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A Randomized Trial of Concurrent Smoking-Cessation and Substance Use Disorder Treatment in Stimulant-Dependent Smokers.

Journal of Clinical Psychiatry 2014;75(4):336-343. [doi: 10.4088/JCP.13m08449]

Therea M. Winhusen, PhD (University of Cincinnati/CinARC, OV Node), Gregory S. Brigham, PhD (Maryhaven, Inc., OV Node), Frankie B. Kropp, MS (University of Cincinnati/CinARC, OV Node), Robert Lindblad, MD (EMMES Corporation, CTN Clinical Coordinating Center), John G. Gardin, II, PhD (ADAPT, Inc., WS Node), Patricia E. Penn, PhD (La Frontera Center, Inc., WS Node), Candace Hodgkins, PhD (Gateway Community Services, Inc., FNA Node), Thomas M. Kelly, PhD (Western Psychiatric Institute and Clinic, ATS Node), Antoine B. Douaihy, MD (Western Psychiatric Institute and Clinic, ATS Node), Michael J. McCann, MA (Matrix Institute on Addictions, PR Node), Lee D. Love, MA (Gibson Recovery Center, OV Node), Eliot DeGravelles, MD (UT Southwestern Medical Center, TX Node), Ken Bachrach, PhD (Tarzana Treatment Centers, PR Node), Susan C. Sonne, PharmD (Medical University of South Carolina, SC Node), Robert Hiott, MEd (Behavioral Health Services of Pickens County, SC Node), Louise F. Haynes, MSW (Medical University of South Carolina, SC Node), Gaurav Sharma, PhD (EMMES Corporation, CTN Data & Statistics Center), Daniel F. Lewis (University of Cincinnati/CinARC, OV Node), Paul C. VanVeldhuisen, PhD (EMMES Corporation, CTN Data & Statistics Center), Jeff Theobald (University of Cincinnati/CinARC, OV Node), Udi E. Ghitza, PhD (NIDA Center for the Clinical Trials Network).

This is the Primary Outcomes Article for CTN-0046. The purpose of this study, National Drug Abuse Treatment Clinical Trials Network protocol CTN-0046, was to evaluate the impact of concurrent treatments for substance use disorder and nicotine-dependence for stimulant-dependent patients. It was 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 (TAU) (n=271) or TAU with smoking cessation treatment (n=267). All participants received TAU for substance use disorder treatment. Participants assigned to TAU with concurrent smoking-cessation treatment received weekly individual smoking cessation counseling and extended-release bupropion (300mg/d) during weeks 1-10. During post-quit treatment (weeks 4-10), participants assigned to TAU with smoking cessation treatment received a nicotine inhaler and contingency management for smoking abstinence. The primary outcome was weekly proportion of stimulant-abstinent participants during the treatment phase, as assessed by urine drug screens and self-report. Secondary measures included other substance/nicotine use outcomes and treatment attendance.

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. Overall, participants assigned to treatment as usual with smoking cessation treatment averaged 77.2% stimulant-abstinent weeks compared to 78.1% stimulant-abstinent weeks for participants assigned to treatment as usual. There was a similar lack of significant treatment effect on stimulant abstinence at 3-month and 6-month follow-ups. Participants receiving TAU with smoking cessation treatment, relative to those receiving TAU alone, however, had significantly better outcomes on smoking point-prevalence abstinence. Additionally, participants receiving TAU with smoking cessation treatment, relative to those receiving TAU alone, had significantly better outcomes for drug-free days (abstinence from all illicit substances, not just stimulants) at 6-month follow-up.

Conclusions: Providing smoking cessation treatment to cocaine- and/or methamphetamine-dependent patients in outpatient substance use disorder treatment had no effect on stimulant-use outcomes or treatment attendance, but significantly improved smoking-abstinence outcomes. Concurrent smoking cessation and substance use disorder treatment can significantly improve smoking-abstinence outcomes and do not negatively impact non-nicotine outcomes. (Article (Peer-Reviewed), PDF, English, 2014)

Keywords: Cocaine | CTN primary outcomes | Methamphetamine | Motivational incentives | Nicotine replacement therapy | Pharmacological therapy | Smoking | Stimulant abuse | Journal of Clinical Psychiatry (journal)

Document No: 1052, PMID: 24345356, PMCID: PMC4019678.

Submitted by CTN Dissemination Librarians, 3/24/2014.

Bachrach, Ken mail
Brigham, Gregory S. mail
DeGravelles, Eliot mail
Douaihy, Antoine B. mail
Gardin, John G. II mail
Ghitza, Udi E. search mail
Haynes, Louise F. mail
Hiott, Robert mail
Hodgkins, Candace search mail
Kelly, Thomas M. mail
Kropp, Frankie B. mail
Lewis, Daniel F. mail
Lindblad, Robert mail
Love, Lee D.
McCann, Michael J. mail
Penn, Patricia E. mail
Sharma, Gaurav mail
Sonne, Susan C. mail
Theobald, Jeff mail
VanVeldhuisen, Paul C. mail
Winhusen, Theresa M. mail
NIDA-CTN-0046 www
Ohio Valley (Lead) www
Appalachian Tri-State www
Florida Node Alliance www
Pacific Region www
Southern Consortium www
Texas www
Western States www

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