This is a competitive renewal of a grant entitled """"""""Field Study of Smoking Cessation in Alcohol Treatment."""""""" Tobacco use among alcoholics is a major public health problem. The broad objective of this study is to develop recommendations for empirically supported smoking cessation treatment for alcoholic smokers in the initial phase of outpatient alcoholism treatment. In a double blind, placebo controlled clinical trial; a sample of 175 alcohol dependent cigarette smokers will be recruited from the community and treated in a six month outpatient alcohol and tobacco treatment protocol. All subjects will be offered a total of 15 individual treatment sessions with a goal of abstinence from alcohol and tobacco. They will also be randomized to one of two levels of nicotine replacement therapy (NRT). One group will receive Combination INRT consisting of active nicotine patch and active nicotine gum, while a comparison group will receive Single NRT consisting of active nicotine patch and placebo nicotine gum. Smoking and drinking outcome will be assessed across one year from the onset of treatment. In addition to the outcome assessment, Ecological Momentary Assessment (EMA) methodology will be used to examine treatment process. EMA data will be collected using cellular telephones combined with Interactive Voice Response technology to randomly sample each subject's experience in the natural environment during two week periods before smoking cessation, immediately after smoking cessation, and two months after smoking cessation. This methodology will be used (a) to compare the overall effects of Single versus Combination NRT on frequency and intensity of urge to smoke and urge to drink; (b) to determine the immediate impact of nicotine gwn self administration on subsequent momentary urge to drink and urge to smoke; and (e) to determine the momentary effect of urges to drink and urges to smoke on subsequent nicotine gum self administration. The results of these process analyses will lead to improved understanding of the effects of nicotine replacement on alcoholic smokers and factors affecting their compliance with nicotine gum.
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