New Approaches to Smoking Cessation in Heavy Drinkers

描述（由申请人提供）：重度饮酒者的吸烟率是一般人群的两到三倍，在戒烟和减少饮酒方面都不太成功。这两种行为是美国发病率和死亡率的主要原因之一，两者结合起来比单独使用更大的健康负担。尽管存在这些风险，但吸烟和大量饮酒通常不会同时治疗，现有的联合治疗效果有限。强化综合治疗可能对这一人群有益，同时针对潜在的抑郁和睡眠问题，这些问题经常与吸烟和大量饮酒同时发生，经常在尼古丁或酒精戒断时出现，并促进吸烟和酒精复发。抑郁和睡眠问题不是在吸烟或酒精干预中常规处理，就是被归入可能不使用的选择性内容。本提案的总体目标是开发一个独立的临床研究项目，专门研究针对酗酒者的新型戒烟心理干预措施，该干预措施与酒精治疗相结合，并针对这一人群中潜在的抑郁和睡眠问题。Fucito博士是一名临床心理学家，在药物滥用和实验室和药物治疗临床试验吸烟研究方面拥有广泛的临床研究背景。她擅长研究吸烟、抑郁和睡眠问题之间的联系，以及吸烟在酒精治疗反应中的作用，对吸烟者的抑郁进行认知行为干预，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包括对已完成的戒烟临床试验的分析，以进一步检查重度饮酒者的吸烟复发因素，并为第二阶段干预措施的开发提供信息。第二阶段将需要开发和评估一种强化的、综合的认知行为干预吸烟和酒精（CBT对SA）与标准吸烟咨询（SC）对重度饮酒者的影响。CBT治疗SA将首先在10名重度饮酒吸烟者中进行试点，以改进疗程长度和内容以及治疗师培训程序。随后将对40名重度饮酒吸烟者进行随机对照试验，比较CBT对SA和SC的初步疗效：(1)促进戒烟；(2)减少重度饮酒的数量和频率。指导的职业发展和研究活动旨在发展Fucito博士在以下方面的专业知识：(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；(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)课程学习，(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酒精中毒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。通过这一职业发展和研究，Fucito博士将更好地了解吸烟和酗酒共存的本质和治疗方法，从而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. PUBLIC HEALTH RELEVANCE: Cigarette smoking and heavy drinking are among the leading preventable causes of death and disease in the United States. Smokers who drink alcohol heavily, however, are less able to quit smoking and reduce their alcohol use. More research on effective, integrated treatments for this underserved population is needed to reduce the significant disease burden and healthcare costs.