Cigarette smoking and short-term addiction treatment outcome.

Cigarette smoking is common among patients in cocaine and opioid dependence treatment, and may influence treatment outcome. We addressed this issue in a secondary analysis of data from an outpatient clinical trial of buprenorphine treatment for concurrent cocaine and opioid dependence (13 weeks, N=200). The association between cigarette smoking (lifetime cigarette smoking status, number of cigarettes smoked per day prior to study entry) and short-term treatment outcome (% of urine samples positive for cocaine or opioids, treatment retention) was evaluated with analysis of covariance, bivariate correlations, and multivariate linear regression. Nicotine-dependent smokers (66% of participants) had a significantly higher percentage of cocaine-positive urine samples than non-smokers (12% of participants) (76% vs. 62%), but did not differ in percentage of opioid-positive urine samples or treatment retention. Number of cigarettes smoked per day at baseline was positively associated with percentage of cocaine-positive urine samples, even after controlling for baseline sociodemographic and drug use characteristics, but was not significantly associated with percentage of opioid-positive urine samples or treatment retention. These results suggest that cigarette smoking is associated with poorer short-term outcome of outpatient treatment for cocaine dependence, but perhaps not of concurrent opioid dependence, and support the importance of offering smoking cessation treatment to cocaine-dependent patients.

Preventing relapse among former smokers: a comparison of minimal interventions through telephone and mail.

This study compared 2 minimal interventions for reducing relapse in ex-smokers. One intervention involved 12-month access to a telephone hot line. In the other intervention, 8 relapse-prevention booklets were mailed to participants over 1 year. The 2 interventions were crossed in a 2 x 2 factorial design, yielding control, hot-line-only, mailings-only, and combined conditions. The criterion of at least 1 week of abstinence at baseline was met by 584 participants, 446 of whom also completed a 12-month assessment. Repeated mailings, but not the hot line, reduced relapse for those participants who had been abstinent for less than 3 months at baseline. At follow-up, 12% of those in the mailings conditions were smoking again compared with 35% in the nonmailing conditions. As predicted, both interventions were effective at attenuating the association between depressive symptoms and poor outcome found in the control condition.

Very delayed smoking relapse warrants research attention.

Recent findings suggest that former smokers remain at risk for relapse well beyond the traditional treatment follow-up period of one year. Although progress has been made in understanding factors involved in smoking cessation and short-term maintenance, very little attention has been paid to research on the process, predictors, and treatment implications of very delayed relapse. Possible research questions are offered to stimulate further investigation in this area.

Reactivity to instructed smoking availability and environmental cues: evidence with urge and reaction time.

Reactivity to drug-related cues has been proposed as a possible mechanism to explain maintenance of drug use and relapse. This study examined whether cognitions associated with drug use (the belief that nicotine is available for use) also elicit reactivity. Smokers (N = 132) were randomly assigned in a 2 (Smoking Availability) x 2 (Smoking Stimuli) factorial design. Reactivity was measured by self-reported urge and probe reaction time. A main effect for availability was found in that participants who had been told that they could smoke shortly reported greater urges than those who had been told that smoking would not be permitted for 3 hr. Moreover, smoking-related stimuli produced increases in urge ratings only when participants had been told that smoking would be available shortly. Probe reaction time, in contrast, increased in the presence of smoking stimuli only when participants were told that cigarettes were unavailable. The theoretical and treatment implications of drug availability as a moderator of cue reactivity, as well as the utility of reaction time as an index if drug use motivation, are discussed.