The association between changes in alternative reinforcers and short-term smoking cessation

Patricia M. Goelz*, Janet E. Audrain-McGovern, Brian Hitsman, Frank T. Leone, Anna Veluz-Wilkins, Christopher Jepson, E. Paul Wileyto, Paul A. D'Avanzo, Jonathan G. Rivera, Robert A. Schnoll

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Background: While more than 50% of smokers make a serious quit attempt each year, less than 10% quit permanently. Evidence from studies of adolescent smoking and other substances of abuse suggest that alternative reinforcers, a construct of Behavioral Economic Theory, may contribute to the likelihood of smoking cessation in adults. This study examined the behavioral economics of smoking cessation within a smoking cessation clinical trial and evaluated how depressive symptoms and behavioral economic variables are associated with smoking cessation. Methods: A sample of 469 smokers, enrolled in an effectiveness trial that provided counseling and 8 weeks of 21. mg nicotine patches, was analyzed. Alternative reinforcers (substitute and complementary reinforcers) and depressive symptoms were examined in relation to 7-day point prevalence abstinence, verified with breath carbon monoxide, 8 weeks after the quit date. Results: Controlling for covariates associated with cessation (nicotine dependence, age of smoking initiation, patch adherence), participants who were abstinent at week 8 showed significantly higher substitute reinforcers at all time-points, compared to those who were smoking (p's. < .05). Participants who were abstinent at week 8 showed lower complementary reinforcers and depressive symptoms at all time-points, compared to those who were smoking, but significant differences were confined to week 8 (p's. < .01). There was no significant interaction between alternative reinforcers and depressive symptoms across the 8 weeks on week 8 abstinence. Conclusions: These results support continued examination of Behavioral Economic Theory in understanding adult smoking cessation in order to inform future treatments and guidelines.

Original languageEnglish (US)
Pages (from-to)67-74
Number of pages8
JournalDrug and Alcohol Dependence
Issue number1
StatePublished - May 1 2014


  • Alternative reinforcers
  • Behavioral economics
  • Depression
  • Smoking cessation

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)


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