TIMING OF SMOKING INTERVENTION IN ALCOHOL TREATMENT

酗酒者的吸烟率为80%-90%， 吸烟的酗酒者的发病率和死亡率都有所增加 与不吸烟的人相比。数据显示对……有相当大的兴趣 戒烟，即使是在戒酒的时候。的确有 越来越多的共识认为应该解决尼古丁依赖问题 在这一人群中，但缺乏有效的知识 干预的战略和最佳时机。烟草有 一般被排除在酒精和药物混合治疗之外 因为害怕危及治疗结果，然而 吸烟干预可能改善酒精摄入的新证据 治疗结果。我们建议对这一案件进行一次全面的审判 吸烟干预同时进行的效果观察 酒精强化治疗与延迟吸烟干预的对比 直到酒精治疗后6个月，比较1)短期和 长期戒烟率和2)酒精治疗 结果。我们将招募500名酒精使用障碍患者 明尼苏达州的四个治疗项目中也有吸烟者 (明尼阿波利斯，明尼阿波利斯，哈泽尔登，美景河滨医疗中心， 和梅奥诊所)，并将他们随机分配到同期或 延迟吸烟干预。吸烟干预将会 包括行为成分和透皮尼古丁 替代疗法，并且在两种治疗中将是相同的 除交货时间外，不同的群体之间也存在差异。初级阶段 终点是参与吸烟干预，持续进行 并在戒烟3个月和12个月后指出普遍存在的戒烟问题 吸烟干预，减少饮酒和 饮酒后6个月、12个月和18个月的酒精依赖程度 干预。包括时间线在内的标准方法 Back，酒精依赖量表，Beck抑郁量表， 治疗服务审查，酒精测试，附属报告， Fagerstrom尼古丁依赖试验、唾液可替宁和 过期的一氧化碳将用于收集数据和验证 结果。将使用多变量方法来比较终点 在两个吸烟治疗组中，并测量其疗效 吸烟干预对酒精治疗结果的影响。结果来自 该项目将为最佳时机提供可靠的指导 对酗酒患者进行吸烟干预 治疗，并最终证明是否同时进行 干预对酒精有积极的、消极的或中性的影响 治疗结果。

The prevalence of smoking in alcoholics is 80-90 percent, andsmoking alcoholics suffer increased morbidity and mortality compared to nonsmokers. Data show considerable interest in quitting smoking, even at the time of alcohol treatment. There is growing consensus that nicotine dependence should be addressed in this population, but a lack of knowledge about effective strategies and optimal timing for intervention. Tobacco has generally been excluded from mixed alcohol and drug treatment because fear of jeopardizing treatment outcomes, however there is new evidence that smoking intervention may improve alcohol treatment outcomes. We propose a radomized trial of the effectiveness of smoking intervention delivered concurrently with intensive alcohol treatment vs smoking intervention that is delayed until 6 months after alcohol treatment to compare 1) short and long-term smoking cessation rates and 2) alcohol treatment outcomes. We will recruit 500 patients with alochol use disorder who also smoke from four treatment programs in Minneasota (Fairview Riverside Medical Center, Hazelden, Minneapolis VA, and thhe Mayo Clinic), and randomize them to concurrent or delayed smoking intervention. The smoking intervention will include a behavioral component and transdermal nicotine replacement therapy , and will be the same in both treatment groups with exception of the timing of delivery. The primary endpoints are participation in the smoking intervention, continuous and point prevalent smoking abstinence 3 and 12 months after smoking intervention, and reduction in alcohol consumption and severity of alcohol dependence 6, 12, and 18 months after alcohol intervention. Standard methods including the Time Line Follow Back, Alcohol Dependence Scale, Beck Depression Inventory, Treatment Services Review, breathalyzer tests, collateral reports, Fagerstrom Test for Nicotine Dependence, saliva cotinine, and expired carbon monoxide will be used to collect data and validate outcomes. Multivariate methods will be used to compare ndpoints in the two smoking treatment groups and to measure the effect of smoking intervention on alcohol treatment outcomes. Results from this project will provide reliable guidance about the optimal timing for smoking intervention for patients who undergo alcohol treatment, and conclusively demonstrate whether concurrent intervention has a positive, negative, or neutral effect on alcohol treatment outcomes.