A Randomized Trial of Concurrent Smoking-Cessation and Substance Use Disorder Treatment in Stimulant-Dependent Smokers

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ID: 272419
2013
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Abstract
Article Abstract Objective: To evaluate the impact of concurrent treatments for substance use disorder and nicotine-dependence for stimulant-dependent patients. Method: A randomized, 10-week trial with follow-up at 3 and 6 months after smoking quit date conducted at 12 substance use disorder treatment programs between February 2010 and July 2012. Adults meeting DSM-IV-TR criteria for cocaine and/or methamphetamine dependence and interested in quitting smoking were randomized to treatment as usual (n = 271) or treatment as usual with smoking-cessation treatment (n = 267). All participants received treatment as usual for substance use disorder treatment. Participants assigned to treatment as usual with concurrent smoking-cessation treatment received weekly individual smoking cessation counseling and extended-release bupropion (300 mg/d) during weeks 1-10. During post-quit treatment (weeks 4-10), participants assigned to treatment as usual with smoking-cessation treatment received a nicotine inhaler and contingency management for smoking abstinence. Weekly proportion of stimulant-abstinent participants during the treatment phase, as assessed by urine drug screens and self-report, was the primary outcome. Secondary measures included other substance/nicotine use outcomes and treatment attendance. Results: There were no significant treatment effects on stimulant-use outcomes, as measured by the primary outcome and stimulant-free days, on drug-abstinence, or on attendance. Participants assigned to treatment as usual with smoking-cessation treatment, relative to those assigned to treatment as usual, had significantly better outcomes for drug-free days at 6-month follow-up (χ21 = 4.09, P < .05), with a decrease in drug-free days from baseline of −1.3% in treatment as usual with smoking-cessation treatment and of −7.6% in treatment as usual. Participants receiving treatment as usual with smoking-cessation treatment, relative to those receiving treatment as usual, had significantly better outcomes on smoking point-prevalence abstinence (25.5% vs 2.2%; χ21 = 44.69, P < .001; OR = 18.2). Conclusions: These results suggest that providing smoking-cessation treatment to illicit stimulant-dependent patients in outpatient substance use disorder treatment will not worsen, and may enhance, abstinence from nonnicotine substance use. Trial Registration: ClinicalTrials.gov identifier: NCT01077024 J Clin Psychiatry © Copyright 2013 Physicians Postgraduate Press, Inc. Submitted: March 1, 2013; accepted July 15, 2013. Online ahead of print: December 10, 2013 (doi:10.4088/JCP.13m08449). Corresponding author: Theresa M. Winhusen, PhD, University of Cincinnati, 3210 Jefferson Ave, Cincinnati, OH 45220 (winhusen@carc.uc.edu).
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Authors Theresa M. Winhusen, Gregory S. Brigham, Frankie Kropp, Robert Lindblad, John G. Gardin II, Pat Penn, Candace Hodgkins, Thomas M. Kelly, Antoine Douaihy, Michael McCann, Lee D. Love, Eliot DeGravelles, Ken Bachrach, Susan C. Sonne, Bob Hiott, Louise Haynes, Gaurav Sharma, Daniel F. Lewis, Paul VanVeldhuisen, Jeff Theobald, Udi Ghitza
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Journal the journal of clinical psychiatry
Year 2013
DOI
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https://www.psychiatrist.com/jcp/addiction/substance-use-disorders/randomized-trial-concurrent-smoking-cessation-substance/
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