Intensive Intervention for Smokers - 6
| Status: | Completed |
|---|---|
| Conditions: | Smoking Cessation, Psychiatric, Tobacco Consumers |
| Therapuetic Areas: | Psychiatry / Psychology, Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - 75 |
| Updated: | 11/3/2017 |
| Start Date: | July 2006 |
| End Date: | June 2010 |
Intensive Intervention for Smokers in Alcohol Treatment
The purpose of this study was to determine the efficacy and cost-effectiveness of an
intensive smoking cessation intervention that utilizes extended cognitive-behavioral therapy
and combination nicotine replacement (CNR) in a randomized controlled trial. The intensive
intervention was compared to usual care involving referral to a free-standing smoking
cessation program that provides brief counseling and CNR. We recruited 162 smokers, ages 18
to 75, who are enrolled in the Drug and Alcohol Treatment (DAT) programs at the San Francisco
VA Medical Center (SFVAMC) and Santa Rosa VA Community-based Outpatient Clinic (CBOC). To be
eligible, participants had to be abstinent from alcohol for at least one week, but not more
than 30 days. We compared outcomes for the two study arms by assessing
biochemically-validated point-prevalence smoking status at 3, 6, 9, and 12 months
post-baseline and continuous abstinence over the 12-month follow-up. Expired-air carbon
monoxide (CO) was used to biochemically verify 7-day point prevalence abstinence. We also
conducted an economic analysis to determine the cost-effectiveness of the intensive
intervention compared with usual care. We also examined cross-relapse patterns during the
follow-up period, assessing changes in mood states and use of tobacco, alcohol, and other
drugs at 3, 6, 9, and 12 months.
intensive smoking cessation intervention that utilizes extended cognitive-behavioral therapy
and combination nicotine replacement (CNR) in a randomized controlled trial. The intensive
intervention was compared to usual care involving referral to a free-standing smoking
cessation program that provides brief counseling and CNR. We recruited 162 smokers, ages 18
to 75, who are enrolled in the Drug and Alcohol Treatment (DAT) programs at the San Francisco
VA Medical Center (SFVAMC) and Santa Rosa VA Community-based Outpatient Clinic (CBOC). To be
eligible, participants had to be abstinent from alcohol for at least one week, but not more
than 30 days. We compared outcomes for the two study arms by assessing
biochemically-validated point-prevalence smoking status at 3, 6, 9, and 12 months
post-baseline and continuous abstinence over the 12-month follow-up. Expired-air carbon
monoxide (CO) was used to biochemically verify 7-day point prevalence abstinence. We also
conducted an economic analysis to determine the cost-effectiveness of the intensive
intervention compared with usual care. We also examined cross-relapse patterns during the
follow-up period, assessing changes in mood states and use of tobacco, alcohol, and other
drugs at 3, 6, 9, and 12 months.
Introduction. The purpose of this study was to investigate the efficacy of an intensive
tobacco cessation intervention for alcohol-dependent smokers in early recovery.
Methods. A total of 162 alcohol-dependent smokers were randomized to either intensive
intervention for smoking cessation or usual care. The intensive intervention consisted of 16
sessions of individual cognitive behavior therapy (CBT) and combination nicotine replacement
therapy that lasted 26 weeks. Usual care involved referral to a free-standing smoking
cessation program that provided smoking cessation counseling of varying duration and
guideline-concordant medications. The primary cessation outcome was verified 7-day point
prevalence abstinence (PPA) at 12, 26, 38, and 52 weeks.
Results. At 12 and 26 weeks, the verified 7-day point-prevalence quit rate was significantly
higher for the intensive intervention group than for the usual care group (both p = .03).
However, the quit rates for the two treatment groups were not significantly different at 38
or 52 weeks. Verified 30-day alcohol abstinence rates were not significantly different for
the two treatment groups at any of the follow-up assessments.
Conclusions. The intensive smoking cessation intervention yielded a higher short-term smoking
quit rate without jeopardizing sobriety. A chronic care model might facilitate maintenance of
smoking cessation during the first year of alcohol treatment and perhaps for longer periods
of time. It is hoped that studies such as this will inform the development of more effective
interventions for concurrent alcohol and tobacco use disorders.
tobacco cessation intervention for alcohol-dependent smokers in early recovery.
Methods. A total of 162 alcohol-dependent smokers were randomized to either intensive
intervention for smoking cessation or usual care. The intensive intervention consisted of 16
sessions of individual cognitive behavior therapy (CBT) and combination nicotine replacement
therapy that lasted 26 weeks. Usual care involved referral to a free-standing smoking
cessation program that provided smoking cessation counseling of varying duration and
guideline-concordant medications. The primary cessation outcome was verified 7-day point
prevalence abstinence (PPA) at 12, 26, 38, and 52 weeks.
Results. At 12 and 26 weeks, the verified 7-day point-prevalence quit rate was significantly
higher for the intensive intervention group than for the usual care group (both p = .03).
However, the quit rates for the two treatment groups were not significantly different at 38
or 52 weeks. Verified 30-day alcohol abstinence rates were not significantly different for
the two treatment groups at any of the follow-up assessments.
Conclusions. The intensive smoking cessation intervention yielded a higher short-term smoking
quit rate without jeopardizing sobriety. A chronic care model might facilitate maintenance of
smoking cessation during the first year of alcohol treatment and perhaps for longer periods
of time. It is hoped that studies such as this will inform the development of more effective
interventions for concurrent alcohol and tobacco use disorders.
Inclusion Criteria:
- at least 18 years of age
- alcohol as primary drug of abuse
- currently smoking at least 10 or more cigarettes
- abstinent from alcohol for at least 7 days and not more than 30 days
- self-reported interest in quitting smoking
Exclusion Criteria:
- any contraindications for nicotine patches or lozenges (e.g., unstable angina or
recent myocardial infarction
- skin allergy to the nicotine patch
- severe cardiovascular disease
- lactation
- pregnancy by self-report or by positive serum pregnancy test in pre-menopausal women)
- unstable psychiatric disorder
- severe cognitive impairment
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