Long-term behavior in treated alcoholism: Evidence for beneficial carry-over effects of abstinence from smoking on alcohol use and vice versa

Smoking As an Outcome Moderator In the Treatment of Alcohol Use Disorders

AIMS

To clarify whether smoking interferes with successful treatment of alcohol use disorder (AUD).

METHODS

The current systematic review investigates the potential moderating effect of smoking on behavioural and pharmacological treatment of AUD. In addition, this review summarizes the results of randomized controlled trials investigating the effect of smoking cessation treatments in subjects with AUD on drinking outcomes.

RESULTS

Overall, the results show that 16 out of the 31 pharmacological and psychotherapeutic alcohol treatment studies showed that being a non-smoker or decreased tobacco consumption during AUD treatment is associated with beneficial drinking outcomes, including reduced drinking, later relapse and prolonged alcohol abstinence. As such, smoking predicts poorer drinking outcomes in alcohol treatments. In the stop-smoking studies in patients with AUD, reduced smoking had virtually no effect on drinking behaviours. The inverse association between smoking and drinking outcome observed here indicates that non-smokers may be more successful to attain alcohol abstinence than smokers do. However, this association does not imply per se that smoking triggers alcohol consumption, since it can also mean that alcohol consumption promotes smoking.

CONCLUSIONS

It is concluded that (continued) tobacco smoking may have a negative moderating effect on the treatment outcome of AUD treatments. To optimize treatment outcome of AUD one may consider informing and counselling patients with AUD about the risks of smoking for treatment outcomes and offering support for smoking cessation.

Clinical moderators of response to nalmefene in a randomized-controlled trial for alcohol dependence: An exploratory analysis

BACKGROUND

Nalmefene is the only medication marketed to reduce the consumption of alcohol in patients with alcohol dependence, but it remains unclear which patients could most benefit from it. This study aimed to identify clinical moderators that affect treatment response to nalmefene in patients with alcohol dependence.

METHODS

In a multicenter, randomized, controlled, double-blind, phase 3 study of nalmefene on Japanese patients with alcohol dependence, the relationship between the reduction of heavy drinking days (HDD) and total alcohol consumption (TAC) at 12 and 24 weeks of treatment and baseline variables of the participants were analyzed in a linear regression and multiple adjusted analysis.

RESULTS

Age < 65, no family history of problem drinking, age at onset of problem drinking ≥ 25, and not currently smoking were possible positive moderators. Nalmefene showed a significant HDD reduction in patients with age < 65 or no family history of problem drinking, and a significant TAC reduction in patients with age at onset of problem drinking ≥ 25 or who were not currently smoking. After multiple adjusted analyses, age < 65 (p = .028), no family history of problem drinking (p = .047), and age at onset of problem drinking ≥ 25 (p = .030) were statistically significant. Not currently smoking (p = .071) was marginally significant. In combination, these moderators indicated synergistic effects.

CONCLUSIONS

Alcohol-dependent patients with favorable prognostic factors such as non-smoking status, no family history of problem drinking, and a late-onset of problem drinking selectively benefit from nalmefene. Further research is needed to validate these exploratory results.

Smoking characteristics and alcohol use among women in treatment for alcohol use disorder

BACKGROUND

Understanding the association between smoking and alcohol use among women may help inform the delivery of targeted interventions to address both of these health behaviors.

METHODS

This study analyzed data from N = 138 women enrolled in a randomized clinical trial comparing female-specific individual versus group cognitive-behavior therapy for alcohol use disorder (AUD). We assessed cigarette use patterns, participants' interest in quitting smoking and motivation to quit smoking during treatment for AUD, and examined the relationship between smoking and alcohol use before and during alcohol treatment.

RESULTS

Over a third of the sample reported smoking cigarettes at baseline (N = 47, 34.1%), with the majority of smokers reporting daily cigarette use. At baseline, those who smoked reported a high interest in quitting smoking M = 7.8 out of 10 (SD = 2.7), although most believed they should quit smoking only after achieving some success in quitting drinking (50.0%). However, participants who smoked cigarettes (compared to non-smokers) reported more alcohol abuse and dependence symptoms (p = .001), lower rates of completing the alcohol treatment (p = .03), attended significantly fewer treatment sessions (p = .008), and consumed significantly more drinks per day on average both at baseline (p = .002) and during the treatment period (p = .04).

