This project uses a 2 x 2 factorial design to compare efficacy of two behavioral methods, relapse prevention (RP) and contingency management (CM), for reducing tobacco smoking in methadone treated opiate addicts. All subjects will receive standard transdermal nicotine patch treatment to ameliorate nicotine withdrawal symptoms, which should make comparisons between conditions meaningful. The project also evaluates associations between cigarette smoking and illicit drug use at baseline, during treatment and at follow-up. A total of 220 subjects seeking smoking cessation treatment will be randomly assigned to one of four experimental treatment groups: (1) RP only; (2) CM only; (3) combined RP + CM; and (4) neither RP nor CM - a control condition that will receive nicotine patch only. The battery of assessments to measure various dimensions of smoking include the following: Demographic information; drug use history (ASI); psychiatric diagnosis (SCID); measurement of stage of readiness for change (URICA); biological markers of smoking (CO breath levels, serum thiocyanate); physical measures of drug use (urine toxicology) self-report of smoking and drug use (Fagerstrom, TLFB); mood and physical symptoms (SCL-90-R); treatment compliance (TSR; RP Survey); and staff clinical impression (CGI). Behavioral interventions are manualized and an audiotape procedure will be used to monitor and enhance protocol compliance. The proposed project would provide a definitive controlled trial of the comparative efficacy for integrating behavioral therapies with a pharmacological treatment for smoking cessation in this high risk population. Project findings would have relevance to applied settings and to theoretical understanding of interrelationships between tobacco smoking and other drug use.
