7.17 Contingency management/incentives

Last updated: October 2016 

Suggested citation: Greenhalgh, EM., Stillman, S., & Ford, C. 7.17 Contingency management/incentives. In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from: http://www.tobaccoinaustralia.org.au/chapter-7-cessation/7-17-financial-incentives

Contingency management is a behavioural intervention that uses incentives or rewards, such as cash payments, vouchers, or material goods, to prompt or reinforce behaviour change. Incentives are often included as part of smoking cessation programs in order to encourage participation in a program, to reward compliance, and/or to reward abstinence at various time points.1 A 2015 Cochrane review concluded that incentives appear to increase cessation rates during the programs. Sustained abstinence was achieved in programs that included substantial cash payments for abstinence, but these may be less feasible to implement. Among pregnant women, incentive programs improved cessation rates, both at end-of-pregnancy and post-partum assessments.1 (For more information on the use of financial incentives among pregnant women, see Section 7.11.5).

The Cochrane review also concluded that deposit–refund trials (whereby participants put some of their own money at risk and recoup it if they are successful in changing their behaviour) can suffer from low participation, but those who do take part may achieve higher quit rates than reward-only participants.1 A randomised control trial among pharmacy employees in the US also explored the efficacy of deposit or ‘commitment’ contracts. Some smokers were offered the chance to win $800 if they could quit for six months, while others were asked to put $150 down as a deposit. It they quit for six months, they would get their $150 back plus $650 — a total of $800. Those who put in their own money had significantly higher rates of abstinence than the pure reward group; however, far fewer smokers were willing to sign up to it. Therefore, rewards for quitting were more effective overall than deposit-based contracts owing to their much higher rate of acceptance.2

Financial incentives may also be useful for promoting quitting among priority populations. One small study in the US found that offering small financial incentives for smoking abstinence appeared to be an effective way to facilitate smoking cessation in homeless people.3 Another found that they can improve abstinence rates among socio-economically disadvantaged individuals participating in smoking cessation treatment.4 Limited evidence also supports contingency management for smoking cessation among people with substance use and psychotic disorders.5 Contingency management also appears to be effective for helping highly impulsive adolescent smokers to quit, and to be more effective than cognitive behavioural therapy.6

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1. Cahill K, Hartmann-Boyce J, and Perera R. Incentives for smoking cessation. Cochrane Database of Systematic Reviews, 2015; 5:CD004307. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25983287

2. Halpern SD, French B, Small DS, Saulsgiver K, Harhay MO, et al. Randomized trial of four financial-incentive programs for smoking cessation. New England Journal of Medicine, 2015; 372(22):2108–17. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25970009

3. Businelle MS, Kendzor DE, Kesh A, Cuate EL, Poonawalla IB, et al. Small financial incentives increase smoking cessation in homeless smokers: A pilot study. Addictive Behaviors, 2014; 39(3):717–20. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24321696

4. Kendzor DE, Businelle MS, Poonawalla IB, Cuate EL, Kesh A, et al. Financial incentives for abstinence among socioeconomically disadvantaged individuals in smoking cessation treatment. American Journal of Public Health, 2015; 105(6):1198–205. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25393172

5. Ledgerwood DM. Contingency management for smoking cessation: Where do we go from here? Current Drug Abuse Reviews, 2008; 1(3):340–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19630730

6. Morean ME, Kong G, Camenga DR, Cavallo DA, Carroll KM, et al. Contingency management improves smoking cessation treatment outcomes among highly impulsive adolescent smokers relative to cognitive behavioral therapy. Addictive Behaviors, 2015; 42:86–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25462659