CONCLUSIONS

Findings suggest that women with AUD who also smoke cigarettes have greater difficulty engaging in or responding to treatment for their alcohol use. However, these participants reported high interest in quitting smoking but low perceived readiness during AUD treatment, suggesting that motivational interventions should be considered that could take advantage of the opportunity to treat women for both of these co-occurring behaviors while in treatment.

Longitudinal Findings from a Randomized Clinical Trial of Varenicline for Alcohol Use Disorder with Comorbid Cigarette Smoking

BACKGROUND

This study is the first to examine longitudinal posttreatment outcomes of a placebo-controlled trial of varenicline for alcohol use disorder (AUD) with comorbid cigarette smoking.

METHODS

Participants were 131 adults (n = 39 female) seeking alcohol treatment in a randomized, double-blind, parallel group, placebo-controlled, 16-week multisite trial of varenicline combined with medical management (MM). Timeline follow-back assessments of alcohol and smoking behavior were conducted at the end of treatment (4 months), with follow-ups at 6, 9, and 12 months. Outcomes were percentage of heavy drinking days (PHDD), percent of participants with no heavy drinking days (NHDD), cotinine-confirmed prolonged smoking abstinence (PA), and good clinical outcome on either NHDD or PA.

RESULTS

Treatment improvements were maintained posttreatment. For the sample overall, PHDD or NHDD did not differ significantly by treatment condition (ps > 0.13), but varenicline produced higher rates of PA versus placebo at 4, 9, and 12 months (p < 0.05). Significant differences were observed by sex: Males had higher rates of NHDD with varenicline (28.9%) versus placebo (6.4%) at the end of treatment (p = 0.004), and these effects were maintained at 12 months (varenicline: 40.0% vs. placebo: 19.2%, p = 0.03). Higher rates of PA were seen for varenicline in both males (8.9%) and females (21.1%) versus placebo (males/females: 0%) at the end of treatment (p = 0.05), and this effect was maintained at 12 months for females (varenicline: 21.1% vs. placebo, 0.0%, p = 0.05).

CONCLUSIONS

Varenicline treatment combined with MM appears to have enduring benefits for patients with co-occurring AUD and cigarette smoking, and these effects may differ by sex.

Elevated Behavioral Economic Demand for Alcohol in a Community Sample of Heavy Drinking Smokers

OBJECTIVE

Cigarette smokers are more likely to consume alcohol at higher levels and experience poorer response to treatment for alcohol problems than are nonsmokers. One previous study in university students suggests that a potential reason for the high overlap between alcohol and tobacco use is that concurrent smoking is associated with overvaluation of alcohol, as reflected in elevated behavioral economic demand. The present study sought to extend these initial findings in a community sample with heavier levels of alcohol and tobacco use.

METHOD

Participants were 111 non-treatment-seeking heavy drinkers(defined as 18+/14+ drinks per week for men/women) from a larger study on alcohol pharmacotherapy mechanisms. Forty-nine participants (44%) reported regular smoking (≥5 cigarettes/day). Participants completed a hypothetical alcohol purchase task assessing alcohol consumption at escalating levels of price. Covariates included demographics, drinking quantity, alcohol use disorder severity, depression, and delay discounting.

RESULTS

In covariate-adjusted models, smokers reported significantly higher maximum alcohol expenditures (O_max) and breakpoint price (first price suppressing consumption to zero) compared with nonsmokers. Elevated alcohol demand correlated with drinking quantity and severity in the entire sample, but not with smoking frequency or nicotine dependence among smokers only.

CONCLUSIONS

This study offers further evidence of increased reinforcing value of alcohol among smokers in a sample of heavy drinkers from the community. Clinical implications and potential mechanisms underlying this relationship are discussed.

