Intolerance for withdrawal discomfort and motivation predict voucher-based smoking treatment outcomes for smokers with substance use disorders

Abstract

Identifying predictors of abstinence with voucher-based treatment is important for improving its efficacy. Smokers with substance use disorders have very low smoking cessation rates so identifying predictors of smoking treatment response is particularly important for these difficult-to-treat smokers. Intolerance for Smoking Abstinence Discomfort (IDQ-S), motivation to quit smoking, nicotine dependence severity (FTND), and cigarettes per day were examined as predictors of smoking abstinence during and after voucher-based smoking treatment with motivational counseling. We also investigated the relationship between IDQ-S and motivation to quit smoking. Smokers in residential substance treatment (n = 184) were provided 14 days of vouchers for complete smoking abstinence (CV) after a 5-day smoking reduction lead-in period or vouchers not contingent on abstinence. Carbon monoxide readings indicated about 25% of days abstinent during the 14 days of vouchers for abstinence in the CV group; only 3–4% of all participants were abstinent at follow-ups. The IDQ-S Withdrawal Intolerance scale and FTND each significantly predicted fewer abstinent days during voucher treatment; FTND was non-significant when controlling for variance shared with Withdrawal Intolerance. The one significant predictor of 1-month abstinence was pretreatment motivation to quit smoking, becoming marginal (p < .06) when controlling for FTND. Lower Withdrawal Intolerance significantly predicted 3 month abstinence when controlling for FTND. Higher Withdrawal Intolerance pretreatment correlated with less motivation to quit smoking. Implications for voucher-based treatment include the importance of focusing on reducing these expectancies of anticipated smoking withdrawal discomfort, increasing tolerance for abstinence discomfort, and increasing motivation.

Gender differences in self-reported withdrawal symptoms and reducing or quitting smoking three years later: A prospective, longitudinal examination of U.S. adults

“…While many behavioral and pharmacological treatments (Fiore et al, 2008) focus on reducing withdrawal symptoms, there may be benefits to working with both male and female treatment-seeking smokers on reducing distress related to withdrawal symptoms. Distress tolerance has been associated with smoking lapse (Brown et al, 2005, 2009; Rohsenow et al, 2015) and decreasing distress tolerance, especially tolerance specifically related to withdrawal symptoms, may be a useful aim to incorporate into treatment in order to improve quit attempt outcomes (Brown et al, 2013). Prophylactic emphasis on avoiding the use of cigarettes to cope with withdrawal symptoms may also help to improve quit outcomes.…”

Contingent Vouchers and Motivational Interviewing for Cigarette Smokers in Residential Substance Abuse Treatment

“…Furthermore, given that higher levels of withdrawal discomfort reported by smokers with SUD predict less smoking abstinence during and after CV (Rohsenow, Tidey, Kahler, Martin, Colby, & Sirota, 2015), combining CV treatments with pharmacotherapies that reduce craving or withdrawal discomfort may boost the effectiveness of CV, as has been shown in smokers with serious mental illness (Tidey, Rohsenow, Kaplan, Swift, & Reid, 2011). …”

Treating smokers in substance treatment with contingent vouchers, nicotine replacement and brief advice adapted for sobriety settings

“…For example, varenicline has shown to result in significantly higher rates of abstinence in smokers with SUD 3 and 6 months after starting it (Rohsenow et al, under review), suggesting that CV plus varenicline might be an effective way to increase both initial abstinence and maintenance of abstinence in smokers with SUD, particularly since varenicline reduces relapse rate in smokers attaining initial abstinence (Evins et al, 2014;Tonstad et al, 2006). Since higher levels of withdrawal discomfort predict less smoking abstinence during and after CV for smokers with SUD (Rohsenow, Tidey, Kahler, Martin, Colby, & Sirota, 2015), combining voucher-based smoking treatments with other pharmacotherapies that reduce craving or withdrawal are likely to increase withintreatment abstinence during CV, as the present results suggest. Rohsenow et al Page 11 J Subst Abuse Treat.…”

“…Smokers in SUD treatment indicated that tobacco abstinence effects are major barriers to attempting smoking cessation (Asher, Martin, Rohsenow, MacKinnon, Traficante, and Monti, 2003;Martin, Cassidy, Murphy, & Rohsenow, in press). Expecting to be unable to tolerate the discomforts of tobacco abstinence predicts less tobacco abstinence for smokers with SUD 3 months later (Rohsenow, Tidey, Kahler, et al, 2015). Therefore, medication to reduce the discomfort of abstinence plus additional incentives to undergo smoking abstinence may be needed for these smokers to even attempt to quit smoking.…”