Correlates of motivation to quit smoking among alcohol dependent patients in residential treatment

Factors influencing tobacco use behaviour initiation - From the perspective of the Capability, Opportunity, Motivation- Behaviour (COM-B) Model

Introduction

Non-communicable diseases such as ischemic heart disease, cancer, diabetes, and chronic respiratory diseases are the leading causes of death worldwide, and are associated with tobacco use. The ultimate goal of health professionals and researchers working to combat smoking's extremely harmful health effects is to prevent smoking initiation. Nearly 5500 new smokers are added each day, for a total of almost 2 million new smokers each year. The COM-B model's primary goal is to determine what needs to be done for a behaviour change to occur. Behaviour modification requires an understanding of the factors that drive behaviour.

Aim

The current qualitative study intends to explore the factors affecting tobacco use initiation (TUI) using the COM-B model, given the relevance of investigating the factors affecting TUI and the model.

Methods

The present qualitative study has used a directed content analysis approach. Seventeen participants who reported having started any kind of tobacco in the last six months were recruited in the study using a purposive sampling method to understand the factors affecting TUI. The data was collected through interviews, and all of the participants were from the Hyderabad-Karnataka region of Karnataka, India (a state which has been reported as having the highest prevalence of cigarette smoking in India).

Results

Directed content analysis revealed six categories: psychological capabilities affecting TUI (lack of knowledge about adverse health effects of tobacco, behavioural control, and poor academic performance), physical capabilities affecting TUI (lack of better physical resilience), physical opportunities favouring TUI (tobacco advertisements, easy access of tobacco products, and favourite star smoke on screen), social opportunities favouring TUI (peer influence, tobacco use by parents, tradition of hospitality, tobacco use as a normal behaviour, and toxic masculinity), automatic motivation causal factors of TUI (affect regulation, risk taking behaviours and tobacco use for pleasure) and reflective motivation causal factors of TUI (perceived benefits of tobacco, risk perception, perceived stress, and compensatory health beliefs).

Conclusion

Identifying the factors that influence TUI may help to limit or prevent people from smoking their first cigarette. Given the importance of preventing TUI, the findings of this study indicated the factors that influence TUI, which can be valuable in improving behaviour change processes.

The contribution of positive affect and loneliness on readiness and self-efficacy to quit smoking among Spanish-speaking Mexican American smokers

BACKGROUND

The existing research on affective and interpersonal determinants of smoking cessation largely under-represents minority smokers, such as Latinos.

OBJECTIVE

The current study examined associations between affective and interpersonal factors with intermediary smoking cessation variables among Mexican-American smokers (N = 290; 60% male).

METHODS

Measures of positive and negative affect, social support, and loneliness were each examined for associations with measures of motivational readiness to quit smoking, and smoking abstinence self-efficacy. Significant predictors were entered into models simultaneously to examine their unique associations. Covariates included gender, age, and educational attainment.

RESULTS

Negative affect (b = .68, SE b = .14, p < .001) and loneliness (b = .20, SE b = .09, p < .05) were independently associated with motivation. Negative affect (b = .20, SE b = .06, p < .01) and positive affect (b = .34 SE b = .07, p < .001) were independently associated with self-efficacy. In the final models, only negative affect was associated with motivation (b = .68, SE b = .17, p < .001); whereas negative (b = .17, SE b = .06, p < .01) and positive (b = . 32, SE b = .07, p < .001) affect were associated with self-efficacy.

CONCLUSION

Results highlight the importance of resilience factors (e.g., positive affect) among Mexican-American smokers. Cessation interventions regularly target negative affect among smokers; additional focus on positive affect in cessation interventions with this population may be warranted.

Readiness to Quit Smoking among Smokers in Substance Use Treatment: Associations with Stress, Substance Use Severity, Relapse Concerns and Gender

Smoking prevalence among individuals in substance use treatment remains higher than in the general population. Given that many smokers in substance use treatment are reluctant to quit smoking, it is important to understand the factors that impede smokers' readiness to quit. The current study used baseline data from a randomized controlled trial involving 60 adult smokers receiving substance use treatment to investigate relations between the severity of substance use problems (SSUP), perceived stress (PS), concerns about relapse (i.e., concerns that quitting smoking would hurt one's recovery process (CR)), and readiness to quit smoking. This study also investigated moderating roles of concerns about relapse and gender. Regression analyses showed a significant main effect of concerns about relapse on readiness to quit in the next 30 days, but no effect for either severity of substance use problems, perceived stress, or the SSUPxCR interaction. There were significant interaction effects between PS and both gender and CR. Among men and those with lower concerns about relapse, higher perceived stress was significantly associated with lower readiness to quit. Findings suggest that psychoeducation to alleviate concerns that quitting smoking could limit substance use recovery could be beneficial. Stress management interventions may be especially beneficial to men.

Smoking cessation in inpatient psychiatry treatment facilities: A review

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Smoking rates are high among people with psychiatric illness.

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Smoking cessation interventions are rarely available in inpatient psychiatry settings.

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Smokers with psychiatric illness are just as interested in quitting smoking.

