Characteristics and clinical treatment of tobacco smokers enrolled in a VA substance use disorders clinic.

Individuals with a substance use disorder (SUD) diagnosis are more than twice as likely to smoke cigarettes as the general population. Emerging research has suggested that treating a substance use disorder simultaneously with tobacco use leads to a higher rate of treatment success for both substances. Despite this, substance use treatment protocols tend not to focus on tobacco use; in fact, traditional substance use treatments often discourage patients from attempting to quit smoking. One rationale is that patients may not be motivated to quit smoking. In the current study, data from veterans enrolled in outpatient treatment for a SUD were examined to assess for general characteristics of smokers as compared to non-smokers as well as to examine motivation to quit smoking. Baseline (i.e., pre-treatment) data from 277 Veterans were used. Charts of smokers in the SUD clinic (SUDC) were reviewed to assess how smoking is handled by SUDC providers, and if smokers attempt cessation. Of 277, 163 (59%) SUDC patients reported that they currently smoke cigarettes (M=16.3 cigarettes per day, SD=11.1). Smokers in the clinic reported greater general impairment than nonsmokers on the Short Index of Problems, F(1248)=8.9, p=0.003, as well as greater specific impairment: Physical Problems, F(1258)=13.5, p=0.000; Interpersonal Problems, F(1262)=5.6, p=0.019; Intrapersonal Problems, F(1260)=6.5, p=0.011, and Social Responsibility, F(1262)=14.7, p=0.000. Smokers in the sample were marginally more anxious than their non-smoking counterparts as measured by the GAD-7, F(1254)=4.6, p=0.053, though they were not significantly more depressed (p=0.19). On a 1-10 scale, smokers reported moderate levels of importance (M=5.4, SD=3.1), readiness (M=5.6, SD=3.2), and confidence (M=5.0, SD=3.0) regarding quitting smoking. Review of smokers' medical records reveal that while SUDC providers assess tobacco use at intake (90%) and offer treatment (86.5%), a substantially small portion of smokers attempt cessation (41.1%) while enrolled in SUDC. Moreover, no patients were enrolled in smoking-specific behavioral interventions while in SUDC, though 78 patients did obtain nicotine replacement or another smoking cessation medication (41% were prescribed by a SUDC provider). Contrary to the belief that treatment-seeking substance users are not motivated to quit smoking, these preliminary analyses demonstrate that Veterans were at least contemplating quitting smoking while they were enrolled in substance use treatment. Further, there is evidence that cigarette smokers have greater impairment caused by substance use, suggesting that this subgroup is of particular high need. Specific treatment recommendations are discussed, including how behavioral health providers in SUD clinics may be better able to capitalize on patients' moderate motivation to quit at intake.

Utilizing a multimodal assessment strategy to examine variations of impulsivity among young adults engaged in co-occurring smoking and binge drinking behaviors.

BACKGROUND: Smoking among young adults predicts a greater severity of alcohol use and contributes to an increased difficulty in maturing out of heavy drinking behaviors that are established during college. Moreover, research has implicated impulsivity in the initiation and maintenance of both behaviors. Much less is known, however, about potential variations of impulsivity among young adults and whether a relationship exists between this construct and abstinence from smoking. As a result, this study examined differences and changes in trait and behavioral indices of impulsivity as a function of binge drinking among a sample of cigarette smokers using a multimodal assessment strategy. METHODS: Participants (N=40) were regular cigarette smokers who reported engagement in binge drinking or no binge drinking during the past year. All participants completed self-report and behavioral assessments of impulsivity prior to and following a period of smoking abstinence. RESULTS: Compared to their non-binge drinking peers, binge-drinking smokers reported significantly higher scores on the UPPS (lack of) Premeditation factor (p<.05), while also exhibiting a greater deficit in inhibitory control while in a nicotine satiated state (p<.05). However, no significant differences of inhibitory control were observed between groups following the 24-h deprivation period. CONCLUSIONS: Findings suggest that baseline differences in lack of planning and inhibitory control exist among young adults who concurrently smoke and binge drink. These results provide preliminary data for the need of tailored interventions for this population.

