The effect of differential reinforcement of incompatible behaviors (DRI) on pica for cigarettes in persons with intellectual disability.

Two adults with intellectual disability kept eating cigarette butts. Staff called it pica. The team used DRI. They picked a behavior that could not happen while the client reached for a butt.

They ran an ABAB reversal. When the new behavior earned tokens, pica dropped. When tokens stopped, pica came back. Bread slices shaped like butts gave the mouth a safe substitute.

DRI plus fake bread butts cut pica almost to zero. The reversal proved the plan worked, not luck. One client also stopped picking up butts when new staff watched him. That showed a hint of generalization.

Gerber et al. (2011) reviewed 25 years of ID studies. They flagged pica as a top problem, but said most papers were weak. King et al. (1990) is one of the few they would count as solid.

Weiss et al. (2001) also used an adult ID reversal design. Outdoor activity beat room time for stereotypy. Both studies show single-case reversals can guide residential care.

Lang et al. (2009) tried a different trick: free stereotypy before play. That cut later stereotypy. R et al. used DRI instead. Both worked, so you have two tools, not one.

You now have a cheap, fast plan for cigarette pica. Pick an incompatible behavior, deliver tokens, and give a safe edible that feels like the real thing. Track with an ABAB probe to prove it works in your setting.