Reinforcer pathology and response to contingency management for smoking cessation.

Abstract

The recognition of the interplay between cigarette demand and impulsivity as a proxy of reinforcer pathology (RP) has prompted studies that assess these 2 constructs. Scarce research has examined their interrelation within clinical contexts. This secondary analysis sought to identify different types of treatment-seeking smokers based on cigarette demand and delay discounting and examine their differential response to contingency management (CM). The dataset included 305 participants (68% female) receiving either a cognitive-behavioral treatment (CBT) or CBT + CM. A cluster analysis based on the bifactorial structure of a cigarette purchase task (i.e., psychological inertia and persistence) and delay discounting (base-10 logarithmic transformation of the area under the curve) was conducted. Clusters were compared in abstinence rates at posttreatment and 6-month follow-up. Two RP subgroups emerged, Cluster 1 (n = 128) and Cluster 2 (n = 177), which were interpreted as "individuals with excessive tobacco valuation" and "steep discounters," respectively. At 8 weeks, the percentage of abstinent individuals was higher in those in Cluster 2 compared to those in Cluster 1 (76.3% vs. 61%; χ2 = 8.291, p = .004, ϕ = .16). The nonsignificant effect of treatment condition on cessation outcomes indicated that both clusters equally benefited from CBT or CBT + CM. Support was reached for the generalizability of CBT and CM irrespective of patients' RP subtype. The fact that CM did not enhance abstinence outcomes beyond those obtained with CBT alone, underscores the need to evaluate the effect of innovative treatment procedures tailored to these RP phenotypes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).