Background

Tobacco-related diseases are a leading cause of death among individuals with severe mental illness (SMI), yet interventions to address tobacco cessation are rare in inpatient settings where persons with SMI are hospitalized. While cigarette smoking rates have declined in the general population, they remain high in persons with SMI. Inpatient settings would be a prime location to intervene on tobacco consumption among persons with SMI. The objective of this review was to examine evidence of smoking cessation interventions in psychiatric inpatient facilities.

Method

Using narrative overview guidelines, we searched PubMed, PsycINFO, and CINAHL for smoking cessation RCT studies published between 1950 and 2018. Studies included had to have at least started in inpatient psychiatry settings. Examples of search terms included: smoking cessation in inpatient psychiatry, smoking cessation in inpatient mental health treatment facilities, and smoking cessation and mental health.

Results

Following the inclusion criteria, eight RCT studies were reviewed. One study was among adolescent psychiatric inpatient smokers ages 13–17, and 7 were among adult psychiatric inpatients with mean age 41 years. Treatment periods lasting 8 to 12 weeks started in inpatient settings and continued post discharge. A combination of behavioral and pharmacological interventions were used. Pharmacological interventions were nicotine replacement therapies, and at least one study used varenicline. At baseline, participants smoked an average of 18.1 cigarettes per day.

Conclusion

Smoking cessation in inpatient psychiatry settings is rare or delayed. There is a need for more tailored treatments among this population to help them quit smoking.

Does Motivation Impact OCD Symptom Severity? An Exploration of Longitudinal Effects

Understanding the role of patient motivation in OCD treatment is of clinical importance given the requisite autonomous role of patients in Exposure and Response Prevention. The present study investigated state- and trait-like relations between three variables: two previously established motivational constructs, readiness to change (RTC) and committed action (CA), derived from the University of Rhode Island Change Assessment, and OCD symptom severity as measured by the self-report Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR). Utilizing a random-intercept cross-lagged panel model (RI-CLPM) design, we assessed autoregressive, within-time correlations, and cross-lagged effects of RTC, CA, and Y-BOCS-SR scores at admission, month 1 of treatment, and discharge from an intensive/residential treatment program for OCD. Results revealed significant autoregressive (i.e., state-like) effects for CA and Y-BOCS-SR, negative within-time correlations between state CA and Y-BOCS-SR across all time points, a positive within-time correlation between state CA and RTC at admission, and a cross-lagged effect between state Y-BOCS-SR at month 1 of treatment and state RTC at discharge. Results also demonstrated that the stability of the RTC variable was attributable to trait-like factors in the present sample. This study is novel in its use of RI-CLPM in an OCD sample and represents an important addition to the literature on the longitudinal impacts of dynamic constructs of motivation. Our findings may provide future researchers with strategies to supplement ERP with CA-driven motivational interviewing.

A novel text message-based motivational interviewing intervention for college students who smoke cigarettes

INTRODUCTION

Tobacco use disorder is critical among people aged 16 to 25 years. College campuses are prime locations for smoking cessation interventions for young adults. The vast majority of the smoking research with college students has been epidemiological in nature. This study examined a novel motivational interviewing intervention designed for college students, and explored predictors of smoking behavior change.

METHODS

A quasi-experimental one group pretest-posttest design with repeated measures was used to evaluate a novel text message-based brief motivational interviewing intervention. The data were collected from undergraduate students (N=33) who smoked cigarettes in Fall 2015.

RESULTS

Students’ level of autonomy and relatedness needs satisfaction, autonomous motivation, and smoking cessation self-efficacy increased (p < 0.05), and their rate of daily smoking declined (p <0 .05) over time. However, competence need satisfaction, readiness to quit smoking and severity of nicotine addiction remained unchanged. Smoking cessation self-efficacy was the strongest predictor of smoking behavior change in college students.

CONCLUSIONS

This study adds to the knowledge on smoking behavior among college students. Preliminary evidence indicates that text message-based motivational interviewing and smoking cessation self-efficacy may help guide successful smoking behavior interventions for college students.

Varenicline versus nicotine patch with brief advice for smokers with substance use disorders with or without depression: effects on smoking, substance use and depressive symptoms

AIMS

Varenicline was compared with transdermal nicotine (NRT) for smokers with current substance use disorders (SUD) for effects on 3-month smoking abstinence (primary outcome) and, secondarily, on 3- and 6 month abstinence while adjusting for medication adherence, and on additional smoking and substance use outcomes. Moderation by major depressive disorder history (MDD) and adherence were investigated.

DESIGN

Double-blind double-placebo-controlled randomized design, stratifying by MDD, gender and nicotine dependence, with 3 and 6 months follow-up.

SETTING

University offices in Rhode Island, USA.

PARTICIPANTS

Adult smokers (n = 137), in SUD treatment, substance abstinent <12 months (n = 77 varenicline, 60 NRT).

INTERVENTION AND COMPARATOR

Twelve weeks of varenicline (2 mg/day, after 1-week dose run-up) or NRT (21 mg/day decreasing to 7 mg/day).