Differences in drinking patterns, occupational stress, and exposure to potentially traumatic events among firefighters: predictors of smoking relapse.

BACKGROUND AND OBJECTIVES: Despite the increased awareness regarding the risks of cigarette smoking, this behavior continues to be a serious public health concern. As such, the goal of the current study was to examine risk factors for smoking relapse among individuals employed through fire service. METHODS: In this report, drinking changes, trauma exposure, and occupational stress were compared among firefighters (N = 81) who reported a relapse to cigarette smoking (n = 27), a lifetime former history of smoking (n = 27), or no history of smoking (n = 27). Mechanisms behind tobacco relapse occurring after employment in fire service were explored. RESULTS: Firefighters who relapsed to smoking, when compared to their nonsmoking peers, had higher rates of weekly alcohol consumption throughout their first year of fire service and had greater increases in drinking from preacademy to postacademy. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Gaining a better understanding of these behaviors within this understudied and high-risk population may provide valuable information that can be used in designing future relapse prevention strategies as well as smoking cessation interventions.

Clinical PhD graduate student views of their scientist-practitioner training.

OBJECTIVES: The goal of the scientist-practitioner (S-P) training model is to produce clinical psychologists equipped to integrate and utilize both science and practice in the clinical and research domains. However, much has been written regarding the possible shortcomings of S-P training and whether clinical psychology graduate students are actually gaining the knowledge and skills to integrate science and practice during graduate training and beyond (Chang, Lee, & Hargreaves, 2008; Gelso, 2006; Merlo, Collins, & Bernstein, 2008; Phillips, 1993). METHODS: As such, the present study assessed ratings of satisfaction, perception of ability, and use of the S-P training model within 653 clinical psychology graduate students enrolled in programs that are members of the Council of University Directors of Clinical Psychology. RESULTS: Findings suggest that students are consistently trained in the integration of science and practice and have confidence in their abilities to apply the S-P integration to research and clinical work. However, despite understanding the ways in which science can influence practice, over one third of students reported that they rarely use science-based decisions when informing clients of the clinical services they will be providing. CONCLUSIONS: The implications of these results support the need for a more detailed evaluation of clinical psychology graduate students as well as the use of research-informed practice and the process of providing clients with information they need to make informed choices about treatment.

Examining the interrelationships between social anxiety, smoking to cope, and cigarette craving.

Smokers with symptoms of social anxiety often report smoking as a way to cope with negative affect. These individuals have lower success rates when attempting cessation compared with the general population. However, there is a paucity of research examining the role of social anxiety in nicotine dependence. The present study explored the relationships between symptoms of social anxiety, smoking to cope with these symptoms during social situations (STC), and cigarette craving. Thirty-eight participants completed measures of social anxiety and STC at baseline. Cigarette craving was subsequently assessed pre and post exposure to smoking-related images during periods of nicotine satiation and deprivation. Regression analyses revealed that greater symptoms of social anxiety predicted the frequency of STC behaviors and the number of cigarettes participants thought they would need in order to feel more comfortable in social situations. Symptoms of social anxiety and several behaviors associated with STC (e.g., avoiding social situations in which smoking is not permitted) predicted increases in craving during nicotine deprivation, but not satiation. These findings suggest that symptoms of social anxiety and STC behaviors may play a role in the maintenance of smoking behaviors. Further, targeting symptoms of social anxiety within the context of smoking cessation treatment may be particularly helpful and may improve the rates of smoking cessation among individuals with symptoms of social anxiety.

The effect of chewing gum flavor on the negative affect associated with tobacco abstinence among dependent cigarette smokers.

