Most alcohol and drug treatment programs do not systematically address cigarette smoking during treatment. One obstacle is a concern that smoking cessation early in recovery might increase risk of drinking relapse. Research on concurrent smoking cessation and alcohol treatment has yielded inconsistent results with respect to the impact of smoking cessation on drinking outcome. One problem with these studies is that they did not induce high smoking abstinence rates, so they did not offer much opportunity for smoking abstinence to undermine (or improve) alcohol outcomes. Our research team has recently has been testing the efficacy of various smoking cessation interventions for use during alcohol treatment. We found much better smoking quit ? rates in one study that used frequent brief behavioral contacts combined with contingency management. A second study by our team found somewhat better alcohol outcomes after a smoking cessation treatment that used a combination of nicotine patch and nicotine gum. Based on this research we developed for the proposed study a smoking cessation intervention that combines the most effective features of our earlier interventions. We believe this new intervention approach provides an excellent platform to address questions about the impact of smoking cessation on risk of alcohol relapse. We also believe that more information about the process of concurrent alcohol-tobacco treatment is needed before launching another outcome study. Results of this proposed clinical process study will guide the development of future clinical trials of smoking cessation for individuals with alcohol problems. Participants will be recruited as they begin intensive outpatient alcohol treatment. A randomized, 2-group design will compare one group provided a concurrent smoking cessation (CSC) intervention consisting of frequent brief behavioral contacts combined with contingency management plus open label nicotine patch and gum with a deferred smoking cessation (DSC) intervention group scheduled to receive a smoking intervention three months later. Dependent variables are process assessments reflecting alcohol relapse risk obtained using daily Interactive Voice Response (IVR) technology. These relapse risk processes include alcohol craving, negative affect, alcohol abstinence self efficacy, alcohol outcome expectancies, motivation for alcohol abstinence, and self-control demands. We will test the hypothesis that concurrent smoking cessation will have an impact on these process measures when compared with the deferred treatment control group. We will also follow our treated patients across three months using daily IVR process assessments in order to determine antecedents for relapse to drinking and test for differences between cigarette abstinent and smoking participants in identified drinking relapse antecedents. This study will allow tests of several competing behavioral theories of alcohol-tobacco interaction including cross substance cue reactivity theory, cross substance coping theory and limited strength theory. ? ? ?
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