treatment-as-usual
condition (nicotine replacement; supportive counseling). During the treatment phase, subjects
will be required to answer questions 4x/week in their daily lives via an EMA (Ecological
Momentary Assessment).
Specific Aim 1: To assess motivation to quit smoking and readiness for change prior to a quit
attempt in treatment seeking ADHD and non-ADHD smokers. Hypothesis 1a: The investigators
hypothesize that prior to a quit attempt, smokers with ADHD will exhibit significantly lower
levels of intrinsic motivation to quit, and equal or higher levels of extrinsic motivation to
quit compared to smokers without ADHD. Hypothesis 1b: The investigators hypothesize that
smokers with ADHD will exhibit relatively less readiness for change than smokers without
ADHD.
Specific Aim 2: To assess how baseline levels of motivation to quit and readiness for change
are influenced during a quit attempt as a function of both ADHD status and treatment
modality. Hypothesis 2a. The investigators hypothesize that the CM intervention will result
in relatively greater change in extrinsic motivation to quit versus intrinsic motivation to
quit, and that this effect will be more pronounced among ADHD smokers. Hypothesis 2b: The
investigators hypothesize that overall motivation to quit (intrinsic and extrinsic) and
readiness for change will be significantly influenced by the CM intervention versus treatment
as usual among ADHD smokers.
Exploratory Aim 1: To assess the relative efficacy of a CM intervention versus treatment as
usual in smokers with ADHD. The investigators hypothesize that CM will be more effective for
promoting short-term (4-8 weeks) smoking abstinence, as well as for promoting longer-term
(3-6 months) smoking cessation.
Exploratory Aim 2: To assess the associations among smoking withdrawal/craving, affect, ADHD
symptoms, and motivation to quit/readiness for change. The investigators hypothesize that
higher levels of motivation and readiness for change will be associated with lower levels of
self-reported withdrawal, craving, and negative affect.
influenced in the context of a smoking cessation attempt. A total of 60 adult (i.e. age
18-55) smokers (N=40 with ADHD; N=20 without ADHD) who are interested in quitting will be
enrolled into a 3-arm trial allocated as follows. Twenty of the ADHD smokers and the 20
non-ADHD smokers will be assigned to a traditional 8-week contingency management intervention
in which monetary payments will be made contingent upon biologically verified evidence of
smoking abstinence. The 20 additional ADHD smokers will be assigned to a treatment-as-usual
condition (nicotine replacement; supportive counseling). During the treatment phase, subjects
will be required to answer questions 4x/week in their daily lives via an EMA (Ecological
Momentary Assessment).
Specific Aim 1: To assess motivation to quit smoking and readiness for change prior to a quit
attempt in treatment seeking ADHD and non-ADHD smokers. Hypothesis 1a: The investigators
hypothesize that prior to a quit attempt, smokers with ADHD will exhibit significantly lower
levels of intrinsic motivation to quit, and equal or higher levels of extrinsic motivation to
quit compared to smokers without ADHD. Hypothesis 1b: The investigators hypothesize that
smokers with ADHD will exhibit relatively less readiness for change than smokers without
ADHD.
Specific Aim 2: To assess how baseline levels of motivation to quit and readiness for change
are influenced during a quit attempt as a function of both ADHD status and treatment
modality. Hypothesis 2a. The investigators hypothesize that the CM intervention will result
in relatively greater change in extrinsic motivation to quit versus intrinsic motivation to
quit, and that this effect will be more pronounced among ADHD smokers. Hypothesis 2b: The
investigators hypothesize that overall motivation to quit (intrinsic and extrinsic) and
readiness for change will be significantly influenced by the CM intervention versus treatment
as usual among ADHD smokers.
Exploratory Aim 1: To assess the relative efficacy of a CM intervention versus treatment as
usual in smokers with ADHD. The investigators hypothesize that CM will be more effective for
promoting short-term (4-8 weeks) smoking abstinence, as well as for promoting longer-term
(3-6 months) smoking cessation.
Exploratory Aim 2: To assess the associations among smoking withdrawal/craving, affect, ADHD
symptoms, and motivation to quit/readiness for change. The investigators hypothesize that
higher levels of motivation and readiness for change will be associated with lower levels of
self-reported withdrawal, craving, and negative affect.
Individuals with ADHD have altered reinforcement/motivational functioning that are likely
related to risk for smoking and recalcitrance for quitting. The investigators lab has
demonstrated that the abstinence-induced reinforcing effects of cigarette smoking are more
pronounced in ADHD smokers. However, in spite of these increases and demonstrated differences
in withdrawal severity, interventions that provide reinforcement contingent on abstinence
appear to work well for smokers with ADHD. To date, no studies have explicitly investigated
how motivational processes are associated with smoking cessation attempts in ADHD smokers.
The proposed pilot research is therefore highly innovative since it will evaluate how these
processes change and influence outcomes during two different kinds of smoking cessation
interventions. The project will also provide important pilot data on potential differences
between ADHD and non-ADHD smokers in the context of a contingency management (CM) trial,
which will help guide the development of more refined and targeted cessation interventions
for this high risk group of smokers.
related to risk for smoking and recalcitrance for quitting. The investigators lab has
demonstrated that the abstinence-induced reinforcing effects of cigarette smoking are more
pronounced in ADHD smokers. However, in spite of these increases and demonstrated differences
in withdrawal severity, interventions that provide reinforcement contingent on abstinence
appear to work well for smokers with ADHD. To date, no studies have explicitly investigated
how motivational processes are associated with smoking cessation attempts in ADHD smokers.
The proposed pilot research is therefore highly innovative since it will evaluate how these
processes change and influence outcomes during two different kinds of smoking cessation
interventions. The project will also provide important pilot data on potential differences
between ADHD and non-ADHD smokers in the context of a contingency management (CM) trial,
which will help guide the development of more refined and targeted cessation interventions
for this high risk group of smokers.
Inclusion Criteria:
- 18-55 years of age
- Male or female; if female of child-bearing potential, must be using an acceptable form
of contraception
- ADHD Diagnosis:
- For ADHD Groups: confirmed primary diagnosis, any subtype as determined by the
clinician administered CAADID and clinical interview
- For Control Group: NO diagnosis of ADHD as determined by clinician administered CAADID
and clinical interview
- ADHD Symptom Ratings:
- For ADHD Groups: T-Score > 65 on one of the DSM-IV relevant scales (Inattentive
Symptoms, Hyperactive-Impulsive Symptoms, Total Symptoms or ADHD Index) on both the
Self-Report and Observer versions of the CAARS
- For Control Group: T-Score < 60 on all of the DSM-IV relevant scales (Inattentive
Symptoms, Hyperactive-Impulsive Symptoms, Total Symptoms or ADHD Index) on both the
Self-Report and Observer versions of the CAARS
- Self-report smoking at least 10 cigarettes/day
- Provides an afternoon exhaled carbon monoxide reading of at least 10 ppm.
- Cognitive functioning > 80 as assessed by the KBIT-II
Exclusion Criteria:
- History of chronic/significant medical condition
- Use of any psychoactive medication in the past 12 months, other than FDA-approved
medication for the ADHD group only
- Estimated IQ < 80 on Kaufmann Brief Intelligence Test, Second Edition
- Has a primary diagnosis of any other Axis I Disorder (determined by the Structured
Diagnostic Interview for DSM; SCID) that is significantly impairing and would
contraindicate participation in the present study
- Has a primary diagnosis of any Axis II Disorder
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