MEASUREMENTS

Primary: point-prevalence smoking abstinence (7-day, confirmed) at 3 months. Secondary: point-prevalence abstinence at 6 months, quantity and frequency of smoking and substance use at 3 and 6 months, and within-treatment abstinence, medication adherence and depressive symptoms. Smoking outcome analyses were repeated controlling for adherence and investigating adherence as a moderator.

FINDINGS

Effects on 3-month abstinence were P < 0.065 without a covariate (Bayes factor 3.35, supporting the effect strongly) and differed significantly when controlling for baseline smoking [varenicline: 13%, NRT: 3%; odds ratio (OR) = 4.81, 95% confidence interval (CI) 1.00, 23.13, P < 0.05]. The threefold difference at 6 months was not significant. Medication effect on abstinence across time was significant (P < 0.05) covarying adherence and baseline smoking (OR = 6.40, 95% CI = 1.00, 40.93). Medication differences in 3-month abstinence occurred among participants with ≥ 77% adherence (P < 0.02). No significant medication effects on heavy drinking, drug use or depressive symptoms were found.

CONCLUSIONS

Varenicline appears to improve the chances of achieving at least 3 months of smoking abstinence in smokers with substance use disorders trying to stop, compared with transdermal nicotine patches, the effect being independent of history of depressive disorder.

Perceived barriers to smoking cessation among adults with substance use disorders

The majority of adults seeking substance use disorder treatment also smoke. Smoking is associated with greater substance use disorder severity, poorer treatment outcome, and increased mortality among those with substance use disorders. Yet, engaging this population in smoking cessation treatment is a significant challenge. The aim of this study was to examine perceived barriers to smoking cessation among treatment-seeking adults with alcohol or opioid use disorder. Additionally, we examined whether anxiety sensitivity - a known risk factor for barriers to smoking cessation in the general population - was associated with more barriers to smoking cessation in this sample. A sample of 208 adults was recruited for a one-time study and completed self-report measures of anxiety sensitivity and perceived barriers to smoking cessation. Results indicated that the most common barriers were anxiety (82% of the sample), tension/irritability (76%), and concerns about the ability to maintain sobriety from their primary substance of abuse (64%). Those who reported more barriers also reported lower confidence in the ability to change their smoking behavior. Higher anxiety sensitivity was associated with more perceived barriers to smoking cessation, even when controlling for cigarette dependence severity. These results suggest that there are several perceived barriers to smoking cessation among treatment-seeking adults with substance use disorders. In addition to psychoeducational interventions aimed to modify negative beliefs about smoking cessation, anxiety sensitivity may be a promising therapeutic target in this population.

Treating Smokers in Substance Treatment With Contingent Vouchers, Nicotine Replacement and Brief Advice Adapted for Sobriety Settings

Treatment for substance use disorders (SUD) provides an opportunity to use voucher-based treatment for smoking. Nicotine replacement (NRT) could improve outcomes previously observed with vouchers without NRT.

METHODS

A randomized controlled trial compared contingent vouchers (CV) for smoking abstinence to noncontingent vouchers (NV), when all received counseling and NRT. Smokers who had not sought smoking treatment (n=340) in residential SUD treatment were provided 14days of vouchers for complete smoking abstinence per exhaled carbon monoxide (CO) after a 5-day smoking reduction period, or vouchers only for breath samples, plus brief advice (four sessions) and 8weeks of NRT.

RESULTS

Within treatment, 20% had complete abstinence with CV, 5% with NV (p<.001), and participants showed 50% of days abstinent in CV compared to 22% in NV (p<.001). Across 1, 3, 6 and 12months after randomization, CV resulted in significantly fewer cigarettes per day (p<.01) and fewer days smoking (p<.01), but with small effects. Point-prevalence abstinence differences across follow-up (e.g., 4% CV, 2% in NV at 6 and 12months) were not significant. No differences in substance use were seen.

CONCLUSIONS

Within-treatment effects on abstinence are stronger than in a prior study of the same CV with BA but without NRT, but NRT does not improve abstinence after vouchers end. Implications for voucher-based treatment include investigating effects when combined with stronger smoking medications and using motivational interviewing. Smoking treatment does not harm SUD recovery.

Was it the drink? The conditioned association of alcohol and desire to quit smoking on the dual use of little cigars/cigarillos and cigarettes among men and women

INTRODUCTION

Dual use of little cigars/cigarillos (LCCs) with cigarettes is becoming more popular; especially among men, but infrequently studied. Dual tobacco users show a higher prevalence of health-risk behaviors such as drug and alcohol use, are likely exposed to higher levels of nicotine and tobacco-related toxicants, and have greater difficulty quitting and maintaining abstinence. This study examined the effects of alcohol use, and desire to quit smoking on dual use of LCCs and cigarettes among men and women.

METHODS

Data utilized responses from a screening survey of 571 adult smokers. Basic demographic information, current cigarette use, desire to quit smoking, frequency of current LCC use, and alcohol and drug use were collected.

