This study was designed to increase understanding about the alcohol-tobacco interaction processes that impact the treatment of individuals with combined alcohol and nicotine dependence. Treatment outcome methodology will be combined with sophisticated Ecological Momentary Assessment methodology in order to examine the extent to which smoking serves as a cue for alcohol craving and/or a response to alcohol craving in treated alcoholics. A secondary aim of the study will be to examine treatment outcome effects of delivering a smoking cessation intervention concurrent with ambulatory treatment for alcohol dependence. If smoking cessation treatment is found to affect alcohol outcome, further analyses will be conducted to determine the impact of possible mediators of this effect such as alcohol abstinence self-efficacy and alcohol-related coping skills. Subjects will be 112 alcoholics who have requested alcohol treatment and are willing to attempt smoking cessation. Subjects will be veterans participating in the Substance Abuse Day Programs at the Newington and West Haven campuses of the VA Connecticut Healthcare System. Non-veteran women will be recruited from the community and enrolled in the Day Program to ensure adequate gender representation. One week after admission to the Day Program, subjects will be randomly assigned to one of the following two conditions: (1) Intensive smoking cessation therapy (behavioral counseling plus nicotine replacement using nicotine patches) concurrent with alcohol treatment, or (2) Brief smoking cessation advice concurrent with alcohol treatment. Two days before completing the Day Program, subjects will be instructed in self-monitoring of moods, situations, drinking, smoking and urges to drink or smoke using a hand-held computer that will beep them for assessment at random times 4 times/day. They will also be instructed to activate the computer immediately prior to, and just following, smoking each of four cigarettes per day. After leaving treatment they will continue to self-monitor for 14 days. Outcome will be measured at 14 days, three months and six months posttreatment using interviews, questionnaires, and biological measures.
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