Previous research has found high rates of psychiatric disorders among veterans with war zone-related posttraumatic stress disorder (PTSD). However, many studies in this area are methodologically limited in ways that preclude unambiguous interpretation of their results. The purpose of this study was to address some of these limitations to clarify the relationship between war zone-related PTSD and other disorders. Participants were 311 male Vietnam theater veterans assessed at the National Center for PTSD at the Boston Veterans Affairs Medical Center. The Clinician-Administered PTSD Scale and the Structured Clinical Interview for DSM-III-R were used to derive current and lifetime diagnoses of PTSD, other axis I disorders (mood, anxiety, substance use, psychotic, and somatoform disorders), and two axis II disorders (borderline and antisocial personality disorders only). Participants also completed several self-report measures of PTSD and general psychopathology. Relative to veterans without PTSD, veterans with PTSD had significantly higher rates of current major depression, bipolar disorder, panic disorder, and social phobia, as well as significantly higher rates of lifetime major depression, panic disorder, social phobia, and obsessive-compulsive disorder. In addition, veterans with PTSD scored significantly higher on all self-report measures of PTSD and general psychopathology. These results provide further evidence that PTSD is associated with high rates of additional psychiatric disorders, particularly mood disorders and other anxiety disorders. The implications of these findings and suggestions about the direction of future research in this area are discussed.

Alcohol-tobacco interactions and relapse precipitants were examined among alcohol-dependent smokers in a trial of concurrent alcohol and tobacco treatment. After discharge from treatment, participants completed 14 days of electronic diary (ED) assessments of mood, self-efficacy, urges to drink or smoke, and drinking and smoking behavior. ED data revealed an increase in frequency of alcohol urges after smoking episodes. Drinking relapse episodes were predicted by prior ED ratings of low self-efficacy to resist drinking and high urge to smoke. Smoking relapse episodes were predicted by high urge to smoke and high negative, high arousal mood. Results support a cross-substance cue reactivity model of multiple substance use and a limited-strength model, but not a cross-substance coping model.

A scale for assessing war-zone-related posttraumatic stress disorder (WZ-PTSD scale) was derived from the Symptom Checklist-90-R by identifying items that best discriminated Vietnam theater veterans with and without PTSD (N = 202). The 25-item WZ-PTSD scale had excellent internal consistency, and signal detection analyses revealed that its diagnostic utility was comparable to or exceeded that of several established PTSD scales and measures of global distress. In a cross-validation sample (N = 99), the diagnostic utility of the WZ-PTSD scale was stable, whereas other PTSD scales performed more poorly. The WZ-PTSD scale appears to be a valuable new measure of PTSD that can be particularly useful in archival data sets or in any situation where other PTSD measures are not available.

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...

Alcohol dependent smokers (N = 118) enrolled in an intensive outpatient substance abuse treatment program were randomized to a concurrent brief or intensive smoking cessation intervention. Brief treatment consisted of a 15-minute counseling session with 5 min follow-up. Intensive intervention consisted of three one-hour counseling sessions plus eight weeks of nicotine patch therapy. The cigarette abstinence rate, verified by breath CO, was significantly higher for intensive (27.5%) versus brief (6.6%) treatment at one month post quit date but not at six months when abstinence rates fell to 9.1% and 2.1%. Smoking treatment assignment did not significantly impact alcohol outcomes. Although intensive smoking treatment was associated with higher rates of short term tobacco abstinence, other, perhaps more intensive smoking interventions are needed to produce lasting smoking cessation in alcohol dependent smokers. Keywordssmoking; smoking cessation; nicotine; alcoholism; alcoholism treatment Although cigarette smoking prevalence among U.S. adults has declined to 21 percent (Centers for Disease Control and Prevention, 2005), the majority of individuals with alcohol problems remain current smokers (Hughes, 1995;Lasser et al., 2000). The Department of Health and Correspondence concerning this article should be addressed to Ned Cooney, VA Connecticut Healthcare System /116A-3, 555 Willard Avenue, Newington, Connecticut 06111. E-mail: E-mail: ned.cooney@yale.edu. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptHuman Services (DHHS) Clinical Guidelines for Treating Tobacco Use and Dependence provided a consensus recommendation that smokers receiving treatment for chemical dependency should be provided smoking cessation treatments including both counseling and pharmacotherapy (Fiore, Bailey, Cohen et al., 2000). However, the Guideline panel noted that that this recommendation was made in the absence of definitive randomized clinical trials.Most community-based treatment settings offer no smoking cessation intervention at all (Fuller et al., in press). A brief counseling intervention such as recommended by the Agency for Healthcare Policy and Research (Smoking Cessation Clinical Guideline Panel & Staff, 1996) may be the most feasible approach in these settings. However, this brief counseling approach may be inadequate in light of research that indicates a strong dose-response relationship between the amount of clinician contact time and successful treatment outcome. Additionally, the most successful of the concurrent alcohol-tobacco treatment trials included nicotine replacement as a component (Cooney, Cooney, Patten, & George, 2004). A recent review (Hughes and Kalman, 2006) found consistent evidence that comorbid alcohol problems were associated with more severe nicotine dependence, suggesting that those with alcohol problems might have a greater need for intensive smoking intervention. The present study was designed to compare brief smoking cessation counseling with a ...

