New Approaches to Smoking Cessation in Heavy Drinkers

描述（由申请人提供）：重度饮酒者吸烟率比一般人群高出两到三倍，戒烟和减少饮酒的成功率都较低。这两种行为是美国发病率和死亡率的主要原因之一，当两者结合起来时，会比单独使用更大的健康负担。尽管有这些风险，但吸烟和酗酒通常不会同时治疗，现有的联合治疗效果有限。强化、综合的治疗可能对这一人群有益，并针对潜在的抑郁症和睡眠问题，这些问题经常与吸烟和酗酒同时发生，通常在尼古丁或酒精戒断后出现，并促进吸烟和酒精复发。抑郁症和睡眠问题要么没有在吸烟或酒精干预中得到常规解决，要么被降级为可能不会使用的选修内容。该提案的总体目标是开发一个独立的临床研究项目，专门针对重度饮酒者进行新型戒烟心理治疗干预，并将其与酒精治疗相结合，并针对该人群中潜在的抑郁症和睡眠问题。Fucito博士是一名临床心理学家，在药物滥用方面具有广泛的临床研究背景，并在实验室和药物治疗临床试验吸烟研究方面接受过专门培训。她在吸烟，抑郁症和睡眠问题之间的关联以及吸烟在酒精治疗反应中的作用方面具有专业知识，对吸烟者的抑郁症进行认知行为干预，并评估重度饮酒者的吸烟药物治疗。研究计划的第一阶段将涉及对已完成的戒烟临床试验进行分析，以进一步检查酗酒者的吸烟复吸因素，并为第二阶段的干预开发提供信息。第二阶段将需要开发和评估密集的，综合的认知行为干预吸烟和酒精（CBT SA）与标准的吸烟咨询（SC）在重度饮酒者。SA的CBT将首先在10名重度饮酒吸烟者中进行试点，以完善会话长度和内容以及治疗师培训程序。然后将对40名重度饮酒吸烟者进行随机对照试验，以比较SA与SC的CBT的初步疗效：（1）促进戒烟和（2）减少重度饮酒的数量和频率。Fucito博士的专业知识：（1）心理治疗疗效研究，（2）先进的纵向统计技术，（3）酒精滥用评估和治疗，以及（4）睡眠问题的分类和治疗。这些培训目标将通过以下方式实现：（1）课程，（2）与相关专家的指导和咨询，（3）临床经验，（4）通过耶鲁心理治疗发展中心和酗酒转化神经科学中心提供的研讨会和资源，以及（5）拟议的研究项目。通过这项职业发展和研究，Fucito博士将更好地了解同时吸烟和酗酒的性质和治疗，为独立的职业生涯提供信息。

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.