There is an increasing number of smokeless tobacco users in the United States. It is estimated that there are now approximately 12 million users of smokeless tobacco. The increase in the consumption of smokeless tobacco is of particular concern since a number of oral pathologies including cancer have been associated with smokeless tobacco. As of yet, there is no systematic study examining the treatment of smokeless tobacco users. Previous research has demonstrated that the use of nicotine gum among cigarette smokers is effective in alleviating some symptoms of tobacco withdrawal and in facilitating treatment success. Nicotine gum may be particularly useful in the treatment of smokeless tobacco users since our previous research has demonstrated that smokeless tobacco users experience significant withdrawal symptoms. The proposed research will systematically examine the most efficacious treatment for smokeless tobacco chewers. The research will involve four studies conducted over the course of five years. The first three studies will help determine the components to be employed in treatment which will result in the most efficacious approach. The first study will be a descriptive investigation of the situational factors and internal states associated with the use of smokeless tobacco, and the duration and amount of tobacco the individual chews during each of these events. The second study will examine the extent to which nicotine gum alleviates withdrawal symptoms from smokeless tobacco. The third study will determine the most effective dose (2 vs 4mg) and schedule of administration (fixed interval versus ad lib) of nicotine gum to optimize treatment outcome. The fourth study will incorporate the information obtained from the first three studies and compare the efficacy of four types of treatments on abstinence from smokeless tobacco: (1) placebo gum with minimal treatment contact; (2) nicotine gum with minimal treatment contact; (3) intensive behavioral treatment with placebo gum; and (4) intensive behavioral treatment with nicotine gum.
