A randomized trial of concurrent smoking-cessation and substance use disorder
treatment in stimulant-dependent smokers.
Author(s): Winhusen TM(1), Brigham GS, Kropp F, Lindblad R, Gardin JG 2nd, Penn P, Hodgkins
C, Kelly TM, Douaihy A, McCann M, Love LD, DeGravelles E, Bachrach K, Sonne SC,
Hiott B, Haynes L, Sharma G, Lewis DF, VanVeldhuisen P, Theobald J, Ghitza U.
Affiliation(s): Author information:
(1)University of Cincinnati, 3210 Jefferson Ave, Cincinnati, OH 45220
winhusen@carc.uc.edu.
Publication date & source: 2014, J Clin Psychiatry. , 75(4):336-43
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
(χ(2)(1) = 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%; χ(2)(1) = 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.
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