New Approaches to Smoking Cessation in Heavy Drinkers

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DESCRIPTION (provided by applicant): Heavy drinkers smoke cigarettes at rates two to three times higher than the general population and are less successful both quitting smoking and reducing their alcohol use. The two behaviors are among the leading causes of morbidity and mortality in the United States and when combined represent a greater health burden than either alone. Despite these risks, smoking and heavy alcohol use are not typically treated concurrently and the existing combination treatments are of limited effectiveness. Intensive, integrated treatment may be beneficial for this population as well as targeting potential depression and sleep problems which frequently co- occur with smoking and heavy drinking, often emerge upon nicotine or alcohol withdrawal, and promote smoking and alcohol relapse. Depression and sleep problems are either not routinely addressed in smoking or alcohol interventions or relegated to elective content that may not be used. The overall goal of this proposal is to develop an independent clinical research program specializing in novel smoking cessation psychotherapy interventions for heavy drinkers that are integrated with alcohol treatment and target potential depression and sleep problems in this population. Dr. Fucito is a clinical psychologist with a broad clinical research background in substance abuse and specific training in laboratory and pharmacotherapy clinical trial smoking research. She has expertise in the associations among smoking, depression, and sleep problems and the role of smoking in alcohol treatment response, conducting cognitive- behavioral interventions for depression in smokers, and evaluating smoking pharmacotherapy treatment for heavy drinkers. Phase 1 of the research plan will involve analyses of completed smoking cessation clinical trials to further examine smoking relapse factors in heavy drinkers and inform Phase 2 intervention development. Phase 2 will entail the development and evaluation of an intensive, integrated cognitive-behavioral intervention for smoking and alcohol (CBT for SA) versus standard smoking counseling (SC) in heavy drinkers. CBT for SA will first be piloted with 10 heavy drinking smokers to refine session length and content and therapist training procedures. A randomized controlled trial with 40 heavy drinking smokers will then be conducted to compare the preliminary efficacy of CBT for SA versus SC for: (1) promoting smoking abstinence and (2) reducing the quantity and frequency of heavy drinking. Mentored career development and research activities are designed to develop Dr. Fucito's expertise in: (1) psychotherapy efficacy research, (2) advanced, longitudinal statistical techniques, (3) alcohol misuse assessment and treatment, and (4) classification and treatment of sleep problems. These training goals will be achieved through: (1) coursework, (2) mentorship and consultation with relevant experts, (3) clinical experiences, (4) seminars and resources available through the Yale Psychotherapy Development Center and Center for the Translational Neuroscience of Alcoholism, and (5) the proposed research projects. Through this career development and research, Dr. Fucito will acquire a better understanding of the nature and treatment of co-occurring cigarette smoking and heavy drinking to inform an independent career.