A controlled smoking cessation trial for substance-dependent inpatients.

Smoking treatment for newly recovering drug and alcohol-dependent smokers in a residential rehabilitation program was examined. The randomly assigned conditions (n = 50 each) were multicomponent smoking treatment (MST), MST plus generalization training of smoking cessation to drug and alcohol cessation (MST+G), or usual care (UC). Fifty participants who declined smoking treatment (treatment refusers) also were studied. Both treatment conditions achieved continuous smoking abstinence rates (MST: 12%, MST+G: 10%, at 12-month follow-up) that were significantly higher than in the UC condition (0%). The MST condition had a continuous drug and alcohol abstinence rate that was significantly higher than that of the MST+G condition (40% vs. 20% at 12-month follow-up) although neither differed significantly from that of the UC condition (33%). These results support the feasibility of smoking treatment for this population and provide information regarding appropriate treatment components.

Issues related to smoking cessation among substance abusers.

Initial studies have found that stop-smoking treatments for newly recovering substance abusers have been neither harmful to sobriety nor effective in achieving smoking cessation. The development of more effective stop-smoking treatments for this population could be aided by delineating their particular smoking-related characteristics. This article describes the biopsychosocial characteristics of newly recovering substance abusers that are relevant to smoking cessation, and suggests that there are notable differences between abusers and nonabusers that may contribute to abusers' greater difficulty in quitting smoking. It also recommends changes in existing treatment protocols where applicable and identifies key areas for future research.

Substance-dependent inpatients who accept smoking treatment.

Delineating the characteristics of substance-dependent inpatients who are interested in receiving smoking treatment is critical to developing effective recruitment strategies and interventions for this population. Thus, this study comprehensively assessed and compared substance-dependent inpatients who accepted (n = 75) versus refused (n = 25) a stop-smoking treatment. Univariate analyses found treatment acceptors were younger, more addicted to nicotine, had more smoking-related health problems, had more positive attitudes about quitting smoking, and had more positive attitudes about the relationship between smoking cessation and drug/alcohol sobriety (e.g., believed cessation would positively impact sobriety). Logistic regression revealed that believing inpatient treatment was the best time to quit smoking was the primary factor associated with accepting treatment. Aside from their attitudes about the relationship between smoking cessation and sobriety, substance abusers who accepted smoking treatment appeared similar (e.g., in demographics, smoking behaviors) to nonabusers described in previous studies.

Cigarette smoking in alcohol and cocaine abusers.

This study compared the cigarette smoking of substance abusers whose primary substance of abuse was cocaine (cocaine group: n = 18) or alcohol (alcohol group: n = 23). Cigarette smoking and smoking topography was assessed daily (via self-report and single cigarette topography assessments) at baseline and following a switch to a cigarette brand with 30% lower nicotine. The alcohol and cocaine groups did not differ at baseline on cigarettes smoked per day, cigarette nicotine, smoking topography, or the Fagerstrom Tolerance Questionnaire. However, the cocaine group exhibited marked increases in compensatory smoking relative to the alcohol group following the 30% reduction in cigarette nicotine, as evidenced by decreases in the average time interval between each puff, p < .05, increases in the total amount of time spent puffing, p < .05, and increases in estimated total amount of time spent puffing per day, p < .05. These findings provide initial data that cocaine and alcohol abusers may titrate nicotine differently and suggest that cocaine abusers may require additional or modified smoking cessation treatments.

A cognitive-behavioral therapeutic community for substance dependent and homeless veterans: treatment outcome.

This paper presents data regarding a residential rehabilitation program that integrates cognitive-behavioral and therapeutic community techniques to treat homelessness and substance abuse. The study cohort was 110 military veterans admitted to a Domiciliary Care for Homeless Veterans program of the Department of Veterans Affairs. The cohort had multiple psychosocial problems at admission, and all had drug/alcohol abstinence as a treatment goal. Structured interviews conducted at 3, 6, 9, and 12 months postdischarge revealed that a substantial proportion had positive outcomes with respect to housing, substance abuse abstinence, employment, and self-rated psychological symptoms. This integrated cognitive-behavioral therapeutic community approach appears to be a viable treatment for this subset of homeless and also may be effective for other populations with similar clinical characteristics.

Drug and alcohol abuse inpatients' attitudes about smoking cessation.

Attitudes about quitting cigarette smoking were assessed at admission to a substance abuse treatment program for homeless veterans. The majority were interested in quitting smoking, believed that inpatient drug/alcohol treatment was the best time to quit, and that quitting would not threaten their sobriety. Using cluster analysis, four subgroups of inpatients with different levels of interest, confidence, and motivation regarding quitting smoking were identified. Our inpatients' positive attitudes about quitting smoking stand in contrast with previously reported attitudes of many health professionals, and suggest that inpatient treatment could be an opportune time to provide stop-smoking interventions. Findings also suggest that different treatment approaches may be needed for subgroups of inpatients with varying attitudes about quitting.

A computer-directed program for smoking cessation treatment.

