BACKGROUND: Treatments for drug addiction and smoking in severely mentally ill (SMI) adults are needed. OBJECTIVES: To investigate the effect of a contingency management (CM) intervention targeting psycho-stimulant on cigarette smoking. METHODS: 126 stimulant dependent SMI smokers were assigned to CM or a non-contingent control condition. Rates of smoking-negative (<3 ppm) carbon monoxide breath-samples were compared. RESULTS: Individuals who received CM targeting psycho-stimulants were 79% more likely to submit a smoking-negative breath-sample relative to controls. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: This study provides initial evidence that a behavioral treatment for drug use results in reductions in cigarette smoking in SMI adults.