Intensive Intervention for Smokers in Alcohol Treatment

Clinical Professor, Department of Psychiatry

The primary aim of this study is to determine the efficacy and cost-effectiveness of an intensive smoking cessation intervention that utilizes extended cognitive-behavioral therapy (ECBT) and combination nicotine replacement (CNRT), consisting of nicotine patches and adjuvant nicotine replacement (choice of lozenge, gum, nasal spray, or inhaler).    Effective smoking cessation interventions have yet to be identified for alcohol-dependent smokers in early recovery.  The primary aim of this study is to determine the efficacy and cost-effectiveness of an intensive smoking cessation intervention that utilizes extended cognitive-behavioral therapy (ECBT) and combination nicotine replacement (CNRT), consisting of nicotine patches and adjuvant nicotine replacement (choice of lozenge, gum, nasal spray, or inhaler). The ECBT is a manual-based 16-session extended cognitive-behavioral treatment.  CNRT includes nicotine patches, used for four months, and adjuvant nicotine replacement, used for six months. The overall goal of this study is to determine whether alcohol-dependent smokers who are randomly assigned to Intensive Intervention (Study Arm 1) are more likely to quit smoking and maintain abstinence than those assigned to usual care (Study Arm 2).  Usual care involves referral to a free-standing smoking cessation program that provides brief smoking cessation counseling and guideline-concordant medications.  Hypothesis 1: The Intensive Intervention will yield a significantly higher biochemically-verified 7-day point-prevalence quit rate at 3, 6, 9, and 12 months than usual care.  Hypothesis 2: The Intensive Intervention will yield a significantly higher continuous abstinence rate than usual care. The secondary aims are to determine the cost-effectiveness of the Intensive Intervention compared with usual care, and to determine the effects of smoking cessation on use of alcohol and other drugs.  Hypothesis 3: The Intensive Intervention will be more cost-effective than usual care for smoking cessation.  Hypothesis 4: The alcohol abstinence rate for the Intensive Intervention condition will be significantly higher at 12 months than the usual care group.  Finally, we are investigating cross-sectional and prospective relationships between changes in mood states and changes in use of tobacco, alcohol, and other drugs during the follow-up period.