This report describes a computer-directed cigarette smoking cessation program that individualizes nicotine fading schedules for smokers based upon their daily smoking behavior. Previous outcome data from minimal intervention and intensive stop-smoking treatment studies are presented. Preliminary urinary cotinine data also are presented to validate the program's underlying assumption that computer-directed nicotine fading results in across-treatment reductions in biological levels of nicotine.

Batter up! Relapse prevention for homeless veteran substance abusers via softball team participation.

Thirty-four veterans of a residential rehabilitation program for homelessness and substance abuse participated on a community-based softball team. Compared to nonparticipants, participants stayed in treatment longer and were more likely to complete all aspects of the program (inpatient and outpatient). They also were more likely to be abstinent from drugs/alcohol, employed, and housed 3 months postdischarge. Participation appeared to enhance outcomes by providing in vivo opportunities for practicing coping skills and developing supportive relationships. A softball program may be a viable adjunct treatment in which formally taught cognitive-behavioral skills can be applied in a natural, but semistructured setting.

The abstinence violation effect and very low calorie diet success.

This study evaluated the relationship between Marlatt and Gordon's (1985) Abstinence Violation Effect (AVE) and fasting outcomes of patients enrolled in a Very Low Calorie Diet (VLCD) and behavior education program. Within the first 11 weeks of the VLCD, 41 of 76 patients reported a fasting lapse and rated this lapse on an attribution scale. Patients reporting greater characterological attributions for their first lapse (i.e., a higher AVE) lost a smaller percentage of their excess weight during active fasting than patients reporting more situational attributions r(39) = -.36, p less than .025. First lapse AVE ratings did not distinguish between program dropout versus completer status, but high AVE dropouts did spend fewer weeks in the VLCD program than low AVE dropouts, r(12) = -.54, p less than .05. Although a faster's initial level of obesity accounted for the largest portion of weight loss outcome variance, the AVE accounted for a significant additional portion of outcome.

Smoking cessation for substance abuse inpatients.

The impact of a smoking cessation program on substance abuse inpatients was investigated. Thirty-nine male veterans were randomly assigned to stop-smoking (n = 19) or wait-list conditions (n = 20), and followed up 3- and 6-months postdischarge. Compared to wait-list subjects, stop-smoking subjects were more likely to continue inpatient treatment at least 30 days following study enrollment and reported greater posttreatment reductions in cigarette nicotine delivery. Importantly, assessments of postdischarge substance use and hospital readmission rates did not reveal any adverse effects from participation in the stop-smoking program.

Characteristics of telephone applicants to a residential rehabilitation program for homeless veterans.

This study gathered descriptive data on 163 individuals who applied by telephone to a residential rehabilitation program for homeless veterans and compared these data with general veteran and homeless populations. Ss were a young (M = 40.82 years) and educated (M = 13.34 years of schooling) subgroup of homeless men (98.16%) with histories of relatively high, stable functioning (e.g., previous successful employment) and high rates of medical (47.47%), substance abuse (67.1%), psychiatric (41.93%; primarily nonpsychotic), and legal (71.15%) problems. These characteristics appear to be different from those of other subgroups of homeless (e.g., homeless chronically mentally ill, skid-row alcoholics), and they provide a basis for beginning to develop distinct remedial strategies that are specific to this subpopulation. The advantages of studying subgroups of homeless and the utility of the telephone interview data collection methodology are discussed.

Computerized smoking cessation program for the worksite: treatment outcome and feasibility.

This study demonstrated the effectiveness of a computer-delivered smoking cessation program for the worksite. 58 VA Medical Center employees were randomly assigned to a computer group (computerized nicotine fading and stop-smoking contest) or a contest-only group. In comparison with the contest-only group, the computer group had nonsignificantly higher abstinence rates across follow-up, had marginally lower CO levels at the 3- and 6-month follow-ups, and smoked cigarettes with lower nicotine levels at the 10-day and 6-month follow-ups.

Self-efficacy and relapse among inpatient drug and alcohol abusers: a predictor of outcome.

Monthly intreatment ratings of self-efficacy to avoid drug and alcohol abuse were examined among 419 substance abuse inpatients of a residential treatment community. Posttreatment interviews were conducted with 81 patients approximately 6 months following discharge to assess the relationship between self-efficacy and relapse. As expected, self-efficacy increased during treatment and was higher among abstainers than relapsers at follow-up. Contrary to expectations, low self-efficacy at intake was related to longer inpatient residence and more positive conditions of discharge. Furthermore, abstainers had slightly lower self-efficacy scores than relapsers at intake and increased their self-efficacy two-fold over relapsers during the course of treatment. Contrary to previous research with tobacco smoking, self-efficacy ratings at the end of treatment were not related to substance abuse at follow-up. It is proposed that the present findings are consistent with previous research in demonstrating a relationship between self-efficacy and outcome, and provide new information suggesting that low self-efficacy may be related to positive outcome under certain circumstances. Hypotheses are advanced regarding (1) the potential utility of intreatment change measures, (2) the role of underestimation in self-efficacy ratings and (3) the role of denial in substance abuse populations.

Can across-treatment changes in cumulative puff duration predict treatment outcome during nicotine fading.

