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Addressing Substance Abusers Who Also Smoke

Institution: Northern California Institute for Research & Education
Investigator(s): Karen Sees, D.O.
Award Cycle: 1994 (Cycle 3) Grant #: 3KT-0121 Award: $270,931
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: New Investigator Awards
Abstracts

Initial Award Abstract
The detrimental consequences of cigarette smoking are alarming, but should be even more alarming for the substance abuse treatment community. While less than one third of the adult population in the United States continues to smoke, the smoking rate in alcoholics/drug addicts is seventy percent or greater. Unfortunately, although cigarette smoking is recognized as causing nicotine dependence, the substance abuse treatment community continues to minimize its significance. The dogma persists that it is too difficult to give up all addictions at the same time. The extremely limited research on smoking cessation in alcoholics and drug addicts does not support this dogma. In fact, data suggests attempting smoking cessation in this population may increase their abstinence rate from other drugs of abuse.

A treatment intervention project with a sub-study will be completed during the three year funding period of this New Investigator Award. The research will focus on substance abusers who also smoke. Reports have consistently shown that mere physician's advice to quit smoking increases the percent of patients who are successful, and if the physicians advice is linked to a patient's health problem that is caused or exacerbated by smoking, the abstinence rate increases even more. The treatment intervention project will investigate whether these findings on smoking cessation hold true for patients enrolled in substance abuse treatment for another addiction. A random assignment to group design will be used where 250 subjects in substance abuse treatment are assigned to receive either a standard-care medical evaluation followed by advice to stop smoking, or a comprehensive medical evaluation looking specifically for smoking related health problems followed by linked advice, which is smoking cessation advice linked to any adverse health effects found in the subject. Pearson's chi-square will be used for comparing the proportions in each of the two conditions for equality on smoking verses non-smoking status. The main effect of group difference and the interaction of group difference by time will be tested by a 2 X 2 X K design using a log-linear model. A log-rank test will be used to compare 'attrition' between groups. The sub-study will use a correlational design based on data from subject interviews. Sixty subjects will be interviewed. These interviews will explore the relationship between cigarette smoking and the use of other drugs of abuse, including alcohol, focusing on cigarette smoking before, during and after other drug use, and any association between relapse to other drug use and cigarette smoking. Data collection methods, data collection instruments, and hypotheses for future research exploring the relationship between cigarette smoking and the use of other drugs of abuse will be formulated. Frequency counts, bar graphs and box plots will be used to examine the demographic variables.

In the first 30 months that this study was funded we recruited 145 subjects. One hundred subjects attended the advice session, 55 subjects have completed their six-month follow-up assessments, and 34 subjects have completed their twelve-month follow-up assessments. At the one month follow-up (following advice session), no subjects had quit smoking. However, self-reports indicated a small treatment group difference in whether subjects had reduced the amount of cigarettes smoked (68.2% of the Linked group had "cut down" vs. 43.5% of the Standard group, chi-square=2.78, p=.095), but no corresponding difference was found in CO levels (means of 19.2 for Linked and 22.4 for Standard, t-test p=.3853). This finding calls into question the validity of past advice to stop smoking studies which relied solely on self report of smoking with no biomedical verification.
Publications

Nicotine, negative affect, and depression
Periodical: Journal of Consulting and Clinical Psychology Index Medicus:
Authors: Hall SM, Munoz R, Reus V, Sees KL ART
Yr: 1993 Vol: 61 Nbr: 5 Abs: Pg: 761-767