Effect of Varenicline Combined With Medical Management on Alcohol Use Disorder With Comorbid Cigarette Smoking: A Randomized Clinical Trial

IMPORTANCE

Individuals with alcohol use disorder have high rates of cigarette smoking. Varenicline tartrate, an approved treatment for smoking cessation, may reduce both drinking and smoking.

OBJECTIVES

To test the efficacy of varenicline with medical management for patients with alcohol use disorder and comorbid smoking seeking alcohol treatment, and to evaluate the secondary effects on smoking abstinence.

DESIGN, SETTING, AND PARTICIPANTS

This phase 2, randomized, double-blind, parallel group, placebo-controlled trial was conducted at 2 outpatient clinics from September 19, 2012, to August 31, 2015. Eligible participants met alcohol-dependence criteria and reported heavy drinking (≥5 drinks for men and ≥4 drinks for women) 2 or more times per week and smoking 2 or more times per week; 131 participants were randomized to either varenicline or placebo stratified by sex and site. All analyses were of the intention-to-treat type. Data analysis was conducted from February 5, 2016, to September 29, 2017.

INTERVENTIONS

Varenicline tartrate, 1 mg twice daily, and matching placebo pills for 16 weeks. Medical management emphasized medication adherence for 4 weeks followed by support for changing drinking.

MAIN OUTCOMES AND MEASURES

Percentage of heavy drinking days (PHDD) weeks 9 to 16, no heavy drinking days (NHDD) weeks 9 to 16, and prolonged smoking abstinence weeks 13 to 16.

RESULTS

Of 131 participants, 39 (29.8%) were women and 92 (70.2%) were men, the mean (SD) age was 42.7 (11.7) years, and the race/ethnicity self-identified by most respondents was black (69 [52.7%]). Sixty-four participants were randomized to receive varenicline, and 67 to receive placebo. Mean change in PHDD between varenicline and placebo across sex and site was not significantly different. However, a significant treatment by sex by time interaction for PHDD (F1,106 = 4.66; P = .03) revealed that varenicline compared with placebo resulted in a larger decrease in log-transformed PHDD in men (least square [LS] mean difference in change from baseline, 0.54; 95% CI, -0.09 to 1.18; P = .09; Cohen d = 0.45) but a smaller decrease in women (LS mean difference, -0.69; 95% CI, -1.63 to 0.25; P = .15; Cohen d = -0.53). Thirteen of 45 men (29%) had NHDD taking varenicline compared with 3 of 47 men (6%) taking placebo (Cohen h = 0.64; 95% CI, 0.22-1.03), whereas 1 of 19 women (5%) had NHDD compared with 5 of 20 women (25%) taking placebo (Cohen h = -0.60; 95% CI, -1.21 to 0.04). Taking varenicline, 8 of 64 participants (13%) achieved prolonged smoking abstinence; no one (0 of 67) quit smoking taking placebo (P = .003; Cohen h = 0.72; 95% CI, 0.38-1.07).

CONCLUSIONS AND RELEVANCE

Varenicline with medical management resulted in decreased heavy drinking among men and increased smoking abstinence in the overall sample. Varenicline could be considered to promote improvements in men with these dual behavioral health risks.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01553136.

An international systematic review of smoking prevalence in addiction treatment

AIMS

Smoking prevalence is higher among people enrolled in addiction treatment compared with the general population, and very high rates of smoking are associated with opiate drug use and receipt of opiate replacement therapy (ORT). We assessed whether these findings are observed internationally.

METHODS

PubMed, PsycINFO and the Alcohol and Alcohol Problems Science Database were searched for papers reporting smoking prevalence among addiction treatment samples, published in English, from 1987 to 2013. Search terms included tobacco use, cessation and substance use disorders using and/or Boolean connectors. For 4549 papers identified, abstracts were reviewed by multiple raters; 239 abstracts met inclusion criteria and these full papers were reviewed for exclusion. Fifty-four studies, collectively comprising 37,364 participants, were included. For each paper we extracted country, author, year, sample size and gender, treatment modality, primary drug treated and smoking prevalence.

