Nicotine fading, behavioral contracting, and extended treatment: effects on smoking cessation

Two approaches to smoking cessation were evaluated. One approach, the standard condition, utilized a nicotine fading procedure, group support, and an attendance contingent monetary contract. The other approach, the maintenance condition, utilized nicotine fading, group support, and a smoking-contingent monetary contract. The maintenance condition also received two additional post-cessation sessions and additional instructions for cessation. Both conditions significantly improved over the course of the study. The maintenance condition achieved significantly better outcome on the reported average cigarettes per day, cessation rates, and CO levels for the follow-up periods. The maintenance condition also had significantly lower SCN levels at the three month follow-up. The maintenance condition also had significantly lower diastolic and systolic blood pressure at the six month follow-up when compared to the standard condition. However, few other significant health differences emerged when smoking subjects were compared with reduced smoking or nonsmoking subjects for this study. The maintenance condition was shown to be more cost effective than the standard condition. The results were interpreted as indicating the promise of nicotine fading and behavioral contracting procedures. Limitations of the wide-scale application of these methods was noted, however. In particular, group smoking cessation projects reach limited subjects, successful projects still have only moderate success rates, and the wide-spread application of these methods would strain available resources. It is recommended that further research and clinical efforts continue with nicotine fading, behavioral contracting and rapid smoking cessation programs. In addition, efforts at applying behavioral contracting principles without therapeutic support was suggested. Finally, more research on the functional determinants of tobacco smoking was recommended.