Monetary Incentives Improve Cessation in Mentally Ill Smokers

man breaking a cigarette in half
man breaking a cigarette in half
Abstinence-contingent incentives improved smoking cessation outcomes among economically disadvantaged smokers with mental illness.

Abstinence-contingent incentives improved smoking cessation outcomes among 661 economically disadvantaged smokers with mental illness receiving tobacco treatment at community mental health centers, according to a study published in Psychiatric Services in Advance.

Mary F. Brunette, MD, of the Department of Psychiatry, Geisel School of Medicine at Dartmouth, in Hanover, New Hampshire, and colleagues explored the efficacy of 3 different interventions — pharmacotherapy alone, prescriber visit and facilitated quitline (PV+Q), and prescriber visit and telephone cognitive-behavioral therapy — in a population of Medicaid beneficiaries with mental illness. Between 2012 and 2015, adults who wished to quit smoking were randomly assigned to one of the 3 treatment groups with or without abstinence-contingent incentives for 4 weeks after a quit attempt and assessed for biologically verified abstinence at 3, 6, 9, and 12 months.

Participants included 148 smokers with schizophrenia disorders, 150 with bipolar disorder, 158 with major depressive disorder, and 205 with anxiety and other disorders. The study authors did not find a significant effect of any of the 3 interventions for those who did not receive abstinence-contingent incentives. However, those who received monetary incentives were more likely to abstain from smoking, with an adjusted odds ratio of 1.77 (P =0.009). A post hoc comparison demonstrated greater abstinence at 12 months in the PV+Q with incentives group than in the PV+Q without incentives group (14% vs 4%, respectively; adjusted odds ratio =3.94; P =0.014). No significant differences were noted in cessation outcomes among the different diagnostic groups.

Study limitations included the brevity of the abstinence incentives, which were delivered for one month. The authors suggested that a longer duration of incentives might be more effective. Another limitation was that a substantial minority of participants missed research assessments. This population often misses research appointments because of psychiatric instability, disorganization, or lack of transportation. As missed smoking assessments were counted as smoking, the findings of this study are conservative and may underestimate the actual rates of abstinence in this group.

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“This research indicates the promise of combining cotinine- and breath carbon monoxide-based, abstinence-contingent incentives to assist low-income Medicaid beneficiaries with mental illness in quitting smoking,” the study authors concluded.


Brunette MF, Pratt SI, Bartels SJ, et al. Randomized trial of interventions for smoking cessation among Medicaid beneficiaries with mental illness [published online November 15, 2017]. Psychiatr Serv. doi:10.1176/