ENHANCING ALCOHOL CONTROL WITH SMOKING CESSATION THERAPY

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The long-term objective of the proposed research is development of effective cigarette smoking cessation methods for recovering alcoholics. Tobacco use rates are high in this group. Those who continue to smoke are at risk for all the adverse health effects of tobacco use observed in the general population. Further, rates of oral and esophogeal cancers greatly exceed those observed among adults who only drink or only smoke. The specific aims are to successively test 2 minimal smoking cessation interventions to determine long-term effects on alcohol and on tobacco use among graduates of residential alcohol treatment programs. The pilot phase intervention will include physician counseling and provision of smoking cessation self-help materials at treatment center discharge. The evaluation phase intervention will include similar physician counseling and self-help materials, plus 3 followup telephone calls by health educators after discharge. In the pilot phase, data from a 1991 survey of Nebraska treatment centers will identify 4 centers interested in addressing nicotine dependence in their clients, as measured by the aggregated Support for Smoking Cessation (SFSC) score. The SFSC score will assign these centers to 2 strata. Within strata, centers will be randomized to the intervention (IN) or usual care (UC) condition. Using a screening measure to identify clients who smoke, each center will enroll 30 clients [N = 120] who consent to 6 month followup and physiologic confirmation of tobacco use. In intervention centers, a specially trained physician, or alternate treatment staff member, will deliver one-time smoking cessation counseling to clients immediately prior to discharge and provide self-help materials. Followup assessment of alcohol and tobacco use will be identical for IN and UC clients and will be done by mail and telephone at 1 and 6 months after discharge. Subjects will receive a $10.00 incentive for each completed questionnaire. Tobacco quitters will be asked to provide a sample of their saliva for cotinine analysis to verify self-report data. In the evaluation phase, the expanded intervention with telephone followup will be used. 12 centers will be recruited, matched by SFSC score, and randomly assigned to the IN or UC condition (6 each). Each evaluation phase center will enroll 50 clients [N = 600]. These participants will be assessed in the same manner as pilot phase clients but will be followed for an additional 12 months, to 18 months post treatment center discharge.