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Results indicate that barriers to OEND implementation continue to exist, and not all clinicians or practice specialties at VACHS are comfortable with dispensing naloxone. A targeted approach to training health care clinicians may lead to increased acceptance of naloxone dispensing. Additional research is needed to elicit the best method of improved acceptance of naloxone to expand naloxone access.

Anderson, 1993) was associated with worse drug use outcomes, and a recent study comparing concurrent versus delayed smoking intervention found worse drinking outcomes in the concurrent treatment group (Joseph, Willenbring, Nugent, &. Nelson, 2004). The lack of consistency among outcome studies suggests a need to focus more carefully on the processes involved in smoking and smoking cessation among treated alcohol dependent smokers.A number of theories have been advanced to explain the association between smoking and alcohol dependence (Cooney, Cooney, Patten, & George, 2004;Kalman, 1998), including behavioral theories that focus on factors that may underlie relapse after cessation of alcohol and tobacco use. The cross-substance coping response hypothesis (Monti, Rohsenow, Colby, &. Abrams, 1995), which is based on a social leaming model, postulates that smoking may be used to cope with cravings for alcohol, or drinking may be used to cope with craving for cigarettes. Research on cross-substance coping has yielded mixed results. This theory is supported by questionnaire data from detoxified alcoholics showing that many expected that they would smoke to cope with urges to drink (Monti et al, 1995). Laboratory data contrary to this theory were reported by our research group (Cooney, Cooney, Pilkey, Kranzler, &. Oncken, 2003). We examined alcohol-dependent smokers enrolled in alcohol treatment and found that acute cigarette deprivation led to high levels of cigarette craving but no increase in alcohol urges. However, a similar laboratory study conducted with a hazardous drinking, nontreatment seeking sample found that cigarette deprivation was associated with an increased urge to drink (Palfai, Monti, Ostafin, &. Hutchison, 2000). Cross-substance coping response theory leads to the testable prediction that, among abstinent alcoholics, smoking occasions are associated with increased alcohol urges prior to smoking and with decreased alcohol urges immediately after smoking.An altemative theory-cross-substance cue reactivity-is based on classical conditioning principles. Alcohol and tobacco are often consumed together, and thus, repeated pairings of smoking cues with drinking behavior and vice versa are thought to result in these cues acquiring conditioned stimulus properties (Istvan & Matarazzo, 1984). Thus, smoking may come to elicit urges to drink, and drinking may elicit urges to smoke. Laboratory-based studies of alcohol-dependent smokers have supported this theory, with findings that alcohol cue exposure elicits smoking urges (Cooney et al, 2003;Drobes, 2002;Gulliver et al, 1995;Rohsenow et al, 1997). One study also demonstrated that smoking cues elicit alcohol urges (Drobes, 2002). Cross-substance cue reactivity theory would predict that concurrent treatment of smoking and drinking would lead to better alcohol outcomes than would alcohol treatment alone because ex-smokers have less exposure than do continuing smokers to cues that elicit alcohol craving. Another prediction is that continuing smokers experience incr...