Effect of smoking cessation counseling on recovery from alcoholism: findings from a randomized community intervention trial

Litt

Psychology of Addictive Behaviors

et al. 2007

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 ...

mentioning

confidence: 95%

Concurrent brief versus intensive smoking intervention during alcohol dependence treatment.

Litt

Psychology of Addictive Behaviors

et al. 2007

“…When alcoholics are compared across various stages of their disease, individual quit attempts result in quit rates of 3-19% at 4-6 months while in alcoholism treatment (Bobo et al, 1996;Bobo et al, 1998;Grant KM, 2003;Joseph et al, 2004;Kalman et al, 2001) and 9-29% at 4-6 months in alcoholics who reported they were no longer drinking (Hays et al, 1999;Kalman et al, 2006;Martin et al, 1997) (Table 1).…”

Section: Previous Studies Of Smoking Cessation In Alcoholicsmentioning

confidence: 99%

Bupropion and nicotine patch as smoking cessation aids in alcoholics

Grant

Kelley

Smith

et al. 2007

Alcohol

This is a double blind placebo controlled study of sustained release bupropion as a smoking cessation aid in alcoholics undergoing treatment for their alcoholism. Participants (N=58) were enrolled within one week of entry into alcohol treatment from community and Veterans Affairs Substance Use Disorder programs. All participants received nicotine patch and were invited to attend a smoking cessation lecture and group. Cigarette smoking and alcohol outcomes were measured at six months. Bupropion when added to nicotine patch did not improve smoking outcomes. One-third of participants on bupropion reported discontinuing the drug during weeks 1-4. Participants reported cigarette outcomes with nicotine patch which are similar to those seen in the general population. All study participants significantly reduced cigarette use. Co-morbid affective disorder or antipersonality disorder did not affect outcomes. Alcohol outcomes were improved in those who discontinued cigarettes.

Drug and Alcohol Dependence

“…However, sequential or delayed smoking cessation treatment is rarely delivered under current systems of care, arguing for the need to deliver smoking cessation concurrently with alcohol treatment. One body of work suggests that concurrent smoking cessation treatment does not adversely affect alcohol outcomes, and perhaps, results in improved alcohol outcomes (Bobo et al 1996;Bobo et al 1998;Kalman et al 2001;Prochaska et al 2004). However, in suggesting that concurrent smoking cessation treatment adversely affects alcohol treatment outcomes, recent results from the Timing of Alcohol and Smoking (TASC) randomized controlled trial stand in contrast to these findings (Joseph et al 2004).…”

Section: Introductionmentioning

confidence: 99%

Ethnic differences in alcohol treatment outcomes and the effect of concurrent smoking cessation treatment

Kodl²,

Willenbring

et al. 2008

The Timing of Alcohol and Smoking Cessation (TASC) Study tested the optimal timing of smoking cessation treatment in an alcohol dependent population. Previously reported results suggest that providing concurrent smoking cessation treatment adversely affects alcohol outcomes. The purpose of this analysis was to investigate whether there are ethnic differences in alcohol and tobacco outcomes among a diverse sample of alcohol dependent smokers using data from the TASC trial in which 499 participants were randomized to either concurrent (during alcohol treatment) or delayed (6 months later) smoking intervention. This analysis focused on smokers of Caucasian (n = 381) and African American (n = 78) ethnicity. Alcohol outcomes included 6-months sustained alcohol abstinence rates and time to first use of alcohol post-treatment. Tobacco outcomes included 7-day point prevalence smoking abstinence. Random effects logistic regression analysis was used to investigate intervention group and ethnic differences in the longitudinally assessed alcohol outcomes. Alcohol abstinence outcomes were consistently worse in the concurrent group than the delayed group among Caucasians, but this was not the case for African Americans. No significant ethnic differences were observed in smoking cessation outcomes. Findings from this analysis suggest that concurrent smoking cessation treatment adversely affects alcohol outcomes for Caucasians but not necessarily for African Americans.