RESULTS

Dual users were more likely to be male and younger, report drug use in the past 90-days, and have a lower desire to quit smoking. Regression analyses showed a 3-way interaction of gender, alcohol use frequency, and desire to quit smoking, such that men who drank alcohol more frequently who had a higher desire to quit smoking used LCCs more frequently than men with a lower desire to quit.

DISCUSSION

Alcohol use may be a risk factor for men's dual use of LCCs and cigarettes among those who want to quit smoking. Implications for prevention and treatment are discussed.

Influences of barriers to cessation and reasons for quitting on substance use among treatment-seeking smokers who report heavy drinking

OBJECTIVES

We examined behavioral and cognitively-based quit processes among concurrent alcohol and tobacco users and assessed whether smoking and drinking were differentially influenced.

METHODS

Participants were 200 treatment-seeking smokers (37.50% female; M_age = 30.72; SD = 12.68) who reported smoking an average of 10 or more cigarettes daily for at least one year.

RESULTS

Barriers to cessation (BCS) and reasons for quitting (RFQ) were generally correlated with substance use. BCS moderated the relationship between quit methods and cigarette use such that quit methods were negatively associated with smoking, particularly among those with more BCS. RFQ moderated the association between quit methods and cigarette use such that quit methods were negatively linked with smoking among those with fewer RFQ, but positively linked with smoking among those with more RFQ. Two 3-way interactions emerged. The first 3-way indicated that among individuals with fewer RFQ, quit methods was negatively associated with smoking, and this was strongest among those with more BCS. However, among those with more RFQ, smoking and quit methods were positively associated, particularly among those with more BCS. The second 3-way showed that among those with fewer RFQ, quit methods was negatively linked with drinking frequency, and this was strongest among those with more BCS. However, among those with fewer BCS, drinking and quit methods were positively linked.

CONCLUSIONS

The relationship between behavioral and cognitively-based quit processes and substance use is not straightforward. There may be concurrent substance-using individuals for whom these processes might be associated with increased substance use.

Individualized Treatment for Tobacco Dependence in Addictions Treatment Settings: The Role of Current Depressive Symptoms on Outcomes at 3 and 6 Months

INTRODUCTION

Individuals with concurrent tobacco dependence and other addictions often report symptoms of low mood and depression and as such may have more difficulty quitting smoking. We hypothesized that current symptoms of depression would be a significant predictor of quit success among a group of smokers receiving individualized treatment for tobacco dependence within addiction treatment settings.

METHODS

Individuals in treatment for other addictions were enrolled in a smoking cessation program involving brief behavioral counseling and individualized dosing of nicotine replacement therapy. The baseline assessment included the Patient Health Questionnaire (PHQ9) for depression. Smoking cessation outcomes were measured at 3 and 6 months post-enrollment. Bivariate associations between cessation outcomes and PHQ9 score were analyzed.

RESULTS

Of the 1,196 subjects enrolled to date, 1,171 (98%) completed the PHQ9. Moderate to severe depression (score >9) was reported by 28% of the sample, and another 29% reported mild depression (score between 5 and 9). Contrary to the extant literature and other findings by our own group, there was no association between current depression and cessation outcome at either 3 months (n = 1,171) (17.0% in those with PHQ9 > 9 vs. 19.8% in those with PHQ9 < 5, p = .32) or 6 months (n = 834) (17.8% vs. 18.9%, p = .74).

CONCLUSIONS

Contrary to our hypothesis, depression severity as measured by the PHQ9 did not predict cessation outcome in this clinical population. A possible explanation may be the individualized treatment and supportive environment of an addictions treatment setting. These data indicate that patients in an addictions treatment setting can successfully quit smoking regardless of current depressive symptoms.

Contingent vouchers and motivational interviewing for cigarette smokers in residential substance abuse treatment

Residential drug treatment provides an opportunity to intervene with smokers with substance use disorders (SUD). A randomized controlled clinical trial compared: (1) contingent vouchers (CV) for smoking abstinence to noncontingent vouchers (NCV), crossed with (2) motivational interviewing (MI) or brief advice (BA), for 184 smokers in SUD treatment. During the voucher period, 36% of carbon monoxide readings indicated smoking abstinence for those receiving CV versus 13% with NCV (p < .001). Post-treatment (3-9 months) point-prevalence abstinence rates were low (3-4% at each follow up), with more abstinence when CV was combined with MI (6.6% on average) than with BA (0% on average). No differential effects on drug use or motivation to quit smoking occurred. Thus, CV had limited effects on long-term smoking abstinence in this population but effects were improved when CV was combined with MI. More effective methods are needed to increase motivation to quit smoking and quit rates in this high-risk population.

A Perspective on Cigarette Smoking During Alcohol and Substance Use Treatment

Individuals in treatment for substance use continue to smoke at higher rates than the general population of the United States. This editorial presents a different perspective on cigarette smoking that might reflect aspects of the subculture of individuals who, representing a heterogeneous population, smoke while recovering from substance use associated problems. We discuss factors that independently and, in combination, influence cigarette smoking during treatment and recovery from substance use. We conclude that more qualitative research is needed to understand which factors, not typically emphasized in standard tobacco cessation programming, may contribute to cigarette smoking cessation for this population.