RESULTS

The random-effect pooled estimate of smoking across people in addiction treatment was 84% [confidence interval (CI) = 79, 88%], while the pooled estimate of smoking prevalence across matched population samples was 31% (CI = 29, 33%). The difference in the pooled estimates was 52% (CI = 48%, 57%, P < .0001). Smoking rates were higher in programs treating opiate use compared with alcohol use [odds ratio (OR) = 2.52, CI = 2.00, 3.17], and higher in ORT compared to out-patient programs (OR = 1.42, CI = 1.19, 1.68).

CONCLUSIONS

Smoking rates among people in addiction treatment are more than double those of people with similar demographic characteristics. Smoking rates are also higher in people being treated for opiate dependence compared with people being treated for alcohol use disorder.

Evidence that a volitional help sheet reduces alcohol consumption among smokers: a pilot randomized controlled trial

Cigarette smokers have greater problems with alcohol than members of the general population, due partly to the influence of smoking on alcohol consumption. The present study was designed to test the ability of implementation intentions to reduce alcohol consumption among cigarette smokers. Sixty-five smokers (37 women, 28 men; age M=33.77, SD=9.69) were randomly allocated to an active control condition (n=31) or were asked to form implementation intentions using a volitional help sheet (n=34). The outcome measure was subsequent alcohol intake, measured 1-month postbaseline. There was a significant decrease in alcohol consumption in the intervention group but not in the control condition. At the end of the study, alcohol consumption had decreased significantly, by 2.00 standard units (i.e., 16 grams alcohol) per week in the intervention group, but had increased marginally (by 0.46 standard units per week) in the active control condition (d=0.63). The findings support the efficacy of the volitional help sheet to reduce alcohol consumption among smokers. Further research is needed to refine the volitional help sheet and explore its efficacy among other at-risk groups.

Tobacco smoking among male and female alcohol treatment-seekers: clinical complexities, treatment length of stay, and goal achievement

BACKGROUND

Literature suggests that tobacco smoking among clients in alcohol treatment has important clinical implications, including poorer treatment outcome. Much of this literature, however, has been derived from research-based treatment samples that utilized stringent inclusion and exclusion criteria, limiting generalizability of findings.

OBJECTIVE

In order to further our understanding of the correlates of smoking among clients with alcohol problems, the present research examines tobacco smoking status at admission for 21,128 adult treatment seekers from 253 community outpatient substance abuse clinics across New York State.

METHODS

This sample includes tobacco smokers at admission (62%) and women (25%). Clinical complexities at admission (unemployment, lack of high school diploma/GED, criminal justice involvement, mental illness, polysubstance abuse) and length of treatment stay and alcohol-related goal achievement at discharge were assessed by clinic staff.

RESULTS

Mixed models revealed that tobacco smoking was significantly associated with all five clinical complexities; interactions with gender indicated that this association was stronger for women with regard to criminal justice involvement and polysubstance abuse. Also, these smokers evidenced shorter substance disorder treatment duration and were less likely to achieve alcohol-related treatment goals relative to their nonsmoking counterparts.

CONCLUSIONS

Admission tobacco smoking status of alcohol treatment seekers is an important client characteristic with regard to clinical presentation and treatment outcome. Our findings underscore the need to further our understanding of the complexities associated with smoking and especially as it pertains to female smokers.

A preliminary double-blind, placebo-controlled randomized study of baclofen effects in alcoholic smokers

RATIONALE

There is presently no approved single treatment for dual alcohol and nicotine dependencies.

OBJECTIVE

This pilot study investigated baclofen effects in alcoholic smokers.

METHODS

This was a preliminary double-blind placebo-controlled randomized clinical study with 30 alcoholic smokers randomized to baclofen at 80 mg/day or placebo. A subgroup (n=18) participated in an alcohol cue-reactivity experiment.

