ADDRESSING NICOTINE ADDICTION IN DRUG ABUSE PATIENTS

金伯·p·里希特博士，公共卫生专业的行为心理学家，他将利用MRSDA来发展在药物滥用治疗中解决尼古丁成瘾问题的专业知识，估计有80%的人吸烟。该提案将她在药物滥用预防、药物滥用治疗和心血管疾病风险降低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年需要的培训和研究经验，以发展和启动一个完全独立的职业，解决药物滥用治疗人员中的尼古丁成瘾问题。职业发展：活动包括神经系统化学方面的培训，高级生物统计学，成瘾治疗和研究方面的培训，与尼古丁/药物成瘾研究人员进行为期一周的实习，以及强化的生物伦理学课程。研究计划：拟议的研究计划的目标是更好地了解正在接受化学依赖治疗的人的吸烟行为和尼古丁依赖，并确定可接受的和潜在有效的方法来减少这一人群的吸烟。具体来说，该计划涉及三项研究，解决五个研究问题。研究1从患者的角度探讨了戒烟的关键问题。它由美沙酮维持治疗（MMT）和其他药物依赖项目的四个客户亚组中的两个焦点小组组成。这8次会议将确定客户a)戒烟的兴趣，b)戒烟的障碍，c)成功的戒烟策略，d)可能适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，研究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测器记录他们吸烟的频率和时间。将收集和分析美沙酮服用时间和剂量的数据，以及一氧化碳水平和尼古丁渴望和戒断的心理测量，以评估美沙酮的剂量和时间是否与卷烟消费量和吸烟欲望的激增有关。研究3是一项试点研究，旨在探讨多组分干预戒烟的可行性和潜在疗效。60名MMT患者将被随机分配到治疗组（尼古丁吸入器和动机性访谈）或对照组（安慰剂吸入器和类似的工作人员接触）。主要结局包括戒烟率和平均每日香烟使用量。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。研究计划采用探索性、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，但都是建立在先前研究结果的基础上的。本研究可作为系统研究其他药物依赖患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.