The association between anxiety sensitivity and motivation to quit smoking among women and men in residential substance use treatment

BACKGROUND

Smoking-attributed mortality is the leading cause of death among individuals in residential substance use treatment. As such, identifying factors that influence smoking cessation is highly relevant and important for this group. Motivation to quit (MTQ) smoking is one such factor that is related to smoking cessation.

OBJECTIVES

In the present study we examine the relationship between Anxiety Sensitivity (AS) and MTQ among individuals enrolled in a residential substance use treatment center in Washington, DC. In light of gender differences in smoking cessation as well as factors that contribute to cessation, we examined this relationship by gender in men and women using multiple group path analysis.

METHODS

Participants (n = 472) completed a measure of MTQ, the structured clinical interview for DSM-IV (SCID-IV-TR), a measure of AS, and self-reported their number of cigarettes smoked per day prior to entering a restricted environment.

RESULTS

RESULTS indicated that AS was significantly related to MTQ in women (standardized path estimate = 0.21, p = .01), but was not significantly related to MTQ in men. Conclusions/Importance: Findings suggest the importance of considering AS as a factor in MTQ for women and subsequent smoking cessation among individuals in residential substance use treatment. RESULTS of this study contribute to the extant literature on predictors of MTQ and highlight the need for tailored cessation interventions with AS as one potential cessation treatment target.

Smoke and Mirrors: The Perceived Benefits of Continued Tobacco use Among Current Smokers

Despite 50+ years of public health efforts to reduce smoking rates in the United States, approximately one-fifth of the adults living in this country continue to smoke cigarettes. Previous studies have examined smokers’ risk perceptions of cigarette smoking, as well as the perceived benefits of quitting smoking. Less research has focused on the perceived benefits of smoking among current cigarette smokers. The latter is the main focus of the present paper. Questionnaire-based interviews were conducted with a community-based sample of 485 adult current cigarette smokers recruited from the Atlanta, Georgia, metropolitan area between 2004 and 2007. Active and passive recruiting approaches were used, along with a targeted sampling strategy. Results revealed that most current cigarette smokers perceive themselves to experience benefits as a result of their cigarette use, including (among others) increased relaxation, diminished nervousness in social situations, enjoyment of the taste of cigarettes when smoking, and greater enjoyment of parties when smoking. Perceiving benefits from cigarette smoking was associated with a variety of tobacco use measures, such as smoking more cigarettes, an increased likelihood of chain smoking, and overall negative attitude toward quitting smoking, among others. Several factors were associated with the extent to which smokers perceived themselves to benefit from their tobacco use, including education attainment, the age of first purchasing cigarettes, the proportion of friends who smoked, hiding smoking from others, being internally-oriented regarding locus of control, and self-esteem.

A cross-lagged path analysis of five intrapersonal determinants of smoking cessation

BACKGROUND

Prominent theories of drug use underscore the importance of considering the inter-relationships (e.g., reciprocal relations, indirect effects) of determinants of drug use behavior. In the area of smoking, few studies have examined multiple determinants of cessation in this way, and in prospective analyses. The current study is an examination of the prospective cross-lagged relationships among five intrapersonal determinants of cessation.

METHODS

Data from a longitudinal cohort study on racial differences in the process of smoking cessation were used to examine reciprocal relations among abstinence motivation, abstinence self-efficacy, positive affect, negative affect, and craving. Each of these five measures assessed on the quit day were regressed onto the same measures assessed 1-2 weeks pre-quit. The relationships of these variables at quit day with 1-week post-quit abstinence from smoking were also examined.

RESULTS

When the five variables were examined simultaneously in a cross-lagged path analysis, motivation and self-efficacy, and self-efficacy and positive affect showed cross-lagged relations. Only self-efficacy on the quit day uniquely predicted 1-week post quit abstinence. There were significant indirect effects of motivation and positive affect on cessation via self-efficacy.

CONCLUSIONS

The current study reaffirms the importance of motivation and self-efficacy in smoking cessation, and suggests that positive affect may play a role in smoking cessation.

Motivational interviewing versus brief advice for cigarette smokers in residential alcohol treatment

Residential treatment for substance use disorders (SUD) provides opportunity for smoking intervention. A randomized controlled trial compared: (1) motivational interviewing (MI) to brief advice (BA), (2) in one session or with two booster sessions, for 165 alcoholics in SUD treatment. All received nicotine replacement (NRT). MI and BA produced equivalent confirmed abstinence, averaging 10% at 1 month, and 2% at 3, 6 and 12 months. However, patients with more drug use pretreatment (>22 days in 6 months) given BA had more abstinence at 12 months (7%) than patients in MI or with less drug use (all 0%). Boosters produced 16-31% fewer cigarettes per day after BA than MI. Substance use was unaffected by treatment condition or smoking cessation. Motivation to quit was higher after BA than MI. Thus, BA plus NRT may be a cost-effective way to reduce smoking for alcoholics with comorbid substance use who are not seeking smoking cessation.

