Skip to main content

Advertisement

SpringerLink
Log in

Effects of contingency management and bupropion on cigarette smoking in smokers with schizophrenia

  • Original Investigation
  • Published:
Psychopharmacology Aims and scope Submit manuscript

Abstract

Rationale

Individuals with schizophrenia have high smoking-related morbidity and mortality rates and need powerful and innovative smoking cessation interventions.

Objectives

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.

Methods

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.

Results

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.

Conclusions

The results of this study indicate the efficacy and feasibility of this CM intervention for reducing smoking in individuals with schizophrenia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Addington J, el-Guebaly N, Campbell W, Hodgins DC, Addington D (1998) Smoking cessation treatment for patients with schizophrenia. Am J Psychiatry 155:974–976

    PubMed  CAS  Google Scholar 

  • Biener L, Abrams DB (1991) The Contemplation Ladder: validation of a measure of readiness to consider smoking cessation. Health Psychol 10:360–365

    Article  PubMed  CAS  Google Scholar 

  • Brown S, Kim M, Mitchell C, Inskip H (2010) Twenty-five year mortality of a community cohort with schizophrenia. Br J Psychiatry 196:116–121

    Article  PubMed  Google Scholar 

  • Budney AJ, Higgins ST (1998) Treating cocaine dependence: a community reinforcement plus vouchers approach. National Institute on Drug Abuse, Rockville

    Google Scholar 

  • Carroll KM, Rounsaville BJ (2007) A perfect platform: combining contingency management with medications for drug abuse. Am J Drug Alc Abuse 33:343–365

    Article  Google Scholar 

  • Chou KR, Chen R, Lee JF, Ku CH, Lu RB (2004) The effectiveness of nicotine-patch therapy for smoking cessation in patients with schizophrenia. Int J Nurs Stud 41:321–330

    Article  PubMed  Google Scholar 

  • Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, New Jersey

    Google Scholar 

  • Cox LS, Tiffany ST, Christen AG (2001) Evaluation of the brief questionnaire of smoking urges (QSU-brief) in laboratory and clinical settings. Nicotine Tob Res 3:7–16

    Article  PubMed  CAS  Google Scholar 

  • Dale LC, Glover ED, Sachs DP, Schroeder DR, Offord KP, Croghan IT, Hurt RD (2001) Bupropion for smoking cessation: predictors of successful outcome. Chest 119:1357–1364

    Article  PubMed  CAS  Google Scholar 

  • de Leon J, Diaz FJ (2005) A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr Res 76:135–57

    Article  PubMed  Google Scholar 

  • DeMarce JM, Burden JL, Lash SJ, Stephens RS, Grambow SC (2007) Convergent validity of the Timeline Followback for persons with comorbid psychiatric disorders engaged in residential substance use treatment. Addict Behav 32:1582–1592

    Article  PubMed  Google Scholar 

  • Evins AE, Mays VK, Rigotti NA, Tisdale T, Cather C, Goff DC (2001) A pilot trial of bupropion added to cognitive behavior therapy for smoking cessation in schizophrenia. Nicotine Tob Res 3:397–403

    Article  PubMed  CAS  Google 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 25:218–225

    Article  CAS  Google 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 27:380–386

    Article  PubMed  CAS  Google 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 153–163

    Google Scholar 

  • Finlay JM, Zigmond MJ (1997) The effects of stress on central dopaminergic neurons: possible clinical implications. Neurochem Res 22:1387–1394

    Article  PubMed  CAS  Google 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 NY

  • Gallagher SM, Penn PE, Schindler E, Layne W (2007) A comparison of smoking cessation treatments for persons with schizophrenia and other serious mental illnesses. J Psychoactive Drugs 39:487–497

    PubMed  Google Scholar 

  • George TP, Ziedonis DM, Feingold A, Pepper WT, Satterburg CA, Winkel J, Rounsaville BJ, Kosten TR (2000) Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. Am J Psychiatry 157:1835–1842

    Article  PubMed  CAS  Google Scholar 

  • George TP, Vessicchio JC, Termine A, Bregartner TA, Feingold A, Rounsaville BJ, Kosten TR (2002) A placebo controlled trial of bupropion for smoking cessation in schizophrenia. Biolog Psychiatry 52:53–61

    Article  CAS  Google Scholar 

  • George TP, Vessicchio JC, Sacco KA, Weinberger AH, Dudas MM, Allen TM, Creeden CL, Potenza MN, Feingold A, Jatlow PI (2008) A placebo-controlled trial of bupropion combined with nicotine patch for smoking cessation in schizophrenia. Biol Psychiatry 63:1092–1096

    Article  PubMed  CAS  Google 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 40:77–86

    Google Scholar 

  • Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO (1991) The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict 86:1119–1127

