Incremental efficacy of adding bupropion to the nicotine patch for smoking cessation in smokers with a recent history of alcohol dependence: Results from a randomized, double-blind, placebo-controlled study

Abstract

Aims The primary aim of this study was to compare the efficacy of smoking cessation treatment using a combination of nicotine patch and bupropion vs. nicotine patch and placebo bupropion. A secondary aim was to investigate whether the efficacy of bupropion is moderated by belief about whether one is receiving active or placebo medication. Methods Participants were recruited from a residential substance abuse treatment program and the community. We randomly assigned 148 smokers with between two and twelve months of alcohol abstinence to nicotine patch plus bupropion or nicotine patch plus placebo. All participants also received seven counseling sessions. Results At follow up, differences between medication conditions were not significant. Seven-day point prevalence quit rates in the patch plus bupropion vs. patch plus placebo conditions at week 24 were 6% and 11%, respectively. Differences between groups on prolonged abstinence and time to first smoking lapse were also not significant. However, among participants who received bupropion, those who accurately “guessed” that they were receiving bupropion were more likely to remain abstinent than those who incorrectly believed they were receiving placebo. Conclusions Findings do not support combining nicotine patch and bupropion for smoking cessation in this population. However, findings support previous studies suggesting the importance of assessing the blind in smoking cessation studies and its possible moderating effect on medication efficacy. Future directions for enhancing smoking cessation outcome in these smokers include investigations of intensive behavioral and pharmacological interventions, including studies of potential interactions between individual genetic differences and medication efficacy.

Smoking Reductions and Increased Self-Efficacy in a Randomized Controlled Trial of Smoking Abstinence–Contingent Incentives in Residential Substance Abuse Treatment Patients

“…This is in direct contrast with observations of increased smoking during residential SUD treatment (Kelly et al, 2012). Moreover, this level of abstinence, even in our control condition, is on par with abstinence rates achieved in other SUD smokers with smoking cessation pharmacotherapy (Kalman et al 2011;Kalman, Kahler, Garvey, & Monti, 2006;Poling, Rounsaville, Gonsai, Severino, & Sofuoglu, 2010), even though the present study included no medications. Unlike other studies, we also observed increases in smoking abstinence over time.…”

A Randomized Trial of Concurrent Smoking-Cessation and Substance Use Disorder Treatment in Stimulant-Dependent Smokers

“…28–30 The present end-of-treatment PPA rate does, however, compare favorably with PPA rates from smoking-cessation trials completed with alcohol-dependent patients. 31,32 Smoking-cessation trials typically include longer-term follow-up assessments. The final follow-up assessment for the present trial was at 6 months post-smoking quit for which the PPA rate was 13.1% for the TAU+SCT participants.…”

“…As with the end of treatment PPA rate, this is lower than the 6-month PPA rate of approximately 26% reported for bupropion in past trials with non-substance abusing populations, 30,33 but is comparable to 6-month PPA rates from trials with alcohol-dependent smokers. 31,32 Moreover, the odds ratio of 3.81 for TAU+SCT, compared to TAU, for 6-month follow-up suggests that smoking-cessation outcomes over longer-term follow-up can be significantly improved in stimulant-dependent patients in outpatient SUD treatment.…”

Treatment of Comorbid Tobacco Addiction in Substance Use and Psychiatric Disorders

“…The study compared transdermal nicotine patch (TNP) plus bupropion with TNP plus placebo. Although there were group differences, they were not found to be statistically significant [46].…”