Smoking treatment for newly recovering drug and alcohol-dependent smokers in a residential rehabilitation program was examined. The randomly assigned conditions (n = 50 each) were multicomponent smoking treatment (MST), MST plus generalization training of smoking cessation to drug and alcohol cessation (MST+G), or usual care (UC). Fifty participants who declined smoking treatment (treatment refusers) also were studied. Both treatment conditions achieved continuous smoking abstinence rates (MST: 12%, MST+G: 10%, at 12-month follow-up) that were significantly higher than in the UC condition (0%). The MST condition had a continuous drug and alcohol abstinence rate that was significantly higher than that of the MST+G condition (40% vs. 20% at 12-month follow-up) although neither differed significantly from that of the UC condition (33%). These results support the feasibility of smoking treatment for this population and provide information regarding appropriate treatment components.

This study examined the psychometric properties and validity of the Fagerström Tolerance Questionnaire (FTQ), the Fagerström Test for Nicotine Dependence (FTND), and the Heaviness of Smoking Index (HSI) when used as self-report measures of nicotine dependence among male drug/alcohol-dependent smokers (n=191 participants in a large stop-smoking study). All three measures had fairly low internal consistency. The FTQ and FTND had similar two-factor structures, but the FTND factor structure accounted for a greater percentage of the item variance. All three measures were significantly correlated in the expected directions with several independent self-report and biochemical indicators of nicotine dependence (e.g., cigarette pack-years, cotinine) and with baseline measures of smoking topography. The FTND outperformed the FTQ on several correlations, and the HSI outperformed both the FTQ and the FTND. Results concerning correlations between each of the three measures and indicators of compensation in response to reductions in nicotine availability were equivocal. The HSI and FTND were predictive of at least 4 weeks of biochemically verified postquit abstinence among a subsample of individuals receiving smoking treatment (n=93). All three measures had mediocre psychometric properties, and the magnitudes of their relationships with independent indicators were generally modest. All three measures appeared to be valid as self-report measures of nicotine dependence among male drug/alcohol-dependent individuals. The HSI appeared to be the best of the three measures; thus, studies of drug/alcohol-dependent smokers should be sure to report the results from this measure. Efforts to develop self-report measures of nicotine dependence with better properties and performance in this population should continue to be pursued.

The development of a detailed model of substance-abuse treatment (SAT) staff performance is described. The model describes the key behaviors of SAT staff. Specifically, researchers used the critical incident technique to develop the model, which includes a total of 15 dimensions, nested under four meta-dimensions: providing clinical services, employee citizenship behaviors, providing clinical support, and managerial behavior. Development and validation of a measure based on the model are also described. More than 600 SAT staff members in 51 SAT agencies completed the new measure. Factor analyses supported the measure's hypothesized dimensional structure; high internal consistency reliabilities were observed for all scales; and interrater agreement metrics indicated an acceptable level of within-agency agreement. Moreover, the measure correlated in expected and theoretically consistent ways with measures of job satisfaction and other job-related opinions.

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