Mobile Contingency Management for Concurrent Abstinence From Alcohol and Smoking
Mobile Contingency Management for Concurrent Abstinence From Alcohol and Smoking
Alcohol misuse and smoking constitute two of the three leading preventable causes of death in
 the United States. The purpose of this research study is to develop an intervention designed
 to help people stop drinking alcohol and stop smoking at the same time.
Alcohol misuse and smoking constitute two of the three leading preventable causes of death in
 the United States. Reluctance to treat tobacco dependence among those with AUD is misguided
 as recent research suggests smoking cessation treatment can be effective, does not increase
 risk of relapse to alcohol, and may even improve rates of sobriety. There is strong evidence
 for the short-term efficacy for alcohol misuse and smoking of contingency management (CM). It
 is an intensive behavioral therapy that provides incentives (vouchers, money) to individuals
 misusing substances contingent upon objective evidence from drug use. Implementation of CM
 has been limited because of the need to verify abstinence multiple times daily using clinic
 based monitoring. The investigators recently developed a smart-phone application which allows
 a patient to video themselves several times daily while using a small CO monitor and to
 transmit the data to a secure server which has made the use of CM for outpatient smoking
 cessation portable and feasible. This mobile CM (mCM) approach paired with
 cognitive-behavioral counseling and pharmacological smoking cessation aids has been effective
 in reducing smoking.

 Thus, the purpose of this project is to develop a combined alcohol and smoking mCM
 intervention. The intervention will be developed in two successive cohorts of five
 participants, who will provide information on treatment acceptability and feasibility. A
 third cohort of participants (n=45) will participate in a randomized clinical trials to
 further examine feasibility and efficacy. The long term goal is to develop mCM procedures
 that will be used as part of a multi-component intervention to concurrently and effectively
 treat both alcohol misuse and smoking. As part of this project, the investigators will
 develop a multi-component telehealth alcohol and smoking mCM intervention. It will include
 mCM, cognitive-behavioral phone counseling, and standard smoking cessation pharmacotherapy.
 The work proposed in these aims will provide the first step toward implementation of an
 innovative approach that builds upon the power of mHealth technology to reduce the prevalence
 of both alcohol misuse and smoking.
Inclusion Criteria:

 -  currently meet criteria for DSM-5 mild to moderate alcohol use disorder (meeting 2-5
 criteria for AUD)

 -  have been engaging in hazardous drinking over the past month, defined as either
 exceeding a mean of 14 standard drinks/wk for men, 7 drinks/wk for women; or by
 consuming >5 on at least one occasion in the last month for men, >4 drinks on at least
 one occasion in the last month for women

 -  currently smoke >10 cigarettes a day, and have smoked for at least one year

 -  can speak and write fluent conversational English

 -  are willing to make an attempt to quit both alcohol and smoking

 Exclusion Criteria:

 -  are expected to have unstable medication regimen during the study

 -  are currently receiving non-study behavioral treatment for alcohol use disorder or
 smoking

 -  have severe alcohol use disorder (meeting >6 criteria for AUD or having alcohol
 withdrawal symptom criterion)

 -  have AUD that is in early remission, with no symptoms evident over the past month

 -  have experienced myocardial infarction in past 6 months

 -  contraindication to nicotine replacement therapy with no medical clearance to
 participate in the study

 -  use other forms of nicotine such as cigars, pipes, or chewing tobacco

 -  are currently pregnant

 -  have a primary psychotic disorder or current manic episode

 -  have had substance use disorder (other than alcohol or nicotine) in the preceding 3
 months

 -  are currently imprisoned or in psychiatric hospitalization