Concurrent Alcohol and Smoking Treatment: Effects on Alcohol Relapse Risk

描述(由申请人提供)：大多数酒精和药物治疗计划没有系统地解决治疗期间吸烟的问题。一个障碍是担心在康复早期戒烟可能会增加再次饮酒的风险。关于戒烟和饮酒同时进行的研究在戒烟对饮酒结果的影响方面得出了不一致的结果。这些研究的一个问题是，它们不会导致高戒烟率，因此它们没有提供太多机会让戒烟破坏(或改善)酒精结果。我们的研究团队最近一直在测试酒精治疗期间使用的各种戒烟干预措施的有效性。我们发现戒烟要好得多 在一项研究中，使用频繁的短暂行为接触和应急管理相结合的比率。我们团队的第二项研究发现，在联合使用尼古丁贴片和尼古丁口香糖进行戒烟治疗后，酒精结果有所改善。基于这项研究，我们为这项拟议的研究开发了一种戒烟干预措施，它结合了我们早期干预措施中最有效的特征。我们认为，这种新的干预方法提供了一个很好的平台来解决戒烟对酒精复发风险的影响问题。我们还认为，在启动另一项结果研究之前，需要更多关于同时烟酒治疗过程的信息。这项拟议的临床过程研究的结果将指导未来针对有酒精问题的个人进行的戒烟临床试验的发展。参与者将在开始强化门诊酒精治疗时被招募。一项随机的两组设计将比较同时接受戒烟(CSC)干预的一组和计划在三个月后接受吸烟干预的延迟戒烟(DSC)干预组。CSC干预包括频繁的短暂行为接触结合应急管理加上开放标签尼古丁贴片和口香糖。因变量是使用日常互动语音应答(IVR)技术获得的反映酒精复发风险的过程评估。这些复发风险过程包括对酒精的渴望、负面情绪、戒酒自我效能、酒精结果预期、戒酒动机和自我控制需求。与延期治疗对照组相比，我们将测试同时戒烟将对这些过程措施产生影响的假设。我们还将使用每日IVR过程评估对我们的治疗患者进行为期三个月的跟踪，以确定再次饮酒的前因，并测试戒烟和吸烟参与者之间在已确定的饮酒复发前因方面的差异。本研究将检验烟酒相互作用的几种竞争行为理论，包括交叉物质线索反应理论、交叉物质应对理论和有限强度理论。

DESCRIPTION (provided by applicant): Most alcohol and drug treatment programs do not systematically address cigarette smoking during treatment. One obstacle is a concern that smoking cessation early in recovery might increase risk of drinking relapse. Research on concurrent smoking cessation and alcohol treatment has yielded inconsistent results with respect to the impact of smoking cessation on drinking outcome. One problem with these studies is that they did not induce high smoking abstinence rates, so they did not offer much opportunity for smoking abstinence to undermine (or improve) alcohol outcomes. Our research team has recently has been testing the efficacy of various smoking cessation interventions for use during alcohol treatment. We found much better smoking quit rates in one study that used frequent brief behavioral contacts combined with contingency management. A second study by our team found somewhat better alcohol outcomes after a smoking cessation treatment that used a combination of nicotine patch and nicotine gum. Based on this research we developed for the proposed study a smoking cessation intervention that combines the most effective features of our earlier interventions. We believe this new intervention approach provides an excellent platform to address questions about the impact of smoking cessation on risk of alcohol relapse. We also believe that more information about the process of concurrent alcohol-tobacco treatment is needed before launching another outcome study. Results of this proposed clinical process study will guide the development of future clinical trials of smoking cessation for individuals with alcohol problems. Participants will be recruited as they begin intensive outpatient alcohol treatment. A randomized, 2-group design will compare one group provided a concurrent smoking cessation (CSC) intervention consisting of frequent brief behavioral contacts combined with contingency management plus open label nicotine patch and gum with a deferred smoking cessation (DSC) intervention group scheduled to receive a smoking intervention three months later. Dependent variables are process assessments reflecting alcohol relapse risk obtained using daily Interactive Voice Response (IVR) technology. These relapse risk processes include alcohol craving, negative affect, alcohol abstinence self efficacy, alcohol outcome expectancies, motivation for alcohol abstinence, and self-control demands. We will test the hypothesis that concurrent smoking cessation will have an impact on these process measures when compared with the deferred treatment control group. We will also follow our treated patients across three months using daily IVR process assessments in order to determine antecedents for relapse to drinking and test for differences between cigarette abstinent and smoking participants in identified drinking relapse antecedents. This study will allow tests of several competing behavioral theories of alcohol-tobacco interaction including cross substance cue reactivity theory, cross substance coping theory and limited strength theory.