Climate for innovation, 12-step orientation, and tobacco cessation treatment

This study examined the relationship between (1) three indicators of climate for innovation (clinician skills, absence of program obstacles, policy-related incentives) and adoption extensiveness of both behavioral treatments for tobacco cessation (TC) and system-level support for TC in substance use disorder treatment programs, (2) a program's 12-step treatment orientation and adoption extensiveness, and (3) whether 12-step treatment orientation moderates the relationship between climate for innovation and adoption extensiveness. Data were obtained from a random sample of 1006 program administrators. Hierarchical regression results showed that both absence of program obstacles and policy-related incentives are positively related to adoption extensiveness. Twelve-step treatment orientation is neither related to adoption extensiveness nor a moderator of the relationship between climate for innovation and adoption extensiveness. Although the adoption of both behavioral treatments for TC and system-level support for TC is not extensive, we conclude that a 12-step treatment orientation neither hampers nor promotes adoption extensiveness.

Smoking cessation treatment among patients in community-based substance abuse rehabilitation programs: exploring predictors of outcome as clues toward treatment improvement

BACKGROUND

Predictors of smoking cessation (SC) treatment outcome were explored in a multisite clinical trial of SC treatment at community-based, outpatient, substance abuse rehabilitation programs affiliated with the National Drug Abuse Treatment Clinical Trials Network.

OBJECTIVES

To explore baseline demographic and clinical predictors of abstinence during treatment.

METHODS

Cigarette smokers from five methadone maintenance programs and two drug and alcohol dependence treatment programs were randomly assigned to SC treatment as an adjunct to substance abuse treatment as usual or to substance abuse treatment as usual. SC treatment consisted of group counseling (weeks 1-8) plus transdermal nicotine patch treatment (21 mg/day, weeks 1-6; 14 mg/day, weeks 7-8). Demographic and clinical predictors of smoking abstinence were evaluated among those patients assigned to the active SC condition (N = 153) using logistic regression.

RESULTS

Abstinence during treatment was positively associated with younger age, Hispanic or Caucasian (as opposed to African American) ethnicity/race, employment or student status, fewer cigarettes per day at baseline, lower severity of the primary substance problem at baseline, and higher methadone doses (among the subsample in methadone treatment).

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

During future efforts to improve SC treatments among drug- and alcohol-dependent patients, consideration should be given to adequate treatment to reduce the severity of the primary drug or alcohol problem, tailoring treatments for patients with greater severity of smoking and of the primary substance problem, and culturally sensitive interventions. Analysis of predictors of outcome may be a useful tool for treatment development.

Implementing an adapted version of the job seekers' workshop in a residential program for patients with substance use disorders

OBJECTIVES

To evaluate the feasibility and effectiveness of adapting the Job Seekers' Workshop (JSW) to a residential setting within a Massachusetts-based substance use disorder treatment agency.

METHODS

Implementation of the adapted JSW consisted of a continual sequence of three weekly sessions that focused on job interview rehearsals, practice completing job applications, and identification of job leads. Data were compiled on the employment rates of the 188 patients discharged from the residential treatment program during July - December 2006 (baseline participants, n = 95) and January - June 2007 (JSW intervention participants, n = 93). The effectiveness of the adapted JSW was evaluated through a comparison of baseline and intervention participants' employment rates at discharge from residential treatment.

RESULTS

Analyses indicated a trend towards a significant increase in employment at discharge for the intervention period (40.9%) compared to baseline (29.5%), χ(2)(1, N = 188) = 2.675, p = .051.

CONCLUSIONS

Further evaluation of the JSW in residential settings is necessary, but this preliminary research suggests that the intervention could begin to address the need for vocational services in residential treatment for substance use disorders.

Motivation to change alcohol use and treatment engagement in incarcerated youth

Adolescents have been reported to be less motivated to engage and remain in substance abuse treatment than adults. When they appear motivated, it is often due to external motivators such as family pressure or court mandated treatment. The purpose of this study was to determine if adolescents' motivation to change alcohol use was related to treatment engagement while incarcerated and alcohol use after release. Participants (N=114) were youth in a state correctional facility in the Northeast and included adolescents who engaged in at least monthly drinking. Motivation to change alcohol use was measured by the Alcohol Ladder (AL), and treatment engagement was measured by the Treatment Participation Questionnaire (comprised of positive and negative treatment engagement). Measures were administered at baseline, 2 months in facility follow up, and 3 months post release follow up. Analysis indicated acceptable test-retest stability (r=.388, p≤.001). The AL at 3 months post release significantly predicted quantity and frequency of alcohol use after release. The AL at baseline also significantly predicted positive and negative treatment engagement at 2 months into incarceration (i.e., 2 months in facility follow up) indicating predictive validity. These results suggest that the AL is a reliable, valid, and useful instrument for incarcerated youth.

