ADDRESSING NICOTINE ADDICTION IN DRUG ABUSE PATIENTS

金伯·P·里希特博士、M.P.H.是一名接受过公共卫生培训的行为心理学家，他将利用MRSDA开发专业知识，解决药物滥用治疗中的尼古丁成瘾问题，估计80%的人吸烟。该提案将她在药物滥用预防、药物滥用治疗和降低心血管疾病风险方面的行为背景与戒烟的新重点结合起来。该计划概述了她在未来5年发展和启动完全独立的职业生涯所需的培训和研究经验，以解决药物滥用治疗中的人对尼古丁上瘾的问题。职业发展：活动包括神经系统化学培训、高级生物统计学、成瘾治疗和研究培训、尼古丁/药物成瘾研究人员为期一周的实习，以及强化生物伦理学课程。研究计划：建议的研究计划的目标是更好地了解接受化学依赖治疗的人的吸烟行为和尼古丁依赖，并确定在这一人群中减少吸烟的可接受和潜在有效的方法。具体地说，该计划涉及三项研究，涉及五个研究问题。研究1从患者的角度考察戒烟的关键问题。它由美沙酮维持治疗(MMT)和其他药物依赖计划的四个客户小组中的每一个小组组成的一系列两个重点小组。这8次会议将确定客户a)戒烟兴趣，b)戒烟障碍，c)成功的戒烟策略，d)可用于戒烟的避免非法药物使用的策略，以及e)戒烟的治疗偏好。研究2是一项描述性研究，考察了香烟使用模式和美沙酮维持之间的相互作用。21名美沙酮患者将使用电子监视器记录他们吸烟的频率和时间。将收集和分析有关美沙酮的时间和剂量的数据，以及一氧化碳水平和尼古丁渴望和戒断的心理指标，以评估美沙酮的剂量和时间是否与香烟消费和吸烟冲动的激增有关。研究3是一项初步研究，旨在探讨多种成分的戒烟干预措施的可行性和潜在效果。60名MMT患者将被随机分配到治疗组(尼古丁吸入剂和激励性访谈)或对照组(安慰剂吸入剂和类似的工作人员接触)。主要结果包括戒烟率和平均戒烟率。每天吸烟。试点数据将允许确定全面干预试验的样本量，并将用于评估年龄、性别、美沙酮剂量等变量对治疗效果的影响。该研究计划使用探索性、描述性和干预性研究来解决尼古丁成瘾的基本问题。每项研究都是独立的，但都是以前一项研究的结果为基础的。这项研究可以作为系统研究其他药物依赖者或其他药物滥用治疗模式患者尼古丁成瘾的模型。

Kimber P. Richter, Ph.D., M.P.H., is a behavioral psychologist with training in public health who will use the MRSDA to develop expertise in addressing nicotine addiction among persons in drug abuse treatment, an estimated 80 percent of whom smoke. The proposal combines her behavioral background in drug abuse prevention, drug abuse treatment, and cardiovascular disease risk reduction with a new focus on smoking cessation. This plan outlines the training and research experience she will need, over the next 5 years, to develop and launch a fully independent career addressing nicotine addiction among persons in drug abuse treatment. Career Development: Activities include training in the chemistry of the nervous system, advanced biostatistics, training in addictions treatment and research, a week-long internship with a nicotine/drug addictions researcher, and an intensive bioethics course. Research Program: The goal of the proposed research program is to better understand smoking behaviors and nicotine dependence among persons in treatment for chemical dependencies, and to identify acceptable and potentially effective methods for reducing cigarette smoking in this population. Specifically, the plan involves three studies that address five research questions. Study 1 examines key issues in smoking cessation from the patient's point of view. It consists of a series of two focus groups among each of four subgroups of clients in methadone maintenance treatment (MMT) and other drug dependency programs. These 8 sessions is will identify clients' a) interest in quitting, b) barriers to quitting smoking, c) successful strategies used to quit smoking, d) strategies used to avoid illicit drug use that might be adapted for smoking cessation, and e) treatment preferences for quitting smoking. Study 2 is a descriptive study examining interactions in patterns of cigarette use and methadone maintenance. Twenty-one methadone patients will use electronic monitors to record the frequency and timing of their cigarette consumption. Data on methadone timing and dose, as well as carbon monoxide levels and psychological measures of nicotine craving and withdrawal, will be collected and analyzed to assess whether methadone dose and timing are associated with surges in cigarette consumption and smoking urges. Study 3 is a pilot study examining the feasibility and potential efficacy of a multicomponent intervention on smoking cessation. Sixty MMT patients will be randomly assigned to treatment (nicotine inhaler and motivational interviewing) or control (placebo inhaler and comparable staff contact). Primary outcomes include quit rates and avg. daily cigarette use. Pilot data will allow determination of sample sizes for a full-scale intervention trial, and will be used to assess the effects of variables such as age, gender, methadone dose on treatment effects. The research plan uses exploratory, descriptive, and intervention research to address fundamental issues of nicotine addiction. Each study stands on its own, but is designed to build on the findings of the prior study. This research may serve as a model for systematic research on nicotine addiction in patients with other drugs of dependence or who are in other drug abuse treatment modes.