Effects of contingency management and bupropion on cigarette smoking in smokers with schizophrenia
Individuals with schizophrenia have high smoking-related morbidity and mortality rates and need powerful and innovative smoking cessation interventions.
This proof-of-concept study investigated the feasibility and initial efficacy of combining a contingency management intervention with bupropion to reduce smoking in people with schizophrenia.
Using a double-blind, placebo-controlled, between-groups design, 57 non-treatment-seeking participants were randomized to receive 300 mg/day bupropion or placebo. One week later, participants were randomized to a contingency management (CM) intervention in which reductions in urinary cotinine levels were reinforced, or a non-contingent reinforcement (NR) condition in which session attendance was reinforced, regardless of cotinine level. Over the 22-day study period, participants visited the laboratory approximately three times per week to provide urine samples for analysis of cotinine levels, to give breath samples for analysis of carbon monoxide (CO) levels, and to report number of cigarettes smoked per day, nicotine withdrawal symptoms, cigarette craving, and psychiatric symptoms.
Cotinine and CO levels significantly decreased during the study period in participants randomized to the CM condition, but not the NR condition. Bupropion did not reduce cotinine levels or increase the efficacy of CM. Cigarette craving and psychiatric symptom levels significantly decreased during the study in all groups.
The results of this study indicate the efficacy and feasibility of this CM intervention for reducing smoking in individuals with schizophrenia.
KeywordsTobacco dependence Nicotine Psychiatric comorbidity Dual diagnosis Smoking cessation Incentives Craving
- Budney AJ, Higgins ST (1998) Treating cocaine dependence: a community reinforcement plus vouchers approach. National Institute on Drug Abuse, RockvilleGoogle Scholar
- Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, New JerseyGoogle Scholar
- Evins AE, Cather C, Deckersbach T, Freudenreich O, Culhane MA, Olm-Shipman CM, Henderson DC, Schoenfeld DA, Goff DC, Rigotti NA (2005) A double-blind placebo-controlled trial of bupropion sustained-release for smoking cessation in schizophrenia. J Clin Psychpharmacol 25:218–225CrossRefGoogle Scholar
- Evins AE, Cather C, Culhane MA, Birnbaum A, Horowitz J, Hsieh E, Freudenreich O, Henderson DC, Schoenfeld DA, Rigotti NA, Goff DC (2007) A 12-week double-blind, placebo-controlled study of bupropion-SR added to high-dose dual nicotine replacement therapy for smoking cessation or reduction in schizophrenia. J Clin Psychopharmacol 27:380–386PubMedCrossRefGoogle Scholar
- Fahn S, Elton RL, UPDRS Development Committee (1987) Unified Parkinson's Disease Rating Scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M (eds) Recent developments in Parkinson's disease. Florham Park, Macmillan, pp 153–163Google Scholar
- First MB, Spitzer RL, Gibbon M, Williams JBW (1994) Structured clinical interview for DSM-IV Axis-I Disorders. Biometrics Research Dept., NY State Psychiatric Inst., NY NYGoogle Scholar
- GlaxoSmithKline (2010) Prescribing Information (Zyban—bupropion hydrochloride extended-release tablets). http://us.gsk.com/products/assets/us_zyban.pdf
- Gray KM, Carpenter MJ, Baker NL, Hartwell KJ, Lewis AL, Hiott DW, Desas D, Upadhyaya HP (2011) Bupropion SR and contingency management for adolescent smoking cessation. J Sub Ab Res 40:77–86Google Scholar
- Higgins ST, Budney AJ, Bickel WK, Foerg FE, Donham R, Badger GJ (1994) Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Arch Gen Psychiatry 51:586–576Google Scholar
- National Institute of Mental Health (NIMH) (1976) Abnormal involuntary movement scale (AIMS). In: ECDEU Assessment Manual for Psychopharmacology, Rev. 1976. NIMH, Psychopharmacology Research Branch, Division of Basic Brain and Behavioral Sciences, Rockville, MDGoogle Scholar
- Nino-Gomez J, Carlini S, Nemani K, Cather C, Pratt S, Evins AE (2010) Safety and efficacy of varenicline in schizophrenia: Preliminary data from 12-week trial. Presented at the annual meeting of the Society for Research on Nicotine and Tobacco, Baltimore, MDGoogle Scholar
- Parks J, Svendsen D, Singer P, Foti M, Mauer B (2006) Morbidity and mortality in people with serious mental illness. National Association of State Mental Health Program Directors, www.nasmhpd.org
- Weinberger AH, Reutenauer EL, Allen TM, Termine A, Vessicchio JC, Sacco KA, Easton CJ, McKee SA, George TP (2006) Reliability of the Fagerstrom Test for Nicotine Dependence, Minnesota Nicotine Withdrawal Scale, and Tiffany Questionnaire for Smoking Urges in smokers with and without schizophrenia. Drug Alc Depend 86:278–82CrossRefGoogle Scholar
- Williams JM, Steinberg ML, Zimmerman MH, Gandhi KK, Stipelman B, Budsock PD, Ziedonis DM (2010) Comparison of two intensities of tobacco dependence counseling in schizophrenia and schizoaffectivve disorder. J Subst Abuse Treat 38:384–393.Google Scholar
- Ziedonis D, Hitsman B, Beckham JC, Zvolensky M, Adler LE, Audrain-McGovern J, Breslau N, Brown RA, George TP, Williams J, Calhoun PS, Riley WT (2008) Tobacco use and cessation in psychiatric disorders: National Institute of Mental Health report. Nicotine Tob Res 10:1691–1715PubMedCrossRefGoogle Scholar