RESULTS

Baclofen, compared with placebo, significantly decreased the percent days of abstinence from alcohol-tobacco co-use (p=0.004). Alcohol dependence severity moderated baclofen effects, with the higher severity group having the greater baclofen response (p<0.001). Although the percent days of alcohol-tobacco co-use declined in both groups, this decline was greater after placebo than baclofen (p<0.001). Secondary analyses on alcohol or tobacco use alone suggested that the increase in percent days of co-abstinence was driven by the medication differences on heavy drinking days and on percent days smoking. In the cue-reactivity substudy, baclofen slightly decreased alcohol urge (p=0.058) and significantly reduced salivation (p=0.001), but these effects were not related to cue type.

CONCLUSIONS

This study provides preliminary evidence suggesting a possible role of baclofen in the treatment of alcoholic smokers. However, the mixed results and the small sample require larger confirmatory studies.

Bupropion-SR for smoking reduction and cessation in alcohol-dependent outpatients: a naturalistic, open-label study

BACKGROUND

We sought to determine whether sustained-release bupropion (bupropion-SR) reduces smoking and promotes smoking cessation among alcohol-dependent (AD) smokers while they are in early recovery from alcohol.

METHODS

We conducted an open-label, naturalistic study among AD smokers enrolled in an outpatient treatment program. The treatment group (n=58) was offered bupropion-SR and brief smoking cessation counseling. A control group (n=57) was matched to the treatment group by age, sex, ethnicity, cigarette use, and years of alcohol dependence. The controls received no smoking cessation intervention. We collected tobacco and alcohol abstinence data for 6 months after enrollment.

RESULTS

Participants in the treatment group were more likely to abstain from smoking than controls, at any of the followup time points. The treatment group smoked less cigarettes per day (CPD) at baseline, 30 days and 180 days post-baseline, compared to controls. These findings persisted after adjusting for possible covariates.

CONCLUSION

Bupropion-SR may be helpful to quit or reduce smoking for recently abstinent AD individuals.

The Alcohol Relapse Risk Assessment: a scoring system to predict the risk of relapse to any alcohol use after liver transplant

CONTEXT

Alcohol relapse after liver transplant heightens concern about recurrent disease, nonadherence to the immunosuppression regimen, and death.

OBJECTIVES

To develop a scoring system to stratify risk of alcohol relapse after liver transplant.

DESIGN

Retrospective medical record review.

SETTING AND PARTICIPANTS

All adult liver transplants performed from May 2002 to February 2011 at a single center in the United States.

MAIN OUTCOME MEASURE

The incidence of return to any alcohol consumption after liver transplant.

RESULTS

Thirty-four percent (40/118) of patients with a history of alcohol abuse/dependency relapsed to use of any alcohol after liver transplant. Nine of 25 hypothesized risk factors were predictive of alcohol relapse after liver transplant: absence of hepatocellular carcinoma, tobacco dependence, continued alcohol use after liver disease diagnosis, low motivation for alcohol treatment, poor stress management skills, no rehabilitation relationship, limited social support, lack of nonmedical behavioral consequences, and continued engagement in social activities with alcohol present. Each independent predictor was assigned an Alcohol Relapse Risk Assessment (ARRA) risk value of 1 point, and patients were classified into 1 of 4 groups by ARRA score: ARRA I = 0, ARRA II = 1 to 3, ARRA III = 4 to 6, and ARRA IV = 7 to 9. Patients in the 2 higher ARRA classifications had significantly higher rates of alcohol relapse and were more likely to return to pretransplant levels of drinking.

CONCLUSION

Alcohol relapse rates are moderately high after liver transplant. The ARRA is a valid and practical tool for identifying pretransplant patients with alcohol abuse or dependency at elevated risk of any alcohol use after liver transplant.

Smokers report greater demand for alcohol on a behavioral economic purchase task

OBJECTIVE

Cigarette smokers have higher levels of alcohol consumption than nonsmokers and poorer response to alcohol treatment. It is possible that the greater severity of alcohol problems observed in smokers reflects a greater susceptibility to alcohol-related reinforcement. The present study used a behavioral economic purchase task to investigate whether heavy drinking smokers would have greater demand for alcohol than heavy drinking nonsmokers.

