Over 75% of drug abusers receiving methadone maintenance treatment are tobacco smokers. Methadone patients disproportionately suffer from the physical consequences of smoking, including increased mortality, compared to the general population. Yet, smokers receiving methadone treatment are interested in quitting and receiving tobacco cessation treatment, and drug abusing smokers who quit smoking are less likely to use drugs. The few studies of smoking cessation interventions in methadone patients have shown significant reductions in tobacco use during and immediately after treatment;however, the percentages of individuals who quit smoking were small and nearly all those who quit quickly returned to smoking. In addition, the interventions studied were simple and modeled after guidelines for the general population that may not have accounted for the complex needs of drug abusers. To better help methadone maintained smokers quit smoking and maintain tobacco abstinence, we propose a study with the following aims: (1) to determine the structure and elements of smoking cessation treatment that will help methadone maintained smokers quit smoking and maintain long-term tobacco abstinence;(2) to develop a manual for a tailored, intensive smoking cessation intervention for methadone maintained smokers;and (3) to pilot and evaluate in a small randomized controlled trial the immediate and long-term effects of a tailored, intensive smoking cessation intervention for methadone maintained smokers. This study will consist of two projects. Project One will address Aim 1 and involve collecting qualitative data through focus groups with methadone clinic clinical staff and current and previous smokers receiving methadone maintenance treatment. The data collected from Project One will inform Project Two, to develop and pilot in a small randomized controlled clinical trial a tailored, intensive smoking cessation intervention for methadone maintained smokers (Aims 2 and 3). My goal is to become an independent clinical investigator with expertise in smoking cessation, qualitative and quantitative research methods, and behavioral intervention development. The Career Development Plan I have proposed includes mentorship and structured coursework in: (1) qualitative research methods and data analyses;(2) behavioral intervention development and methods for smoking cessation;(3) methodology and logistics of conducting randomized clinical trials;(4) epidemiology of tobacco use;(5) advanced quantitative statistical methods;and (6) responsible conduct of research. In addition, I will participate in local seminars and national scientific meetings.
Reducing tobacco use and increasing smoking cessation attempts among adults are objectives of Healthy People 2010, and determining the effectiveness of interventions targeting persons with co- occurring risk behaviors was identified as a priority in the National Institutes of Health State-of-the- Science Conference Statement on Tobacco Use. We hope to help methadone maintained smokers quit smoking and maintain tobacco abstinence by developing and evaluating and new smoking cessation intervention.
