Pharmaceutically-Enhanced Reinforcement for Reduced Alcohol and Smoking

Using a randomized controlled trial (RCT), the goal of this study is to evaluate the ability of evidence based behavioral treatment (contingency management: CM) to significantly decrease alcohol use and cigarette smoking among treatment-seeking smokers with an alcohol use disorder (AUD) who have initiated pharmacotherapy (varenicline; VC) for smoking cessation.

Inclusion Criteria: 1. 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 2. Seeking AUD treatment 3. Seeking smoking cessation treatment 4. Aged 18+ years 5. DSM-5 diagnosis of AUD 6. Currently smoking daily according to PhenX Smoking Status (100 or more lifetime cigarettes plus current daily smoking) 7. Ability to read and speak English 8. Ability to provide written informed consent 9. Breath alcohol of 0.00 during informed consent 10. 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 11. Attended at least 4 of 6 possible visits during the induction period. Exclusion Criteria: 1. 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 2. Currently receiving any pharmacotherapy for alcohol 3. Currently receiving any pharmacotherapy for smoking 4. No suicide attempt in the last 20 years and 5. Any other medical (discernable by initial blood tests) or psychiatric condition that Drs. Layton or Rodin determine would compromise safe participation.