Background With smoking rates far exceeding the general population, methadone-maintained (MMT) opiate-dependent smokers experience high rates of tobacco-related health consequences. Previous treatment studies have used nicotine replacement and produced low quit rates. Methods We test, using a three-group randomized design, the efficacy of varenicline vs. placebo, in comparison with nicotine replacement therapy (NRT) that combines nicotine patch prescription plus ad libitum nicotine rescue, for smoking cessation. We recruited methadone-maintained smokers from nine treatment centers in southern New England and provided six months of treatment, and a minimal behavioral intervention at baseline (NCI's 5A's). Outcomes included carbon monoxide (CO) confirmed 7-day point smoking cessation prevalence at 6 months and self-reported change in mean cigarettes per day. Results The 315 participants had a mean age of 40, with 50% male and 79% non-Hispanic White, smoked an average of 19.6 (± 10.4) cigarettes / day, and had a mean daily methadone dose of 109 mg. Intent-to-treat analyses, with missing considered to be smoking, showed the rate of CO-confirmed 7-day abstinence at 6-months was 5.4% overall, with varenicline 3.7% compared to placebo 2.2%, and NRT 8.3% (p>.05). Adherence rates during the 7-days immediately prior to 6-month assessment were 34.2% in varenicline, 34.4% in placebo, and 48.8% in NRT. Between baseline and 6-months there was an overall self-reported mean reduction of 8.3 cigarettes / day. Conclusion Varenicline did not increase quit rates over placebo. Smoking cessation rates in methadone-maintained smokers are low and novel treatment strategies are required.

Objective-To test the hypothesis that among hazardously drinking incarcerated women who are returning to the community, a brief alcohol intervention will result in less alcohol use at follow-up relative to standard of care.Methods-Eligible participants endorsed hazardous alcohol consumption--four or more drinks at a time on at least three separate days in the previous three months or a score of 8 or above on the AUDIT. Participants were randomized to either an assessment-only condition or to two brief motivationally-focused sessions, the first delivered during incarceration, the second one month later after community re-entry. Participants recalled drinking behaviors at three and six months after the baseline interview using a 90-day Timeline Followback method.Results-The 245 female participants averaged 34 years of age, and were 71% Caucasian. Participants were abstinent only 47% of days in the three months prior to incarceration. On most days (85%) that they drank, women consumed four or more drinks. Intervention effects on abstinent days were statistically significant at 3-months (OR = 1.96, 95% CI 1.17, 3.30); the percent of days abstinent was 68% for those randomized to intervention and 57% for controls. At 6-months the effect of the intervention was attenuated and no longer statistically significant.Conclusions-Among incarcerated women who reported hazardous drinking, a two-session brief alcohol intervention increased abstinent days at three-months, but this effect decayed by six months. Study participants continued to drink heavily after return to the community. More intensive intervention pre-release and after re-entry may benefit hazardously-drinking incarcerated women.

Methadone-maintained persons are at increased risk for many physical and mental health disorders compared to the general population. Increased physical activity could offset these risks. We assessed physical activity level, and perceived benefits and barriers to exercise in a group of 305 methadone-maintained smokers. Mean participant age was 39.9 years of age, 50.2% were male, 79.7% were non-Hispanic White, and mean body mass index was 29.8. Nearly 45% endorsed fair or poor physical health. Although participants perceived many benefits of exercise and few barriers, only 38% of participants met weekly recommendations for physical activity, and nearly 25% reported no physical activity. Those who met recommended guidelines were significantly more likely to endorse relapse prevention as a benefit of exercise. Motivating MMT patients to increase physical activity could have important physical, mental health, and drug treatment benefits.