Nicotine dependence is the most prevalent substance abuse disorder among psychiatric patients, a group that accounts for 44% of the U.S. tobacco market. While numerous trials have established the effectiveness of smoking cessation interventions for hospitalized medical patients, psychiatric inpatients have largely been excluded. The objective of this proposal is to support the candidate's development of skills to perform patient-oriented research in the area of tobacco dependence treatment with comorbid smokers in new settings. The career plan includes training in clinical trials, cost-effectiveness, and psychopharmacology. The UCSF Department of Psychiatry and the NIDA-funded P50 San Francisco Treatment Center provide an exceptional environment for developing research investigators. The primary mentor, Dr. Sharon Hall, is a leading expert in the treatment of nicotine dependence and other drugs of abuse. Her extensive research background includes treatment of comorbid smokers in psychiatric settings. The primary specific aim of the research plan is to test in a randomized clinical trial (N=300) a series of hypotheses concerning the efficacy of an extended expert-system intervention plus nicotine replacement therapy (NRT) for treating tobacco dependence among patients hospitalized on a smoke-free psychiatric unit. It is hypothesized that the intervention will be more effective than the enhanced standard care control condition (on-unit NRT with self-help brochure) in producing biochemically verified abstinence from cigarettes at 3-, 6-, 12-, and 18-months follow up. Additionally, intervention participants will exhibit greater stage progression, commitment to abstinence, and delay in relapse to smoking following hospital discharge, factors predictive of future success with quitting smoking. Smoking cessation treatments have been shown to be highly cost-effective with the general population of smokers, and cost is likely to be a consideration in efforts to incorporate additional services into an inpatient psychiatric setting. Therefore, a secondary specific aim is to model the cost-effectiveness of the smoking cessation intervention. Intervention efficacy will be examined in a university-based psychiatric inpatient unit. A smaller pilot study (N=48) will examine translation of the intervention to a county hospital serving a more diversified patient population. Findings will be used in submission of an R01 application to conduct a multisite randomized trial.
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