Cigarette smoking is a prototypic case of drug dependence and a dominant cause of coronary heart disease (CHD). CHD is the leading cause of morbidity and mortality in the US. Of the half-million deaths annually attributed to CHD, about 245,000 occur among women. There is an urgent need to determine whether existing smoking cessation interventions are applicable to women since most research has been conducted in men. Identifying effective treatment of tobacco dependence in women with heart disease is a priority in light of the dramatic and immediate health benefits of quitting smoking. This study will compare two theoretically-based treatment interventions that have demonstrated some efficacy in the treatment of tobacco dependence. Hospitalized women N=60) with angiographically documented coronary artery disease will be randomly assigned to a cognitive- behavioral relapse prevention intervention or a health-educational counseling intervention. Both manual-driven intervention will begin during hospitalization and consist of eight weekly sessions conducted by trained therapists. The primary dependent measure will be self-reported tobacco use over a one-year follow-up period. Urine continue determinations will be used to corroborate these reports. Relapse prevention therapy is expected to yield better overall outcome via intensive practice of coping skills. Repeated assessment of patients assigned to these interventions will permit prospective evaluation of behavioral, psychological, and environmental correlates of short- and long-term smoking modification. This information, in combination with pretreatment assessment of smoking and health status, psychosocial functioning, cardiac health knowledge, ad coping skills, will be used to develop differential responder profiles indicating the most efficacious match of patient and therapy. Prospective outcome data from patients who quit without treatment assistance will be used as normative data against which treatment outcomes can be compared. This subgroup of """"""""self- quitters"""""""" will also provide valuable information concerning successful coping strategies for relapse prevention. This application: i) describe a careful study of theoretically based treatments for drug dependence, ii) answers previously neglected questions concerning smoking cessation and effective relapse prevention strategies for the treatment of tobacco/nicotine dependence in health- compromised women, and iii) provides a useful conceptual understanding and research design for treatment of other groups of high-risk drug dependent patients. These outcomes provide a foundation for achieving the national objectives of health promotion and disease prevention.
