The majority of substance dependent persons in recovery smoke cigarettes. Many of these persons are concerned about the effect of smoking on their health and many have unsuccessfully tried to quit smoking. Clinical trials have reported very low quit rates with this population. Failure to use nicotine replacement therapy and underdosing when nicotine replacement has been used may account for these very low quit rates. The major specific aim of this application is to evaluate the impact of 2 different doses of nicotine replacement therapy on smoking quit rates in a sample of smokers in substance abuse recovery who want to quit smoking. This project will also investigate the mechanism(s) accounting for the efficacy of the NP. Substance abusing smokers with between 3 and 12 months of abstinence from non-nicotine drugs will be randomly assigned in a double-blind manner to 1 of 2 conditions. Subjects in condition 1 will receive a 22-mg NP for 8 weeks and an 11-mg NP for 4 weeks. Subjects in condition 2 will receive a 44-mg NP for 4 weeks, a 22-mg NP for 4 weeks and an 11-mg NP for 4 weeks. All subjects will also receive supportive-behavioral group counseling. Smoking outcome will be measured at the end of treatment, and 12 and 24 weeks following end of treatment. Intensive assessments of smoking and other variables will be made on a daily basis for the first week post-quit and on a weekly basis for the remainder of the counseling phase of a subject's participation. Since many recovering substance abusers die of smoking-related illnesses, treatments with demonstrated effectiveness with this population are urgently needed. This project will provide critical information about the differential effects of 2 doses of NP with this population.
