Recent studies have demonstrated that over 75% of alcohol dependent persons in early alcohol recovery smoke cigarettes and that smoking-related mortality exceeds alcohol-related mortality in this population. Fortunately, many alcohol dependent persons in early recovery are interested in smoking cessation treatment. However, studies indicate that these smokers find it very difficult to quit smoking. The long-term quit rate rarely exceeds 12%. Indeed, many of these smokers, themselves believe that quitting smoking is more difficult than quitting drinking and have little confidence in their ability to succeed. Clearly, more effective methods need to be found to help these smokers. We believe that the neurobiology of early recovery, particularly with regard to dopamine, supports the investigation of a smoking cessation medication with dopaminergic properties for smokers in this population. In this study, Ss with between 6 and 8 months of abstinence from alcohol and other non-nicotine drugs will be randomly assigned to receive either 300-mg bupropion (BUP) or placebo medication daily for 8 weeks. All Ss will receive 3 counseling sessions prior to their target quit day and then twice per week counseling for 4 weeks. The primary outcome variable will be 7-day point prevalence at week 7 postquit day (end-of treatment). We will also use multiple regression to analyze end-of-treatment data at a Generalized Estimating Equation to analyze data at the 7-, 12- and 24-week follow up. A secondary aim of this project is to investigate mediating mechanisms of the efficacy of BUP in smoking cessation. We will investigate whether a prequit variable (i.e., smoking satisfaction) and three postquit variables (craving, nicotine withdrawal and negative affect) mediate BUP's efficacy. To our knowledge, this will be the first randomized, placebo-controlled trial of BUP for smoking cessation for smokers in early alcohol recovery. It will also be the first investigation of a prequit variable that may mediate the efficacy of BUP for smoking cessation. Findings from this study will contribute to our knowledge about how to best treat nicotine dependence among persons in recovery and will provide a solid foundation for determining future directions for research in this area.
