Saliva Cotinine as a Measure of Smoking Abstinence in Contingency Management – A Feasibility Study

The present study investigated the feasibility of using twice-weekly monitoring of saliva cotinine in a prize-based contingency-management program for smoking cessation. Saliva samples were tested using semi-quantitative NicAlert™ cotinine test strips. Smokers (N = 20) who reported smoking at least five cigarettes per day were randomly assigned to either a contingent or a non-contingent reinforcement group. A five-day baseline phase was followed by a four-day shaping phase during which participants were asked to gradually decrease smoking. During the subsequent three-week abstinence phase, participants submitted breath CO and saliva samples twice per week. For those in the contingent reinforcement group, prize draws could be earned for negative samples or, on the first day of the abstinence phase and after a relapse, for saliva samples one semi-quantitative level below the previous sample. On each visit participants in both groups were given feedback on their saliva cotinine and breath CO levels, and were given instructions for how much to reduce smoking in order to meet the next smoking criteria. Saliva cotinine measures significantly correlated with breath CO measures and aligned with self-reports of smoking. Attendance in both groups decreased after the shaping phase. Cotinine and CO levels decreased in participants, but there were no significant group differences. Although the present study failed to demonstrate a treatment effect for the prize contingency (possibly due to the relatively low net payment), it appeared that using NicAlert™ saliva cotinine test strips was a relatively easy and effective way to monitor smoking throughout a contingency-management program.