Intervention: Varenicline
Trial phase: Phase 1
ATC code: N07BA03 | S01XA28
SMILES: c1cnc2cc3c(cc2n1)C1CNCC3C1
Sex: All
Age groups: Adult | Older Adult
Healthy volunteers: No
Participants at risk: 26
Group description: Integrated counseling for smoking and alcohol entails weekly counseling for 12-weeks targeting both behaviors. Participants in this condition will also receive 12 weeks of varenicline (Chantix).

Varenicline: 12-weeks of treatment. Dose will be titrated as follows:

Days 1-3: 1 0.5mg tablet once per day Days 4-7: 1 0.5mg tablet twice per day Day 8 - Week 11: 1 1mg tablet twice per day
Eligibility criteria:
Inclusion Criteria:

are at least 18 years of age;
report smoking 100 cigarettes over lifetime and currently smoke at least twice weekly on average in the past 90 days and have a urinary cotinine level of >=30ng/mL by semi-quantitative analysis, and/or >= 2 on a NicAlert dipstick
are interested in quitting smoking;
understand English;
exceed National Institute on Alcohol Abuse and Alcoholism heavy drinking criteria (i.e., for men, >14 drinks/week or 5 drinks/day at least once per month over the past 12 months; for women, >7 drinks/week or >4 drinks/day at least once per month over the past 12 months.

Exclusion Criteria:

meet criteria for alcohol dependence in the past 12 months that is clinically severe defined by

a history of seizures, delirium, or hallucinations during alcohol withdrawal;
a Clinical Institute Withdrawal Assessment scale (Sullivan et al., 1989) score of > 8;
report drinking to avoid withdrawal symptoms, or d) have had prior treatment of withdrawal;
have required medical treatment of alcohol withdrawal within the past 6 months;
are currently enrolled in alcohol treatment;
meet criteria for drug dependence in the past 12 months; with the exception of marijuana dependence
exhibit serious psychiatric illness (i.e., schizophrenia, bipolar disorder, severe major depression, panic disorder, borderline personality disorder, organic mood or mental disorders by history or psychological examination;
report current suicidality (past 12 months), or report suicide attempts within the past 10 years, assessed with the Columbia Suicide Severity Rating Scale;

exhibit current, clinically significant physical disease or abnormality based on medical history, physical examination, or routine laboratory evaluation including:

any unexplained elevations in liver enzymes (i.e., transaminases, bilirubin);
clinically significant, unstable cardiovascular disease/uncontrolled hypertension;
hepatic or renal impairment;
severe obstructive pulmonary disease;
diabetes mellitus requiring insulin or certain oral medications (i.e., sulfonylureas) and an A1C hemoglobin test score of > 7 for participants not prescribed these medications;
baseline systolic blood pressure higher than 150 mm Hg or diastolic blood pressure higher than 95 mm Hg;
are cognitively impaired;
are unable to read/understand English;
are a female of childbearing potential who is pregnant, nursing, or not practicing effective contraception (oral, injectable, or implantable contraceptives, intrauterine device, or barrier method with spermicide);
report new onset of psychiatric disorders or new psychotropic medications within the past 3 months, except individuals who are on a stable dose of a Selective Serotonin Reuptake Inhibitor for at least two months or who report occasional use of prescription sleep aids that they are willing to discontinue;
have used another investigational drug within 30 days or have used medications to treat alcohol (e.g., naltrexone, topiramate, acamprosate, disulfiram) or nicotine use (e.g., clonidine, varenicline, bupropion, nicotine replacement) in the past 3 months or intend to use these medications; (prior use of nicotine replacement in situations where smoking is not permitted (e.g., planes) without the intention to quit smoking is not exclusionary at screening)
intend to donate blood or blood products during the treatment phase of the study;
have a history of cancer (except treated basal cell or squamous cell carcinoma of the skin);
have a history of serious hypersensitivity reactions or skin reactions to varenicline.