The association between changes in alternative reinforcers and short-term smoking cessation

Abstract

Background While more than 50% of smokers make a serious quit attempt each year, less than 10% quit permanently. Evidence from studies of adolescent smoking and other substances of abuse suggest that alternative reinforcers, a construct of Behavioral Economic Theory, may contribute to the likelihood of smoking cessation in adults. This study examined the behavioral economics of smoking cessation within a smoking cessation clinical trial and evaluated how depressive symptoms and behavioral economic variables are associated with smoking cessation. Methods A sample of 469 smokers, enrolled in an effectiveness trial that provided counseling and 8 weeks of 21mg nicotine patches, was analyzed. Alternative reinforcers (substitute and complementary reinforcers) and depressive symptoms were examined in relation to 7-day point prevalence abstinence, verified with breath carbon monoxide, 8 weeks after the quit date. Results Controlling for covariates associated with cessation (nicotine dependence, age of smoking initiation, patch adherence), participants who were abstinent at week 8 showed significantly higher substitute reinforcers at all time-points, compared to those who were smoking (p’s < .05). Participants who were abstinent at week 8 showed lower complementary reinforcers and depressive symptoms at all time-points, compared to those who were smoking, but significant differences were confined to week 8 (p’s < .01). There was no significant interaction between alternative reinforcers and depressive symptoms across the eight weeks on week 8 abstinence. Conclusions These results support continued examination of Behavioral Economic Theory in understanding adult smoking cessation in order to inform future treatments and guidelines.

Longitudinal changes in smoking abstinence symptoms and alternative reinforcers predict long-term smoking cessation outcomes

“…This finding is inconsistent with previous analyses of this sample which showed that depressive symptoms were related to cessation outcome 8 weeks of treatment (Goelz et al, 2014). Perhaps depressive symptoms play a more prominent role during the initial weeks of a quit attempt, but are less predictive of long-term cessation outcomes.…”

“…Our earlier study showed that a reduction in complementary reinforcers and an increase in substitute reinforcers predicted short-term (8-week) abstinence (Goelz et al, 2014). Here, we extend that initial finding by showing that substitute environmental reinforcers are associated with long-term abstinence as well and provide support for the continuing investigation of constructs central to behavioral economics as predictors of smoking cessation outcomes.…”

“…For the current study, only participants randomized to 8 weeks of treatment were included in order to standardize nicotine patch treatment duration and to follow up on our prior study of predictors of short-term cessation (Goelz et al, 2014). To be eligible for the clinical trial, participants had to be 18 years of age or older, report smoking 10 cigarettes per day or more, and indicate an interest in quitting smoking.…”

“…Rooted in Behavioral Economic Theory (Green and Freed, 1993), increased engagement in substitute reinforcers, which are healthier alternative activities to smoking (e.g., physical activity), and decreased engagement in complementary reinforcers, which are activities that increase the reinforcing value of smoking (e.g., consuming alcohol), have been associated with greater probability of successful cessation. Results from a small lab study (Stoops et al, 2011) and a clinical trial of short-term abstinence (Goelz et al, 2014) indicate the need to examine the predictive significance of alternative reinforcers on long-term abstinence. Such analyses could help support the development and evaluation of novel behavioral interventions based on Behavioral Economic Theory to promote tobacco cessation.…”

A behavioral economic perspective on smoking persistence in serious mental illness

“…Providing smokers with personalized risk profiles, such as their lung age or heart age (Morris & Temple, 1985; Davies et al, 2013), and training them to imagine positive future events (e.g., Daniel et al, 2013) may help motivate smokers with SMI to seek treatment by increasing the immediacy and salience of the health costs of smoking and the benefits of abstinence. Helping them to identify and engage in substitute reinforcing activities may reduce the likelihood of relapse during cessation treatment by increasing the opportunity cost of smoking (Goelz et al, 2014). …”