(Applicant?s Abstract) The primary specific aims of this component are to test a series of hypotheses about an experimental intervention for depressed smokers treated in a large urban outpatient psychiatric clinic. While there is a body of research on smoking treatment and depression, interventions for depressed smokers in real-life treatment settings are lacking. It is hypothesized that an experimental smoking cessation intervention, when compared with a control condition, will result in higher biochemically verified abstinence rates, at least one quit attempt, and a more stringent abstinence goal than a brief contact plus referral control. It is also hypothesized that the experimental intervention will decrease utilization of mental health services, that severity of psychiatric symptomatology and of functional impairment will predict smoking status, and that the intervention will be cost-effective. In the proposed study, 400 smokers, who have been screened for depressive disorders will be randomly assigned to either an experimental intervention or to a brief contact plus referral control. The experimental intervention is based on previous work in this laboratory, and on interventions shown to increase readiness to quit smoking. In the experimental smoking intervention, participants will be counseled using an expert system designed to increase treatment readiness at baseline and at 3,6, and 12 months. Participants in the experimental condition will be offered nicotine patch treatment and behavioral counseling. Counseling session content includes cognitive-behavioral mood management interventions, as well as specific smoking management strategies. Participants who fail nicotine patch treatment will be considered for bupropion treatment. Throughout treatment, each participant will be seen by a single smoking treatment counselor. In the brief intervention plus referral control, participants will receive a manual on smoking cessation, and a smoking treatment referral list in a single session. All participants will be assessed on cigarette smoking on the TRC Core battery at intake, and at 3, 6, 12 and 18 months. As part of the collaborative work of the component, a descriptive study of smoking behavior in seriously mentally ill, drug-abusing patients will also be completed using participants and data from Dr. Havassy?s Component. A pilot intervention study based on these data will be completed. Descriptive data on nicotine dependence will be collected from participants in Drs. Batki?s and Sorensen?s components.
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