Multicomponent assessment and treatment of cigarette pica.

The team worked with four adults who kept eating cigarette butts. This behavior is called pica.

First they ran a competing-stimulus assessment to find edible items the adults liked more than cigarettes. Then they tested two treatments: non-contingent reinforcement (NCR) and differential reinforcement of alternative behavior (DRA).

DRA plus a matched edible beat pica in three of four people. The gains stuck even when staff thinned the reward schedule.

NCR helped two people at first, but pica came back when staff gave food less often. One person needed safety locks and close watch because neither plan worked.

Slocum et al. (2017) extends this result. They taught an autistic teen to throw pica items away and the behavior stayed low even with thin reinforcement. Both studies show DRA outlasts NCR after schedule thinning.

Thomas et al. (2023) also extends the work. Parents added response cost to competing items and kept pica down for a full year at home. The 1999 study did not test parent delivery or long follow-up.

Lord et al. (1986) is a predecessor. They used functional analysis to find that less staff attention plus removing helmets cut pica in adults. The 1999 paper kept the FA idea but swapped to reinforcement-based treatment.

If you treat pica, start with a quick competing-stimulus assessment to find a preferred edible. Use that item in a DRA plan instead of simple NCR. You will spend less time on schedule thinning and lower the risk of relapse. Keep safety tools ready for the one-in-four case where reinforcement alone is not enough.