The smoking behavior of 10 male and 15 female smokers was assessed weekly during a standardized nicotine fading program to examine the relationship between compensatory smoking (i.e., increases in the number of cigarettes smoked per day, expired air carbon monoxide (CO), or the frequency and duration of puffs) and posttreatment abstinence from tobacco. Subjects who continued to smoke or relapsed immediately following treatment (Nonabstainers) smoked significantly more cigarettes per day during the program (p less than .05) and exhibited greater across-treatment increases in the time spent puffing a cigarette (i.e., cumulative puff duration) (p less than .05) than subjects who successfully quit smoking (Abstainers). Both Nonabstainers and Abstainers exhibited across-treatment decreases in expired air CO (p less than .001). Similar analyses conducted between subjects who were abstinent versus relapsed 3-6 months following treatment revealed no significant differences in smoking behavior, although both groups exhibited similar across-treatment decreases in CO (p less than .001) and time spent smoking a cigarette (i.e., time alite) (p less than .05). The findings are discussed in reference to their relevance to (a) the development of differential assessment procedures to match smokers to appropriate treatments; (b) the determination of appropriate procedural modifications in the nicotine fading protocol; and (c) nicotine regulation research.

Tobacco smoking: a comparison between alcohol and drug abuse inpatients.

This study compared the tobacco smoking of alcohol and drug abuse patients. The subjects were male inpatients (67 alcohol, 60 drug, and 13 mixed alcohol and drug abusers) of a Veterans Administration substance abuse program who had completed the Tolerance Questionnaire (Fagerstrom, 1978) and the Michigan Alcohol Screening Test (Skinner, 1979) as part of routine intake assessment procedures. As expected, an extremely high percentage (89.6%) of the alcohol abusers reported smoking cigarettes. Interestingly, an equally high prevalence of smoking was noted among the drug (90.0%) and mixed substance abuse (100%) groups. Comparisons conducted between abuse groups indicated that the alcohol abusers smoked significantly more cigarettes per day and had significantly higher Tolerance Questionnaire scores than the drug abusers, but did not differ from the mixed abuse group on any smoking variable. Additional comparisons of the total substance abuse population with a national sample of similarly aged males indicated that only the alcohol group smoked more cigarettes per day, but that all substance abuse groups smoked higher nicotine delivery cigarettes than the national sample.

Smoking topography and carbon monoxide levels in smokers.

Factors which effect the expired air carbon monoxide (CO) levels of smokers were examined in matched subject pairs who smoked an equal number of daytime cigarettes but had different CO levels (mean difference = 15.4 ppm). Measures of puff number, duration, and spacing, as well as the amount of CO increase per cigarette (CO boost), were assessed while subjects smoked a single cigarette in daily laboratory sessions. Subjects with relatively high CO levels had larger increases in CO after smoking a single cigarette than did individuals with low CO levels (p. less than .005) but did not differ on any other smoking topography measure. These data suggest that simple topography measures of puff number and duration may not contribute to between subject differences in tobacco smoke exposure, and that greater attention should be given to more refined measures such as puff volume and depth of inhalation. These data also suggest that the measurement of CO boost per cigarette may provide useful information regarding tobacco smoke intake.

Smoking following myocardial infarction: a critical review of the literature.

This paper critically reviews the available research on the effects of smoking cessation following acute myocardial infarction (MI). Studies that have examined the rate of smoking cessation following an MI indicate that approximately 1/3 to 1/2 of the smokers who suffer from MI subsequently reduce or quit smoking. Furthermore, studies that have examined subsequent mortality and morbidity suggest that individuals who quit smoking following MI exhibit lower mortality and morbidity than those who continue to smoke. It is argued that past studies may have overestimated post-MI smoking cessation rates, and by failing to control for a priori differences between quitters and continuing smokers (e.g., MI severity) may have underestimated the negative effects of smoking following MI. Suggestions for future research are proposed.

Lateral specialization of a perpetual calendar task by a moderately mentally retarded adult.

The lateral eye movements of a moderately mentally retarded adult with exceptional ability in a perpetual calendar task were examined. Questions with a perpetual calendar, mathematical, or musical and spatial content were presented to the subject in a random order and lateral eye movements were rated by blind observers. Results showed that both the perpetual calendar and mathematical questions elicited a significant proportion of lateral movements to the right, ps less than .001 and .05, respectively, whereas the musical and spatial questions did not elicit lateral eye movements with a specific direction.

The effect of paternal alcohol consumption on fetal development in mice.

The purpose of this study was to evaluate the effect of chronic paternal alcohol consumption on fetal growth and development in C3H mice. Male mice were pair-fed isocaloric liquid diets containing either 30%, 20%, or 0% ethanol-derived calories, or given free access to lab chow. After four weeks of treatment, all males were allowed to mate with untreated females. No differences were found between the litters of alcohol-treated males and controls in terms of the number of implantation sites, prenatal mortality, fetal weight, sex ratio, or frequency of soft tissue malformations. The results suggest that paternal alcohol consumption does not grossly alter fetal growth and development in C3H mice.