Targeted Interventions for Weight-Concerned Smokers

Weight gain after quitting smoking is an important barrier to treatment for many smokers. This study will test a drug called naltrexone with weight-concerned smokers to investigate whether or not this drug both improves smoking cessation quit rates and minimizes post quit weight gain.

This is a 6-month randomized, double-blind, placebo controlled trial of 25 mg naltrexone for smoking cessation in a sample of 270 male and female weight-concerned smokers. Participants also receive transdermal nicotine replacement therapy during the first 8 weeks of the study, which they begin on their quit date. Naltrexone study medication will be started a week before their quit date and continued through the six-month period. Brief behavioral counseling and research assessments are provided for two sessions prior to the quit date and then weekly for two weeks, bi-weekly for a month and every four weeks thereafter. A follow-up appointment is completed at 12 months after participants' quit date.

The primary outcomes are six-month point prevalence abstinence and post-cessation weight gain for those who are continuously abstinent (not even a puff).

Secondary outcomes include an examination of alcohol consumption, evaluation of urges, other measures of smoking cessation success, point prevalence abstinence at 12 months, and food preferences. A number of tertiary measures will be obtained for examining predictors of smoking cessation, weight gain, and naltrexone response.

Eligibility Criteria:
Inclusion Criteria:

* 1. Concern about gaining weight after quitting. This will be assessed using questionnaires that will provide a rating system to determine qualified participants.
* 2. Age 18 and older.
* 3. Willingness and ability to give written consent.
* 4. Smoking greater than 10 cigarettes per day for at least 1 year.
* 5. At least one prior attempt to stop smoking.
* 6. Baseline expired carbon-monoxide level of at least 10 ppm.
* 7. Weigh at least 100 lbs.
* 8. English speaking.
* 9. One person per household.

Exclusion Criteria:

* 1. Pregnant or nursing women or women attempting to conceive.
* 2. Unstable cardiac disease.
* 3. History of dermatoses.
* 4. Current alcohol or drug dependence other than nicotine dependence.
* 5. Serious current neurologic, psychiatric or medical illness, including those with a significant risk of committing suicide based on history or investigator's judgment.
* 6. Chronic pain conditions necessitating opioid treatment (naltrexone, an opioid antagonist, will make these medications ineffective).
* 7. History of cirrhosis or significant hepatocellular injury as evidenced by SGOT or SGPT \>3 x normal or elevated bilirubin.
* 8. Current use of smokeless tobacco, pipes, cigars, nicotine gum, patch, nasal spray, inhaler, or lozenges.
* 9. Patients requiring concomitant therapy with any psychotropic drug or on any drug with a psychotropic component except those who are on a stable dose of an Selective Serotonin Reuptake Inhibitor for at least two months for the indications of Major Depressive Disorder, Premenstrual Syndrome (PMS) or Premenstrual Dysphoric Disorder (PMDD).
* 10. Subjects with a positive opiate urine drug screen will be excluded to avoid precipitating opiate withdrawal.
* 11. Current use of opiates.
* 12. Currently on a medically prescribed diet.