A Randomized Trial of Contingency Management for Smoking Cessation During Intensive Outpatient Alcohol Treatment.

INTRODUCTION: This randomized clinical trial was designed to evaluate the efficacy of contingency management (CM) for smoking cessation for smokers with alcohol abuse or dependence delivered concurrently with intensive outpatient alcohol treatment. The study also explored the indirect effects of CM smoking treatment and smoking cessation on alcohol and drug use outcomes. METHODS: Alcohol abuse/dependent smokers were randomized to cognitive behavioral therapy plus nicotine replacement therapy plus contingency management (CBT+NRT+CM) or to cognitive behavior therapy plus nicotine replacement therapy (CBT+NRT) delivered concurrent with a three-week intensive outpatient alcohol treatment program. RESULTS: Participants in the CBT+NRT+CM condition were significantly more likely to be cigarette abstinent at the end of treatment (χ2(1)=8.48, p=.004) with approximately double the carbon monoxide confirmed quit rate (60%) compared with the CBT+NRT condition (29%). At the one-month and six-month time-points there were nonsignificant differences in smoking abstinence outcomes by condition. Smoking treatment condition did not directly affect alcohol abstinence outcomes, but we observed an indirect effect of smoking treatment on alcohol and drug abstinence at one-month follow-up that was mediated by smoking cessation at the end of treatment. CONCLUSIONS: Adding CM to an evidence-based smoking cessation treatment that included medication and behavioral counseling doubled the quit rate at the end of treatment. This finding provides strong evidence for the efficacy of CM for helping alcohol dependent smokers reach the milestone of initial smoking abstinence.

Anxiety and smoking cessation outcomes in alcohol-dependent smokers.

INTRODUCTION: Anxiety-related characteristics, including anxiety sensitivity and trait anxiety, are elevated in individuals with alcohol and nicotine dependence and associated with greater difficulties with quitting smoking. However, little is known about how anxiety-related characteristics are related to smoking cessation outcomes in alcohol-dependent smokers. The present study, part of a larger smoking cessation clinical trial, examined associations between anxiety sensitivity, trait anxiety, nicotine withdrawal symptoms, smoking urges, and smoking cessation outcomes in a sample of 83 alcohol-dependent smokers. METHODS: Participants were enrolled in concurrent alcohol and tobacco treatment as part of a substance-abuse intensive outpatient program. Smoking cessation treatment was administered in a 3-week cognitive-behavioral format that included 8 weeks of open-label nicotine patch treatment. Information on nicotine withdrawal, smoking urges, and CO-confirmed smoking consumption rates was collected at baseline, quit date, end of behavioral treatment, and at a 1-month follow-up. RESULTS: Higher levels of anxiety sensitivity were associated with more smoking urges due to anticipation of negative affect relief at quit date. Higher levels of trait anxiety were associated with more smoking urges due to positive reinforcement and anticipation of relief of negative affect at quit date, as well as more severe nicotine withdrawal symptoms at the end of treatment. Levels of anxiety sensitivity and trait anxiety were not associated with Cox regression survival times to relapse. CONCLUSION: These results indicate that for alcohol-dependent smokers, levels of anxiety sensitivity and trait anxiety are important to consider in the assessment and treatment of nicotine dependence.

Cardiovascular reactivity to and recovery from stressful tasks following a mindfulness analog in college students with a family history of hypertension.

OBJECTIVES: Ninety-seven (97) undergraduates with a family history of hypertension participated in a study that evaluated the effects of a brief mindfulness-induction on cardiovascular reactivity and recovery to two stressors. MATERIALS AND METHODS: Participants were randomized to either a mindfulness-induction or control condition and were then exposed to the cold pressor task (CPT) followed by the mirror-tracing task (MT). Blood pressure and heart rate were measured at baseline and postinduction, as well as during and immediately following each stressor. RESULTS: There were no group differences in reactivity to either stressor. Participants in the mindfulness-analog condition experienced significantly greater latency to systolic blood pressure recovery following the CPT and a tendency toward greater latency to diastolic blood pressure recovery, although these findings were not replicated with the MT task. CONCLUSIONS: These results are contrary to what was hypothesized and to the anecdotal evidence available regarding effects of comprehensive mindfulness interventions on reactivity. The findings are discussed with respect to purported mechanisms of mindfulness and learning theory.

Comparing brief stress management courses in a community sample: mindfulness skills and progressive muscle relaxation.

This study sought to compare a five-week mindfulness meditation (MM) course to a five-week course that taught progressive muscle relaxation (PMR). Forty-three adults from the community were randomly assigned to either MM (n = 19) or PMR (n = 24) courses after responding to flyers and other advertisements for a free stress management course. Mindfulness meditation participants practiced meditation significantly more often than PMR participants practiced relaxation during the intervention period (F[1, 43] = 7.42; P < .05). Interestingly, the two conditions did not differ significantly in their posttreatment levels of relaxation or mindfulness. Although there were no differences between groups on any of the primary outcome measures, across both treatment conditions there were statistically significant reductions from pretreatment to posttreatment in general psychological distress. Thus, although MM did not emerge as clearly superior to PMR, results of this study suggest that a brief mindfulness skills course may be effective for stress management.

Determinants of positive and negative consequences of alcohol consumption in college students: alcohol use, gender, and psychological characteristics.

To examine the influence of alcohol consumption, gender, and psychological risk and protective factors on college students' experiences of negative and positive consequences, the present study of 181 students assessed frequency and quantity of alcohol consumption, negative and positive consequences of alcohol use, positive alcohol expectancies, constructive thinking, and positive and negative affect. Results indicated that men and women differed in their experience of some consequences and that while alcohol consumption was generally more strongly related to consequences for women than for men, it was unrelated to most consequences. Further, when controlling for alcohol consumption, positive alcohol expectancies and negative affect were positively related to experiencing positive and negative consequences while constructive thinking was related to fewer positive and fewer negative consequences. Results indicate that consequences are much more strongly related to psychological risk and protective factors than to alcohol consumption. The article concludes with a discussion of implications for intervention efforts.