Rationale Reinforcer pathology (RP) is a theoretical model based on two processes: delay discounting (DD) and drug demand. Given that RP has been shown to have a predictive value on smoking behaviors, several studies have explored which interventions can reduce RP. Consistent with the RP framework, episodic future thinking (EFT) has shown effects on treatment outcomes and RP processes. The vast majority of studies that assess the effects of EFT on RP consist of experimental studies, and no previous research has tested these effects in a clinical sample of smokers. Objectives The primary aim of this study was to assess the effects of EFT on RP throughout the course of a smoking cessation intervention in smokers with substance use disorders (SUDs). Methods Participants were randomized to cognitive behavior therapy (CBT) + EFT (n = 39) or CBT + EFT + contingency management (n = 33). Cotinine, frequency of EFT practices, cigarette purchase task (CPT), and DD were evaluated in treatment sessions. Mixed-effects model repeated measures analysis was used to explore DD and CPT in-treatment changes as a function of EFT practices and cotinine levels. Results Greater practice of the EFT component significantly reduced cigarette demand (p < .020) as well as DD (p = .003). Additionally, a greater reduction in cotinine levels coupled with greater EFT practice led to a greater decrease in cigarette demand (p < .014). Conclusions EFT reduced the two facets of RP in treatment-seeking smokers with SUDs.

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Background: The recognition of the interplay between cigarette demand and impulsivity as a proxy of reinforcer pathology (RP) has prompted studies that assess these 2 constructs. Scarce research has examined their interrelation within clinical contexts. This secondary analysis sought to identify different types of treatment-seeking smokers based on cigarette demand and delay discounting and examine their differential response to contingency management (CM). Method: The dataset included 305 participants (68% female) receiving either a cognitive-behavioral treatment (CBT) or CBT ϩ CM. A cluster analysis based on the bifactorial structure of a cigarette purchase task (i.e., psychological inertia and persistence) and delay discounting (base-10 logarithmic transformation of the area under the curve) was conducted. Clusters were compared in abstinence rates at posttreatment and 6-month follow-up. Results: Two RP subgroups emerged, Cluster 1 (n ϭ 128) and Cluster 2 (n ϭ 177), which were interpreted as "individuals with excessive tobacco valuation" and "steep discounters," respectively. At 8 weeks, the percentage of abstinent individuals was higher in those in Cluster 2 compared to those in Cluster 1 (76.3% vs. 61%; 2 ϭ 8.291, p ϭ .004, ϭ .16). The nonsignificant effect of treatment condition on cessation outcomes indicated that both clusters equally benefited from CBT or CBT ϩ CM. Conclusions: Support was reached for the generalizability of CBT and CM irrespective of patients' RP subtype. The fact that CM did not enhance abstinence outcomes beyond those obtained with CBT alone, underscores the need to evaluate the effect of innovative treatment procedures tailored to these RP phenotypes.

Objective: The purpose of this secondary analysis is to analyze whether both of the processes of the reinforcer pathology model (delay discounting and demand) are predictors of relapse up to 12-month follow-up in a sample of abstinent smokers who received a smoking cessation treatment. Method: Participants were 202 abstinent smokers who completed the delay discounting task and the cigarette purchase task. In order to analyze the smoking relapse predictors and the impact of time to relapse, Kaplan–Meier curves, log-rank test, and Cox regression analysis were carried out. Results: Fewer years of regular smoking (HR = .79, p = .014), as well as higher delay discounting (HR AUClogd = .80, p = .019) and intensity of demand (HR = 1.26, p = .019) were associated with a higher likelihood of smoking relapse. These variables were associated with a faster relapse. Conclusions: High delay discounting and intensity of demand were associated with a higher risk of relapse after quitting smoking. These findings highlight the importance of adapting treatment strategies for these two variables (delay discounting and cigarette demand), which might confer protective risk against smoking relapse.

Objective: We conducted a systematic review and meta-analysis (ID: CRD42019122315) to assess the evidence for the effectiveness of contingency management (CM) to promote smoking abstinence among individuals with substance use disorder or in recovery. Method: Databases were PubMed, PsycINFO, Cochrane, and EBSCO. The primary eligibility criteria for inclusion in our meta-analysis were as follows: any study examining the efficacy of CM for smoking cessation that reported smoking abstinence and/or cigarette reductions. The methodological quality of the included studies was assessed using the Effective Public Health Practice Project Quality assessment tool. Publication bias was examined using Egger's regression intercept, the Begg-Mazumdar test, and Tweedie's trim-and-fill approach. Results: A total of 22 articles were included, and 13 were included in three meta-analyses: abstinence at posttreatment (12 studies), abstinence at follow-up (8 studies), and reduction outcomes at posttreatment (6 studies). CM was superior to comparison arms in smoking abstinence (RR ϭ 2.555; 95% CI [1.730, 3.775]; p Ͻ .001) and reduction (SMD ϭ .601; 95% CI [0.372, 0.831]; p Ͻ .001) at end-of-treatment. At long-term follow-ups, CM did not show enhanced effects over abstinence beyond those shown in comparison arms (RR ϭ 1.029; 95% CI [0.577, 1.836]; p ϭ .922). Smoking-cessation treatment (all treatments included CM) and smoking abstinence increased the likelihood of abstinence from alcohol and/or illicit drugs. All studies were rated as being of strong or moderate quality, and no marked presence of publication bias was found. Conclusions: CM for smoking cessation in individuals with substance use disorders performs significantly better than control conditions in reducing smoking at end-of-treatment. What is the public health significance of this article?This study informs on the efficacy of contingency management for facilitating short-term smoking abstinence and cigarette reductions in substance users. Delivering contingency management solely or as an adjunctive smoking cessation intervention is advisable for a significant impact on public health.

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