Mobile Contingency Management for Marijuana and Tobacco Cessation

Cannabis is the most widely used illicit drug in the United States with 19.8 million current users. Population based data indicate that almost all cannabis users (90%) have a lifetime history of tobacco smoking and the majority (74%) currently smoke tobacco. While cannabis use alone is associated with significant adverse health effects, tobacco smoking is the number one preventable cause of illness and death in the U.S. This is true even among those using illicit drugs where the tobacco -related mortality rate is twice that of the general population. Among cannabis users, smoking tobacco is associated with increased frequency of marijuana use, increased morbidity, and poorer cannabis cessation outcomes. There is strong evidence for the short -term efficacy for cannabis use disorder (CUD) 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 and effects are short lived. 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. The mobile CM (mCM) approach paired with cognitive-behavioral counseling and pharmacological smoking cessation aids has been effective in reducing smoking in the short and long-term. The purpose of this pilot project is to pilot-test a combined cannabis and smoking mCM intervention. The pilot will allow the investigators to examine feasibility of the treatment and of planned recruitment strategies. These project 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 CUD and cigarette smoking.

Inclusion criteria

• report 40 or more days of cannabis use in the past 90 day;
• have smoked at least seven cigarettes in the past seven days;
• have been smoking for at least the past year;
• can speak and write fluent conversational English;
• are between 18 and 70 years of age; and
• are willing to make an attempt to quit both cannabis and tobacco smoking.

Exclusion criteria

• expected to have unstable medication regimen during the study;
• currently receiving non-study behavioral treatment for cannabis use disorder or smoking;
• myocardial infarction in past six months;
• contraindication to NRT with no medical clearance;
• use of other forms of nicotine such as cigars, pipes, or chewing tobacco with unwillingness to stop use of these forms;
• current pregnancy;
• primary psychotic disorder or current manic episode;
• substance use disorder (other than cannabis or nicotine) within the preceding three months; or
• current imprisonment or psychiatric hospitalization.