Addressing heavy drinking in smoking cessation treatment: A randomized clinical trial.

Abstract

Heavy alcohol use frequently co-occurs with cigarette smoking and may impede smoking cessation. This clinical trial examined whether smoking cessation treatment that incorporates brief alcohol intervention can improve smoking cessation outcomes (7-day verified point prevalence abstinence) and reduce drinks consumed per week. Heavy drinkers seeking smoking cessation treatment were assigned by urn randomization to receive, along with 8-weeks of nicotine replacement therapy, either a 4-session standard smoking cessation treatment (ST, n = 119) or standard treatment of equal intensity that incorporated brief alcohol intervention (ST-BI, n = 117). Across follow-ups over 26 weeks, participants in ST-BI reported approximately 20% fewer drinks per week (p < .027) and greater smoking abstinence (adjusted odds ratio= 1.56 [95% CI =1.01-2.43]) than those in ST; however, effects on smoking were primarily evident at 2 weeks after quit date and were near zero by 16 weeks. The effect of ST-BI on smoking outcome was most robust among moderately heavy drinkers compared to very heavy drinkers. Integrating brief alcohol intervention into smoking cessation treatment appears feasible, but further development is needed to yield lasting effects on smoking.

Heavy-Drinking Smokers' Treatment Needs and Preferences: A Mixed-Methods Study

“…This finding is in contrast to research on patients in alcohol treatment who are typically less motivated to quit smoking (Rohsenow et al 2014; Flach & Diener, 2004). Among the larger population of heavy drinkers not engaged in/seeking alcohol treatment, smoking cessation interventions may provide an opportunity to address problematic alcohol use (Kahler et al, 2008; Toll et al, 2014). Despite more motivation to quit smoking, most participants perceived greater barriers to smoking cessation.…”

“…Adding smoking pharmacotherapy to these interventions yielded higher smoking quit rates, but quit rates were still low and not sustained beyond treatment (Cooney et al, 2015; Kalman, Kim, DiGirolamo, Smelson, Ziedonis, 2010; Prochaska , Delucchi, Hall, 2004). Two studies have examined a brief alcohol intervention integrated into smoking cessation treatment for heavy-drinking smokers seeking to quit smoking (Kahler et al, 2008; Toll et al, 2014). Heavy-drinking smokers, not currently alcohol dependent, received 8 weeks of nicotine patch therapy starting on the quit day and either 4 weeks of standard smoking counseling or standard smoking counseling plus brief alcohol advice starting two weeks before quitting.…”

Clustering of modifiable biobehavioral risk factors for chronic disease in US adults: a latent class analysis

“…56,57 Clinically, these findings suggest that a small, but sizeable, portion of individuals may require multi-substance addiction interventions. 58–60 …”

Time-Varying Smoking Abstinence Predicts Lower Depressive Symptoms Following Smoking Cessation Treatment

“…Participants were 236 smokers seeking cessation treatment in a randomized clinical trial comparing standard smoking cessation treatment (ST) to smoking cessation treatment that incorporated brief alcohol intervention (ST-BI; Kahler et al, 2008). Participants had to be ≥18 years old, smoke ≥10 cigarettes/day, use no other tobacco/nicotine products, and drink heavily: for men >14 drinks per week or ≥5 drinks per occasion at least once a month and for women >7 drinks per week or ≥4 drinks per occasion at least once a month (National Institute on Alcohol Abuse and Alcoholism, 1995).…”