    Article  PubMed  CAS  Google Scholar 

  • Heil SH, Higgins ST, Bernstein IM, Solomon LJ, Rogers RE, Thomas CS, Badger GJ, Lynch ME (2008) Effects of voucher-based incentives on abstinence from cigarette smoking and fetal growth among pregnant women. Addiction 103:1009–1018

    Article  PubMed  Google Scholar 

  • Hennekens CH, Hennekens AR, Hollar D, Casey DE (2005) Schizophrenia and increased risks of cardiovascular disease. Am Heart J 150:1115–1121

    Article  PubMed  Google 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 51:586–576

    Google Scholar 

  • Higgins ST, Heil SH, Solomon LJ, Bernstein IM, Plebani Lussier J, Lynch ME et al (2004) A pilot study on voucher-based incentives to promote abstinence from cigarette smoking during pregnancy and postpartum. Nicotine Tob Res 6:1015–1020

    Article  PubMed  Google Scholar 

  • Higgins ST, Heil SH, Badger GJ, Mongeon JA, Solomon LJ, McHale L, Bernstein IM (2007) Biochemical validation of smoking status in pregnant and recently postpartum women. Exp Clin Psychopharmacol 15:58–66

    Article  PubMed  CAS  Google Scholar 

  • Hughes JR, Carpenter MJ (2006) Does smoking reduction increase future cessation and decrease disease risk? A qualitative review. Nicotine Tob Res 8:739–749

    Article  PubMed  Google Scholar 

  • Hughes JR, Hatsukami DK (1986) Signs and symptoms of tobacco withdrawal. Arch Gen Psychiatry 43:289–294

    PubMed  CAS  Google Scholar 

  • Kalman D, Morissette SB, George TP (2005) Co-morbidity of smoking in patients with psychiatric and substance use disorders. Am J Addict 14:106–123

    Article  PubMed  Google Scholar 

  • Kay SR, Opler LA, Fiszbein A (1987) The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276

    PubMed  CAS  Google Scholar 

  • Kosten T, Oliveto A, Feingold A, Poling J, Sevarino K, McCance-Katz E, Stine S, Gonzalez G, Gonsai K (2003) Desipramine and contingency management for cocaine and opiate dependence in buprenorphine maintained patients. Drug Alcohol Depend 70:315–325

    Article  PubMed  CAS  Google Scholar 

  • Lamb RJ, Morral AR, Galbicka G, Kirby KC, Iguchi MY (2005) Shaping reduced smoking in smokers without cessation plans. Exp Clin Psychopharmacol 13:83–92

    Article  PubMed  CAS  Google Scholar 

  • Lamb RJ, Kirby KC, Morral AR, Galbicka G, Iguchi MY (2010) Shaping smoking cessation in hard-to-treat smokers. J Consult Clin Psychol 78:62–71

    Article  PubMed  CAS  Google 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, MD

  • 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, MD

  • Overall JE, Gorham DR (1962) The brief psychiatric rating scale. Psychol Rep 10:799–812

    Article  Google 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

  • Perkins KA, Lerman C, Stitzer M, Fonte CA, Briski JL, Scott JA, Chengappa KN (2008) Development of procedures for early screening of smoking cessation medications in humans. Clin Pharmacol Ther 84:216–221

    Article  PubMed  CAS  Google Scholar 

  • Perkins KA, Lerman C, Fonte CA, Mercincavage M, Stitzer ML, Chengappa KN, Jain A (2010) Cross-validation of a new procedure for early screening of smoking cessation medications in humans. Clin Pharmacol Ther 88:109–14

    Article  PubMed  CAS  Google Scholar 

  • Poling J, Oliveto A, Petry N, Sofuoglu M, Gonsai K, Gonzalez G, Martell B, Kosten TR (2006) Six-month trial of bupropion with contingency management for cocaine dependence in a methadone-maintained population. Arch Gen Psychiatry 63:219–228

    Article  PubMed  CAS  Google Scholar 

  • Roll JM, Higgins ST, Steingard S, McGinley M (1998) Use of monetary reinforcement to reduce the cigarette smoking of persons with schizophrenia: a feasibility study. Exp Clin Psychopharmacol 6:157–161

    Article  PubMed  CAS  Google Scholar 

  • Saha S, Chant D, McGrath J (2007) A systematic review of mortality in schizophrenia: Is the differential mortality gap worsening over time? Arch Gen Psychiatry 64:1123–1131

    Article  PubMed  Google Scholar 

  • Sobell LC, Sobell MB (1992) Timeline followback: a technique for assessing self-reported alcohol consumption. In: Litten RZ, Allen J (eds) Measuring alcohol consumption: psychosocial and biological methods. Humana, New Jersey, pp 41–72