Many smokers relapse during cessation attempts due to increases in negative affect. Previous research has shown that chewing confectionary chewing gum appears to lessen the severity of acute nicotine withdrawal symptoms and help individuals who are trying to reduce smoking in part due to the flavor of the gum chewed. The current study compared the effects of three flavored gums to a No Gum Control during 48-hour cessation periods for young dependent smokers. Forty-nine smokers participated in three experimental conditions (peppermint, vanilla, and baked apple cardamom flavored gum) as well as a No Gum Control across four weeks while abstaining from smoking for 48-hours each week. Compared to the No Gum Control, participants in the Gum conditions reported lower levels of anxiety, dysphoria, and tension. Vanilla and baked apple cardamom flavored gum resulted in lower levels of negative affect while peppermint flavored gum was not different from the No Gum Control. These findings indicate that some flavors of gum are effective in reducing the negative affect associated with nicotine withdrawal and may serve as a valuable tool in helping smokers quit.

The effect of chewing gum on self-reported nicotine withdrawal: is it the flavor, the act of chewing, or both?

A healthy alternative that has been shown to lessen the severity of nicotine withdrawal symptoms during brief periods of nicotine abstinence (e.g., 3-4 h) is confectionary chewing gum (Cohen and colleagues, 1997, 1999, & 2001). The current study sought to build upon this line of research by examining the impact of chewing gum on nicotine withdrawal severity over an extended period of nicotine abstinence (e.g., 24 h) while also identifying the specific attributes of chewing gum that may be responsible for the reported decreases in withdrawal. Specifically, the acts of chewing, flavor, as well as the combination of the two, were independently examined. Twenty-four dependent cigarette smokers participated in three experimental conditions (e.g., a flavorless gum base, flavor strips, and flavored chewing gum) as well as a no product control across four weeks while abstaining from smoking for 24 h each week. Using repeated measures ANOVAs, a significant difference in withdrawal severity was reported by participants across conditions, F(3, 69)=2.89, p < .05. Follow-up analyses revealed that the flavored gum condition yielded significantly lower withdrawal scores than the flavorless gum base and no product control conditions. These findings indicate that chewing gum appears useful in lessening the severity of nicotine withdrawal symptoms over a 24-hour period of nicotine abstinence and that it is a combination of flavor and chewing that appears to lead to this effect.

The role of impulsivity on smoking maintenance.

In order to better understand why those higher in impulsivity experience more difficulties during smoking abstinence, the current study examined the possible mechanisms contributing to cigarette smoking relapse. Fifty dependent cigarette smokers completed measures designed to assess craving, tobacco withdrawal severity, and negative affect during 48 hours of nicotine abstinence. Using a series of multilevel models (SAS Proc Mixed Procedure), significant impulsivity x time analyses revealed differences in craving, F(2, 96) = 3.74, p<.05, and anxiety, F(2, 96) = 3.23, p<.05. Simple slopes analyses indicated that heightened trait-impulsivity predicted greater increases in craving and anxiety during a 48-hour abstinence period. These findings suggest that smokers with higher levels of impulsivity may lack the ability to find an accessible and comparable substitute for cigarette smoking during a cessation attempt. This study also highlights the importance of considering individual differences when treating those who wish to quit smoking.

Impulsivity and the role of smoking-related outcome expectancies among dependent college-aged cigarette smokers.

The relationship between trait-impulsivity and smoking expectancies on smoking progression in undergraduate college students was examined over a 48-hour period of smoking abstinence. Participants were forty-nine college-aged dependent cigarette smokers who completed measures designed to assess impulsivity, nicotine dependence, and smoking expectancies. Using a series of multilevel models, impulsivity by time analyses indicated significant differences in positive reinforcement expectancies, [F (2, 94)=3.19, p<.05], but not in negative reinforcement expectancies, [F (2, 94)=0.49, p=.61]. Simple slopes analyses indicated that heightened trait-impulsivity predicted greater increases in positive reinforcement outcome expectancies at 48 h of abstinence. Level of impulsivity, however, was not related to changes in negative reinforcement expectancies. Results indicate that during an abstinence period, college students higher in trait-impulsivity may be more prone to relapse due to stronger beliefs about the positive effects from smoking a cigarette. These findings highlight the importance of understanding the interaction of personality and cognitive factors when working with young adult smokers wishing to quit this health-compromising behavior.