Aims-The primary aim was to compare the efficacy of smoking cessation treatment using the combination of active nicotine patch plus active nicotine gum versus therapy consisting of active nicotine patch plus placebo gum in a sample of alcohol dependent tobacco smokers in an early phase of outpatient alcohol treatment. A secondary aim was to determine whether or not there were any carryover effects of combination nicotine replacement on drinking outcomes.Design-Small scale randomized double-blind placebo controlled clinical trial with one-year smoking and drinking outcome assessment.Setting-Two outpatient substance abuse clinics provided a treatment platform of behavioral alcohol and smoking treatment delivered in three months of weekly sessions followed by three monthly booster sessions.Participants-Participants were 96 men and women with a diagnosis of alcohol abuse or dependence and smoking 15 or more cigarettes per day.Intervention-All participants received open-label transdermal nicotine patch and were randomized to receive either 2 mg nicotine gum or placebo gum under double blind conditions. Findings-Analysis of 1-year follow-up data revealed that patients receiving nicotine patch plus active gum had better smoking outcomes than those receiving patch plus placebo gum on measures of time to smoking relapse and prolonged abstinence at 12 months. Alcohol outcomes were not significantly different across medication conditions. Conclusions-Results of this study were consistent with results of larger trials of smokers without alcohol problems showing that combination therapy (nicotine patch plus gum) is more effective than monotherapy (nicotine patch) for smoking cessation. Keywordssmoking; smoking cessation; nicotine; alcoholism; tobacco Although cigarette smoking prevalence among U.S. adults has declined to 21 percent (1), the majority of individuals with alcohol problems remain current smokers (2,3). The negative health consequences of smoking among alcohol abusers are substantial. A longitudinal study of an alcohol treatment sample indicated that smoking killed more alcoholics than did alcohol (4) . NIH Public Access Author ManuscriptAddiction. Author manuscript; available in PMC 2010 September 1. Studies have evaluated smoking cessation interventions for individuals with alcohol and drug problems. Although one review found that smokers with past alcohol problems were as likely to stop smoking on a given quit attempt as smokers without alcohol problems (7), another review (8) concluded that smoking cessation rates tended to be low among individuals in early substance abuse recovery and increased with length of sobriety. A metaanalysis of 11 studies of smoking cessation during substance abuse treatment (9) found long term smoking abstinence rates of 7% in the intervention groups and 6% in the comparison conditions with a summary risk ratio of 1.00. These reviews, taken together with USDHHS clinical practice guideline recommendations, suggest the need to develop more effective smoking cessation interven...

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Research has shown that perceived risk is an important predictor of health behavior change. In turn, drug use risk education is a vital component of many health campaigns. In pregnant women, perceived risk studies have focused primarily on alcohol and tobacco use. Little is known about perceived risks associated with prenatal exposure to illicit drugs. The present study compared drug use attitude (DUA) in both treatment-seeking and non-treatment-seeking drug-using pregnant women as well as a comparison group of non-drug-using pregnant women. The results suggest that non-treatment-seekers are less knowledgeable about specific potential risks of perinatal substance use. In addition, compared to treatment seekers and non-users, non-treatment-seekers were more likely to endorse cutting down on drug use rather than quitting as a means of reducing harm to the developing child. Results of the present study suggest drug-using women may benefit from additional education about harmful effects of drug use.