The overall goal of this proposal is to develop an effective treatment for smoking cessation in a diverse population. The major specific aim is to compare the short and long-term efficacy of transdermal nicotine detoxification (TN) combined with individualized manually driven cognitive behavioral therapy (ICP) with that of a control condition consisting of transdermal nicotine detoxification (TN) plus an individually oriented commercially available smoking cessation video tape series (IVT) and brief discussion of the same duration as the ICB. Completion of treatment and smoking cessation and reduction rates at 3 months, 6 months, and 1 year will be the measures of efficacy. Secondary aims are: 1.) to compare treatment completion rats and cessation rates of smokers with a history of an Axis I disorder to those without a history of an Axis I disorder (including psychoactive substance use disorders); 2.) to determine the extent to which the severity of nicotine dependence at baseline is a negative predictor of treatment response, reflected in treatment completion and smoking cessation and reduction rates at 3, 6, and 12 months post-treatment entry; 3.) to determine the predictive validity of pre- and post-treatment cue reactivity; 4.) to determine whether there is a positive relationship between the initial level of motivation to quit smoking and actual smoking cessation; 5.) to identify social and demographic characteristic associated with positive outcome and; (6.) to group assignment. This is an outpatient, prospective, matched, random assignment experimental study. Seventy medically and psychiatrically stable nicotine dependent cigarette smokers will receive ten consecutive weeks of a standard regimen for nicotine withdrawal (TN) plus 16 concurrent weeks of individualized cognitive behavioral therapy (ICB) while a second group of 70 smokers with similar characteristics will receive the (TN) treatment plus 16 concurrent weeks of educational videotapes about smoking and its adverse consequences (IVT). The 16 week experimental program and the control group programs must be completed by 20 weeks. The two groups will be compared with respect to treatment participation and for smoking cessation and smoking reduction rates will be measured at 3 months, 6 months, and 1 year. Smoking outcomes will be measured by self-report and confirmed by exhaled carbon monoxide measurements and urine nicotine concentrations.