Smoking cessation and chronic pain: patient and pain medicine physician attitudes

Although previous studies suggest that the clinical setting of an interdisciplinary pain treatment program may provide an optimal environment to promote smoking cessation, currently available smoking cessation interventions may be less effective for adults with chronic pain due, in part, to unrecognized clinical factors related to chronic pain. The specific aim of this qualitative study was to solicit information from adult smokers with chronic pain participating in an interdisciplinary pain treatment program regarding their perceptions of how smoking affects pain symptoms, and how these beliefs, cognitions, and emotions may either impede or facilitate smoking cessation. Similar information was solicited from a group of pain specialty physicians. The study involved 18 smokers with chronic pain, and seven physicians. Patients reported that smoking was an important coping strategy for pain and distress, primarily by offering an opportunity for distraction and avoidance, respectively. The majority of patients using opioids reported that opioid consumption stimulated smoking. Important barriers were identified toward making a quit attempt during pain treatment including quitting smoking while making changes in opioid use, and perceived difficulty managing multiple treatment-related stressors. Several pain-related benefits of smoking cessation were identified by physicians, but important barriers to providing smoking cessation services were recognized including lack of time and knowledge about how to help patients quit smoking. The findings of this study identified several novel and important clinical factors that should be incorporated into a targeted smoking cessation intervention for adults with chronic pain.

Counselors' knowledge of the adoption of tobacco cessation medications in substance abuse treatment programs

This study assessed counselors' knowledge of the adoption of evidence-based tobacco cessation medications (TCMs)--varenicline, bupropion, and five nicotine replacement therapies (NRTs)--and predictors of adoption in diverse substance abuse treatment settings. We used Managing Effective Relationships in Treatment Services (MERITS I) data from 658 counselors working in 26 programs. Adoption of varenicline was reported by 16% of counselors, bupropion by 11%, and NRTs by 27%. Knowledge of the adoption of all types of TCMs was more likely to be reported by counselors who worked in treatment programs that adhered less to a 12-step orientation and restricted outdoor smoking for employees. Several additional unique predictors of varenicline and NRTs were identified. 

Validation of a contemplation ladder in an adult substance use disorder sample

Developing brief measures of motivation to abstain from substance use that reliably predict treatment retention and outcome is a high priority in the addiction field. This study examined the psychometric properties of a contemplation ladder designed to assess readiness to abstain from alcohol and drug use respectively, on the basis of the contemplation ladder for smoking cessation developed by Biener and Abrams (1991). Participants were 394 substance-using male and female welfare recipients referred for treatment. The combined alcohol and other drug (AOD) ladder showed discriminant validity with demographic and health characteristics, convergent validity with conceptually related treatment motivation variables, concurrent validity with baseline AOD treatment and substance use variables, and predictive validity for participation in treatment services up to 1 month later and abstinence outcomes up to 1 year later. The AOD ladder showed predictive validity for those in drug-free treatment and no treatment at baseline but not for those in methadone maintenance.

Perceived Risks and Benefits of Quitting Smoking in Non-Treatment Seekers

Little is known about beliefs about quitting and treatment motivation in non-treatment seeking smokers. One hundred eight-eight daily cigarette smokers not currently motivated to quit smoking completed measures of perceived risks and benefits of quitting and motivation to quit. Self esteem related to quitting was positively related to desire to quit, expected success at quitting, confidence in quitting, and motivation to quit. Greater perceived risks of cravings were related to greater expected difficulty of remaining abstinent, and greater perceived risk of increased negative affect was related to decreased expectation of success at quitting, confidence for quitting, and increased expectation for difficulty remaining abstinent. Greater perceived risk of weight gain was related to being less likely to have a goal of complete abstinence. There were no gender, ethnicity, age, or education differences in the relationship of perceived risks and benefits of quitting and motivation. Knowing the risks and benefits that relate to motivation to quit for non-treatment seeking smokers provides the foundation for targeting this group in campaigns to increase quit motivation.

Effects of topiramate or naltrexone on tobacco use among male alcohol-dependent outpatients

BACKGROUND

A high smoking prevalence has been registered among alcoholics. It has been pointed out that alcoholic smokers may have a more severe course and greater severity of alcoholism. This study aims at comparing smoking and non-smoking alcoholics in terms of treatment outcomes and verifying the efficacy of topiramate and naltrexone to decrease the use of cigarettes among alcoholic smokers.

METHODS

The investigation was a double-blind, placebo-controlled, 12-week study carried out at the University of São Paulo, Brazil. The sample comprised 155 male alcohol-dependent outpatients (52 non-smokers and 103 smokers), 18-60 years of age, with an International Classification of Diseases (ICD-10) diagnosis of alcohol dependence. After a 1-week detoxification period, the patients randomly received placebo, naltrexone (50mg/day) or topiramate (up to 300 mg/day). Only the alcoholic smokers who adhered to the treatment were evaluated with reference to the smoking reduction.

RESULTS

Cox regression analysis revealed that the smoking status among alcoholics increased the odds of relapse into drinking by 65%, independently of the medications prescribed, using the intention-to-treat method. Topiramate showed effectiveness to reduce the number of cigarettes smoked when compared to placebo among adherent patients (mean difference=7.91, p<0.01). There were no significant differences between the naltrexone group and the placebo group.

CONCLUSIONS

The results of this study confirm that the treatment is more challenging for smoking alcoholics than for non-smoking ones and support the efficacy of topiramate in the smoking reduction among male alcoholic smokers who adhered to the treatment.