    Chapter  Google Scholar 

  • SRNT Subcommittee on Biochemical Verification (2002) Biochemical verification of tobacco use and cessation. Nicotine Tob Res 4:149–159

    Article  Google Scholar 

  • Steinberg ML, Ziedonis DM, Krejci JA, Brandon TH (2004) Motivational interviewing with personalized feedback: a brief intervention for motivating smokers with schizophrenia to seek treatment for tobacco dependence. J Consult Clin Psychol 72:723–728

    Article  PubMed  Google Scholar 

  • Stitzer ML, Bigelow GE (1982) Contingent reinforcement for reduced carbon monoxide levels in cigarette smokers. Addict Behav 7:403–412

    Article  PubMed  CAS  Google Scholar 

  • Stitzer ML, Bigelow GE (1984) Contingent reinforcement for carbon monoxide reduction: within-subject effects of pay amount. J Appl Behav Anal 17:477–83

    Article  PubMed  CAS  Google Scholar 

  • Stitzer ML, Bigelow GE (1985) Contingent reinforcement for reduced breath carbon monoxide levels: target-specific effects on cigarette smoking. Addict Behav 10:345–349

    Article  PubMed  CAS  Google Scholar 

  • Tevyaw T, Colby SM, Tidey JW, Kahler C, Rohsenow DJ, Barnett NP, Monti PM (2009) Contingency management and motivational enhancement: a randomized clinical trial for college student smokers. Nicotine Tob Res 11:739–749

    Article  PubMed  Google Scholar 

  • Tidey JW, Rohsenow DJ (2009a) Intention to quit moderates the effects of bupropion on smoking urge. Nicotine Tob Res 11:308–312

    Article  Google Scholar 

  • Tidey JW, Rohsenow DJ (2009b) Smoking expectancies and intention to quit in smokers with schizophrenia, schizoaffective disorder and non-psychiatric controls. Schiz Res 115:310–316

    Article  Google Scholar 

  • Tidey JW, Higgins ST, Bickel WK, Steingard S (1999) Effects of response requirement and the presence of an alternative reinforcer on cigarette smoking by schizophrenics. Psychopharmacol 145:52–60

    Article  CAS  Google Scholar 

  • Tidey JW, O'Neill SC, Higgins ST (2002) Contingent monetary reinforcement of smoking reductions, with and without transdermal nicotine, in outpatients with schizophrenia. Exp Clin Psychopharmacol 10:241–247

    Article  PubMed  Google Scholar 

  • Tidey JW, Rohsenow DJ, Kaplan GB, Swift RM, Adolfo AB (2008) Effects of smoking abstinence, smoking cues and nicotine replacement in smokers with schizophrenia and controls. Nicotine Tob Res 10:1047–56

    Article  PubMed  CAS  Google Scholar 

  • Tverdal A, Bjartveit K (2006) Health consequences of reduced daily cigarette consumption. Tob Control 15:472–480

    Article  PubMed  Google Scholar 

  • 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 86:278–82

    Article  Google 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 10:1691–1715

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This work was funded by NIH grant R01-DA17566 to the first author and a Senior Research Career Scientist Award from the Department of Veterans Affairs to the second author. This study was conducted at the Providence Veterans Affairs Medical Center and the Brown University Center for Alcohol and Addiction Studies, Providence, RI, USA. Portions of these data were presented at annual meetings of the College on Problems of Drug Dependence and the Society for Research on Nicotine and Tobacco. The authors thank Laura Dionne for her assistance with data management, Mihir Parikh, Elizabeth Cathers, and Amy Adolfo Signore for assistance with data collection, and the individuals who participated in this study for their contributions.

Conflicts of interest

The authors have no conflicts of interest to report.

Author information

Authors and Affiliations

  1. Center for Alcohol and Addiction Studies, Brown University, Box S-121-5, Providence, RI, 02912, USA

    Jennifer W. Tidey, Damaris J. Rohsenow, Robert M. Swift & Netesha Reid

  2. Providence VA Medical Center, Providence, RI, USA

    Damaris J. Rohsenow & Robert M. Swift

  3. VA Boston Healthcare System, Boston, MA, USA

    Gary B. Kaplan

Authors
  1. Jennifer W. Tidey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Damaris J. Rohsenow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gary B. Kaplan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robert M. Swift
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Netesha Reid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer W. Tidey.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tidey, J.W., Rohsenow, D.J., Kaplan, G.B. et al. Effects of contingency management and bupropion on cigarette smoking in smokers with schizophrenia. Psychopharmacology 217, 279–287 (2011). https://doi.org/10.1007/s00213-011-2282-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00213-011-2282-8

Keywords

Search

Navigation