METHOD

Participants were 207 college students who reported at least one heavy drinking episode in the past month. Of the 207 participants, 33.2% (n = 67) reported smoking cigarettes at least 1 day in the past month. Participants completed the hypothetical alcohol purchase task, a simulation task that asked them to report how many drinks they would purchase at varying price increments.

RESULTS

After the participants' reported alcohol consumption, gender, alcohol problems, and depression were controlled for, analyses of covariance revealed that heavy drinking smokers had significantly greater reported maximum alcohol expenditures (Omax), greater maximum inelastic price (Pmax), and higher breakpoint values (first price suppressing consumption to zero).

CONCLUSIONS

College student heavy drinkers who also smoke cigarettes exhibit increased demand for alcohol. Smokers in this high-risk developmental stage may thus be less sensitive to price and other contingencies that would otherwise serve to modulate drinking and may require more intensive intervention approaches.

Sex differences in neuroadaptation to alcohol and withdrawal neurotoxicity

Recent work suggests that sex differences exist with regard to both the nature of neuroadaptation to alcohol during the development of dependence, and possibly, the neurodegenerative consequences of alcohol dependence. Volumetric studies in human samples show that females may demonstrate increased volumetric brain loss with equal or lesser dependence histories than males. Furthermore, animal studies demonstrate sex differences in glutamatergic, GABAergic, and adenosinergic receptor signaling and endocrine responses following prolonged alcohol exposure. These differences may influence the development of dependence, neuronal function, and viability, particularly during alcohol withdrawal. The present review discusses the current state of knowledge in this regard. It is concluded that there exists a clear need for a more extensive examination of potential sex differences in neurodegenerative consequences of alcohol dependence in men and women, particularly with regard to the role that alterations in amino acid signaling and hypothalamic-pituitary-adrenal axis function may play. Furthermore, we note the need for expanded examination of the unique role that alcohol withdrawal-associated neuronal activity may have in the development of dependence-associated neurotoxicity.

Predictors of Interest in an Alcohol Reduction Clinical Trial of Naltrexone among Undergraduates

Background

We tested predictors of interest in a clinical trial of naltrexone plus counseling for heavy drinking reduction in young adults using a web survey. Respondents could indicate interest in the clinical trial at the conclusion of the survey.

Methods

A random sample of university students completed the survey (N = 584, 60% female). Data were collected in October-November 2010.

Results

Among past-year drinkers (n = 411), 22.6% (n =93) indicated interest. Equivalent levels of interest were found among past-year heavy drinkers. Non-white race and current cigarette smoking predicted interest. Alcohol-related negative consequences score was a trend-level predictor in the full regression model, but a significant predictor in a reduced model.

Conclusions

Non-white students, smokers and those with a high number of negative consequences may be more amenable to drinking reduction via medication and counseling. These findings could facilitate efforts of researchers, administrators, counselors and other professionals to tailor drinking reduction messages and facilitate treatment engagement by undergraduates.

Cigarette smoking predicts differential benefit from naltrexone for alcohol dependence

BACKGROUND

Identifying factors that modify responsiveness to pharmacotherapies for alcohol dependence is important for treatment planning. Cigarette smoking predicts more severe alcohol dependence and poorer treatment response in general. Nevertheless, there is limited research on cigarette smoking as a potential predictor of differential response to pharmacological treatment of alcoholism.

METHODS

We examined the association between cigarette smoking and drinking outcomes in the COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) study, a randomized, double-blind placebo-controlled 16-week trial comparing combinations of medications (i.e., acamprosate and naltrexone) and behavioral interventions (i.e., medical management, combined behavioral therapy) in 1383 alcohol-dependent individuals.

RESULTS

Smokers (i.e., more than one half the sample) significantly differed from nonsmokers on several demographic and drinking-related variables at baseline and generally had poorer treatment outcomes than nonsmokers. However, smokers who received naltrexone had better drinking outcomes than smokers who received placebo, whereas alcohol use among nonsmokers did not vary by naltrexone assignment. This pattern of findings occurred independent of whether patients received combined behavioral intervention or medical management and remained after controlling for alcoholism typology and baseline demographic differences. Approximately 9% of smokers quit smoking, and an additional 10% reduced their cigarette intake during treatment. Reductions in smoking did not vary by treatment assignment.

