Concurrent brief versus intensive smoking intervention during alcohol dependence treatment.

Abstract

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 ...

Simultaneous versus Delayed Treatment of Tobacco Dependence in Alcohol-Dependent Outpatients

“…The results showed worse drinking outcomes in the delayed group and no differences in smoking cessation rates (19 and 8% at week 20). A more recent study provided either brief or intensive smoking cessation treatment concurrently with alcohol dependence treatment and reported 9.1% smoking abstinence at 6 months when an intensive intervention was delivered [38] . Discrepancies in the findings of the four studies may be due to methodological differences, as suggested in a previous review [51] .…”

“…Another study found that patients with relatively short periods of alcohol abstinence at baseline tend to struggle with both types of abstinence [30] . However, most studies examining the risk of alcohol and/or non-nicotine drug relapse suggest that concurrent treatment does not increase the probability of relapse [4,27,[31][32][33][34][35][36][37][38] . Furthermore, we also found empirical evidence that suggests smoking cessation efforts may result in improved alcohol-related outcomes [4,39] .…”

Tobacco use and psychiatric comorbidity among adolescents in substance abuse treatment

“…A mail survey conducted in 1999 and 2000 of substance abuse treatment programs across the United States found that most of the programs routinely assessed tobacco use, but only a small proportion provided tobacco cessation in the treatment plans of youth (Kurst-Swanger & Stockweather, 2003). The belief that quitting smoking while attempting to quit other substances may increase the risk of relapse is pervasive (Bernstein & Stoduto, 1999;Ziedonis, Guydish, Williams, Steinberg, & Foulds, 2006), despite growing empirical evidence that tobacco cessation efforts with adults do not negatively impact recovery (Reid et al, 2008) and in fact may be associated with more positive substance abuse treatment outcomes (Brown et al, 2009;Cooney et al, 2007;Friend & Pagano, 2004;Kohn, Tsoh, & Weisner, 2003;Prochaska, Delucchi, & Hall, 2004). However, the literature on adolescents is more limited (de Dios, Vaughan, Stanton, & Niaura, 2009;Myers & Brown, 1997;Myers & Brown, 2005;Myers & Prochaska, 2008;Myers et al, 2007).…”

Tobacco dependence diagnosis and treatment in Veterans Health Administration residential substance use disorder treatment programs

“…In the VHA, front-line therapies for tobacco cessation on the National Formulary include nicotine replacement therapy (NRT), bupropion and combination therapy [37]. NRT during SUD treatment reduces cigarette consumption and increases the likelihood of tobacco abstinence [30,32,38,39]. NRT also helps to prevent tobacco relapse in patients with a history of alcohol misuse [4,40,41].…”