The effects of fixed versus escalating reinforcement schedules on smoking abstinence

Abstract

Studies indicate that when abstinence is initiated, escalating reinforcement schedules maintain continuous abstinence longer than fixed reinforcement schedules. However, these studies were conducted for shorter durations than most clinical trials and also resulted in larger reinforcer value for escalating participants during the 1st week of the experiment. We tested whether escalating reinforcement schedules maintained abstinence longer than fixed reinforcement schedules in a 12-week clinical trial. Smokers (146) were randomized to an escalating reinforcement schedule, a fixed reinforcement schedule, or a control condition. Escalating reinforcement participants received $5.00 for their first breath carbon monoxide (CO) sample <3 ppm, with a $0.50 increase for each consecutive sample. Fixed reinforcement participants received $19.75 for each breath CO sample <3 ppm. Control participants received payments only for delivering a breath CO sample. Similar proportions of escalating and fixed reinforcement participants met the breath CO criterion at least once. Escalating reinforcement participants maintained criterion breath CO levels longer than fixed reinforcement and control participants. Similar to previous short-term studies, escalating reinforcement schedules maintained longer durations of abstinence than fixed reinforcement schedules during a clinical trial.

Can an incentive-based intervention increase physical activity and reduce sitting among adults? the ACHIEVE (Active Choices IncEntiVE) feasibility study

“…When sufficient points were accrued (see incentives schedule in Table 1 ), participants were posted incentives at 2 weeks post-baseline, 4 weeks, and then monthly. The incentives schedule was designed to be incremental, consistent with Contingency Management theory, which posits that gradually increasing the value of incentives as behavior change progresses or is maintained will produce more sustained behavior change [ 21 , 22 ]. The level of challenge of the physical activity and reduced sitting goals, and the value of incentives, hence increased over the course of the intervention.…”

Some current dimensions of the behavioral economics of health-related behavior change

“…The results showed a systematic decrease in preference for the smoking option (i.e., less relapse) as a function of increasing duration of abstinence indicating that an initial period of sustained abstinence decreases the relative reinforcing effects of cigarette smoking compared to a common non-drug alternative reinforce (Bradstreet et al, 2014; Lussier et al, 2005; Yoon et al, 2009). Such knowledge has been used in designing treatment interventions to promote longer-term behavior change in such challenging populations as cocaine-dependent outpatients (Higgins et al, 2007) and is part of the general rationale underpinning the widely used escalating schedules of reinforcement with reset contingencies in incentives-based interventions (Roll & Higgins, 2000; Higgins et al, 2007; Romanowich & Lamb, 2015). Of course, despite these instructive studies on how to promote more lasting behavior change following discontinuation of incentive-based interventions, relapse remains a challenge with this treatment approach (e.g., John et al, 2012; Volpp et al, 2008) as it is with other behavior change strategies underscoring the need for continued study and a more complete understanding of how to sustain behavior change (e.g., Leahey et al, this issue).…”

Comparing fixed‐amount and progressive‐amount DRO Schedules for tic suppression in youth with chronic tic disorders

“…Investigations related to the contributions of both subject‐specific factors (e.g., age, delay tolerance) and parameters of the DRO‐P contingency (e.g., the amount‐resetting feature, reinforcer magnitude, DRO interval) may be of particular interest. The interaction between baseline response rate and the effects of DRO‐P schedules is of particular interest, as subjects with high baseline response rates may contact fewer reinforcing elements of the DRO‐P schedule (Romanowich & Lamb, ).…”

“…These “progressive‐amount” schedules have been the subject of several studies within the area of substance use. In general, results have shown that progressive‐amount schedules were more effective than fixed‐amount schedules in engendering sustained abstinence from the target response of cigarette smoking or methamphetamine use (Roll & Higgins, ; Roll, Higgins, & Badger; ; Roll et al, ; Romanowich & Lamb, ). It is important to note that researchers found comparable rates of submitting positive samples for fixed‐amount and progressive‐amount voucher schedules; the two schedules differed mainly in the extent to which they resulted in sustained drug‐free periods.…”