CONCLUSIONS

These results suggest that naltrexone might be particularly beneficial for improving alcohol use outcomes in alcohol-dependent smokers.

Tabakentwöhnung bei stationären Patienten mit einer Alkohol- abhängigkeit – Motivationsfaktoren und Erfolgsaussichten

Einleitung: Die Raucherprävalenz ist bei alkoholkranken Personen überdurchschnittlich hoch. Die gesundheitliche Bedeutung der Tabakabstinenz, aber auch potentielle synergistische Effekte auf die Alkoholabstinenz legen nahe, während einer stationären Alkoholbehandlung auch eine Tabakentwöhnung anzubieten. Ziel: Untersucht wurden die Aufhörbereitschaft und der Abstinenzerfolg nach einer Raucherentwöhnung während einer sechswöchigen stationären Alkoholismustherapie bei alkoholkranken Personen mit zusätzlicher psychiatrischer Komorbidität. Methodik: 90 von 94 Personen eines Behandlungsjahrgangs nahmen an der Untersuchung teil. Sie durchliefen eine Psychoedukation zur Tabakabhängigkeit und hatten nachfolgend die Gelegenheit, eine Raucherentwöhnungsgruppe zu besuchen. Erfasst wurden soziodemographische Daten, Motivation sowie die Abstinenzquoten von Tabak und Alkohol am Ende und drei Monate nach der Therapie. Ergebnisse: Wichtige Motivationsgründe für eine Tabakabstinenz sind die Vorteile des Nichtrauchens. 40 % (n = 28) der rauchenden Patienten (n = 69) ließen sich zu einer Tabakentwöhnung motivieren, 25 % (n = 7) schlossen die Behandlung abstinent ab. Auch wenn keiner der Patienten über drei Monate tabakabstinent blieb, so war doch der Anteil alkoholrückfälliger Patienten in der Raucherentwöhnungsgruppe niedriger (21,4 %; n = 6/28) als bei den übrigen Patienten (29,3 %; n = 12/41)). Diskussion: Die Tabakentwöhnung im Rahmen einer stationären Alkoholismusbehandlung scheint nicht von Nachteil für die Patienten zu sein. Bei der Einführung eines Therapieangebotes sollten motivationale Faktoren, Bewältigungsfertigkeiten für rückfallgefährliche Situationen sowie Begleitsymptome komorbider Störungen stärker im Vordergrund stehen als bei anderen Rauchern.

A preliminary investigation of varenicline for heavy drinking smokers

RATIONALE

Varenicline, an approved smoking cessation pharmacotherapy, also shows promise as a potential treatment for alcohol dependence. However, varenicline has not been tested in heavy drinkers, and it remains to be determined whether varenicline could reduce alcohol craving and consumption in smokers who are trying to quit smoking.

OBJECTIVES

We conducted a preliminary study to examine the effect of varenicline on drinking behavior and the effects of extended varenicline pretreatment on smoking.

METHODS

Thirty heavy drinking smokers received smoking cessation counseling and were randomly assigned to receive either an extended 4-week pretreatment with varenicline 2 mg daily or the usual 1-week pretreatment. Those in the extended pretreatment group received active medication for 8 weeks (i.e., 4 weeks of active pre-treatment followed by 4 weeks of active treatment), and participants in the usual pretreatment group received active medication after a placebo lead in (i.e., 3 weeks of placebo followed by active medication for 5 weeks).

RESULTS

Participants who received varenicline during the first 3 weeks reported significantly greater reductions in alcohol craving and numerically fewer heavy drinking days compared to those who received placebo, and these differences persisted during the open-label phase. Extended pretreatment was associated with numerically greater reductions in cigarette smoking over the entire study period. There were no differences, however, in smoking abstinence rates following the smoking quit date between the two groups.

CONCLUSIONS

Findings from this preliminary study suggest that varenicline may be a promising strategy for concurrently reducing heavy drinking and promoting smoking changes in heavy drinkers.