Pharmaceutically-Enhanced Reinforcement for Reduced Alcohol and Smoking

This randomized, placebo-controlled trial to determine the effectiveness of contingency management for reducing alcohol use and cigarette smoking among adults who want to quit or reduce their co-addiction. Contingency management is a powerful and cost-effective technique that has been used successfully for decades to promote abstinence from benzodiazepines, cocaine, tobacco, etc. Contingency management, and a non-contingent control condition will be used combined with varenicline (VC) and manualized counseling in the form of module videos.

Inclusion criteria

• 4 or more standard drinks on the same occasion for women (5 or more standard drinks on the same occasion for men) on at least 4 occasions in the prior 30 days
• Seeking AUD treatment
• Seeking smoking cessation treatment
• Aged 18+ years
• DSM-5 diagnosis of AUD
• Currently smoking daily according to PhenX Smoking Status (100 or more lifetime cigarettes plus current daily smoking)
• Ability to read and speak English
• Ability to provide written informed consent
• Breath alcohol of 0.00 during informed consent
• Provision of at least 1 EtG-positive urine test at any time during the induction period and at least one COT-positive urine test at any time during the induction period; and
• Attended at least 4 of 6 possible visits during the induction period.

Exclusion criteria

• Significant risk of dangerous alcohol withdrawal, defined as a history of alcohol detoxification or seizure in the last 12 months and expression of concern by the participant about dangerous withdrawal
• Currently receiving any pharmacotherapy for alcohol
• Currently receiving any pharmacotherapy for smoking
• No suicide attempt in the last 20 years and
• Any other medical (discernable by initial blood tests) or psychiatric condition that Drs. Layton or Rodin determine would compromise safe participation.