The prevalence of smoking in alcoholics is 80-90 percent, andsmoking alcoholics suffer increased morbidity and mortality compared to nonsmokers. Data show considerable interest in quitting smoking, even at the time of alcohol treatment. There is growing consensus that nicotine dependence should be addressed in this population, but a lack of knowledge about effective strategies and optimal timing for intervention. Tobacco has generally been excluded from mixed alcohol and drug treatment because fear of jeopardizing treatment outcomes, however there is new evidence that smoking intervention may improve alcohol treatment outcomes. We propose a radomized trial of the effectiveness of smoking intervention delivered concurrently with intensive alcohol treatment vs smoking intervention that is delayed until 6 months after alcohol treatment to compare 1) short and long-term smoking cessation rates and 2) alcohol treatment outcomes. We will recruit 500 patients with alochol use disorder who also smoke from four treatment programs in Minneasota (Fairview Riverside Medical Center, Hazelden, Minneapolis VA, and thhe Mayo Clinic), and randomize them to concurrent or delayed smoking intervention. The smoking intervention will include a behavioral component and transdermal nicotine replacement therapy , and will be the same in both treatment groups with exception of the timing of delivery. The primary endpoints are participation in the smoking intervention, continuous and point prevalent smoking abstinence 3 and 12 months after smoking intervention, and reduction in alcohol consumption and severity of alcohol dependence 6, 12, and 18 months after alcohol intervention. Standard methods including the Time Line Follow Back, Alcohol Dependence Scale, Beck Depression Inventory, Treatment Services Review, breathalyzer tests, collateral reports, Fagerstrom Test for Nicotine Dependence, saliva cotinine, and expired carbon monoxide will be used to collect data and validate outcomes. Multivariate methods will be used to compare ndpoints in the two smoking treatment groups and to measure the effect of smoking intervention on alcohol treatment outcomes. Results from this project will provide reliable guidance about the optimal timing for smoking intervention for patients who undergo alcohol treatment, and conclusively demonstrate whether concurrent intervention has a positive, negative, or neutral effect on alcohol treatment outcomes.
