Intensive Intervention for Smokers - 6
Condition: Tobacco Use Disorder; Alcohol Dependence
MeSH terms: Alcoholism; Tobacco Use Disorder
Study type: Interventional

Summary: 
      The purpose of this study was to determine the efficacy and cost-effectiveness of an
      intensive smoking cessation intervention that utilizes extended cognitive-behavioral therapy
      and combination nicotine replacement (CNR) in a randomized controlled trial. The intensive
      intervention was compared to usual care involving referral to a free-standing smoking
      cessation program that provides brief counseling and CNR. We recruited 162 smokers, ages 18
      to 75, who are enrolled in the Drug and Alcohol Treatment (DAT) programs at the San Francisco
      VA Medical Center (SFVAMC) and Santa Rosa VA Community-based Outpatient Clinic (CBOC). To be
      eligible, participants had to be abstinent from alcohol for at least one week, but not more
      than 30 days. We compared outcomes for the two study arms by assessing
      biochemically-validated point-prevalence smoking status at 3, 6, 9, and 12 months
      post-baseline and continuous abstinence over the 12-month follow-up. Expired-air carbon
      monoxide (CO) was used to biochemically verify 7-day point prevalence abstinence. We also
      conducted an economic analysis to determine the cost-effectiveness of the intensive
      intervention compared with usual care. We also examined cross-relapse patterns during the
      follow-up period, assessing changes in mood states and use of tobacco, alcohol, and other
      drugs at 3, 6, 9, and 12 months.
    

Detailed description: 
      Introduction. The purpose of this study was to investigate the efficacy of an intensive
      tobacco cessation intervention for alcohol-dependent smokers in early recovery.

      Methods. A total of 162 alcohol-dependent smokers were randomized to either intensive
      intervention for smoking cessation or usual care. The intensive intervention consisted of 16
      sessions of individual cognitive behavior therapy (CBT) and combination nicotine replacement
      therapy that lasted 26 weeks. Usual care involved referral to a free-standing smoking
      cessation program that provided smoking cessation counseling of varying duration and
      guideline-concordant medications. The primary cessation outcome was verified 7-day point
      prevalence abstinence (PPA) at 12, 26, 38, and 52 weeks.

      Results. At 12 and 26 weeks, the verified 7-day point-prevalence quit rate was significantly
      higher for the intensive intervention group than for the usual care group (both p = .03).
      However, the quit rates for the two treatment groups were not significantly different at 38
      or 52 weeks. Verified 30-day alcohol abstinence rates were not significantly different for
      the two treatment groups at any of the follow-up assessments.

      Conclusions. The intensive smoking cessation intervention yielded a higher short-term smoking
      quit rate without jeopardizing sobriety. A chronic care model might facilitate maintenance of
      smoking cessation during the first year of alcohol treatment and perhaps for longer periods
      of time. It is hoped that studies such as this will inform the development of more effective
      interventions for concurrent alcohol and tobacco use disorders.
    

Intervention name(s): Usual Care; Extended cognitive behavior therapy
Intervention type(s): Other; Behavioral
Intervention description(s): Referral to smoking cessation clinic; 16 sessions of cognitive behavior therapy over 6 months
Other intervention name(s): Smoking cessation clinic
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Tobacco use disorder; Alcohol dependence