Smokers' expectancies for abstinence: preliminary results from focus groups

Smokers' expectancies regarding the effects of cigarette use are powerful predictors of smoking motivation and behavior. However, studies have not investigated the consequences that smokers expect when they attempt to quit smoking: abstinence-related expectancies. The primary goal of this qualitative study was to gain initial insight into smokers' expectancies for abstinence. Eight focus groups were conducted with 30 smokers diverse with respect to age, gender, and ethnoracial background. Content analyses indicated that smokers anticipate a variety of outcomes from abstinence. The most frequently reported expectancies included pharmacologic withdrawal symptoms, behavioral withdrawal symptoms, decreased monetary expense, and immediate improvement of certain aspects of physical functioning and health. Additional expectancies concerned weight gain, improved attractiveness, enhanced social functioning/self-esteem, long-term health outcomes, and loss of relationships. Finally, a number of relatively unheralded expectancies were revealed. These involved nicotine replacement therapy effectiveness, alcohol and other drug use, cue reactivity, cessation-related social support, aversion to smoking, and "political process" implications. This study provides a preliminary step in understanding smokers' expectancies for abstinence from cigarettes.

The effects of warning smokers on perceived risk, worry, and motivation to quit

BACKGROUND

Research concerning motives for smoking cessation has focused on beliefs (cognitions) that people have, especially risk perceptions, with less attention directed to worry (negative affect) concerning one's smoking.

PURPOSE

We tested a manipulation to encourage smokers to think and worry more about their smoking behavior. We contrasted risk perceptions and worry as predictors of contemplation to quit smoking.

METHODS

Smokers were randomly assigned to two conditions in which they carried personal digital assistants for 2 weeks. When signaled, smokers read smoking consequence statements or daily hassle statements.

RESULTS

After 2 weeks, experimental smokers reported greater perceived risk and worry about developing a medical condition compared to control smokers. Both perceived risk and worry independently mediated the relationship between the experimental manipulation and increased contemplation to quit smoking; however, worry was the strongest mediator in a multiple mediation model.

CONCLUSION

Worry may be foremost for motivating smokers to attempt quitting.

Antismoking Threat and Efficacy Appeals: Effects on Smoking Cessation Intentions for Smokers with Low and High Readiness to Quit

This study examined the effects of sequencing different types of antismoking threat and efficacy appeals on smoking cessation intentions for smokers with low and high levels of readiness to quit. An experiment was done to test predictions based on Witte's (1992) Extended Parallel Process Model and research by Cho and Salmon (2006). A national probability sample of 555 adult smokers was recruited to take part in this study. Results found a positive two-way interaction effect between message threat and perceived level of message efficacy on intentions to seek help for quitting. A three-way interaction effect was found between message threat, perceived level of message efficacy, and readiness to quit on quitting intentions. Both threat and efficacy were important for smokers with low readiness to quit, whereas efficacy was most important among smokers with high readiness to quit. Implications of the results for antismoking campaigns are discussed along with limitations and future directions.

Survey of clinician attitudes toward smoking cessation for psychiatric and substance abusing clients

The current study examined mental health clinician attitudes regarding smoking cessation for psychiatric and substance abusing patients. Participants included n = 15 never smokers, n = 12 former smokers, and n = 7 current smokers. There was a trend (p = 0.08) for current smokers as compared to former and never smokers to be less likely to encourage their clients to stop smoking. Overall, clinicians strongly agreed that an individual's motivation is the most important determinant of success in quitting. Clinicians were concerned that smoking cessation would initiate a relapse to substance abuse. We suggest that mental health clinicians can be instrumental in providing information, encouragement, and opportunities for their patients to attempt smoking cessation.

Self-efficacy for cocaine abstinence: pretreatment correlates and relationship to outcomes

Little research has been conducted on the relationship of self-efficacy at treatment entry to individual differences or to treatment outcome for patients with cocaine dependence. Those relationships were examined in 163 cocaine-dependent patients in a residential treatment program using two measures of self-efficacy administered in the first week of treatment: beliefs about success in quitting in general and confidence about not using in 11 cocaine-specific high-risk situations. The most robust correlates of self-efficacy were greater desire to stop using and lower urge to use in high-risk situations. Age, depressive symptoms, cognitive functioning, recent substance use, and past success with quitting also correlated with self-efficacy. Both measures of self-efficacy predicted quantity and frequency of cocaine use and abstinence at 3 but not 6 months after treatment after controlling pretreatment cocaine use. Results suggest that treatments should target self-efficacy in cocaine-dependent patients.

Readiness for change and drug use outcomes after treatment

AIMS

The present study represents the first large-scale test of the capacity to predict illicit drug treatment outcomes of an instrument [Stages of Change and Treatment Eagerness Scale (SOCRATES)] purporting to measure processes underlying stages of change. The main hypothesis was that 'taking steps' should be predictive of less frequent use of illicit opiates (heroin and non-prescribed methadone) at follow-up.

DESIGN

The sample comprised 1075 people seeking treatment for drug abuse problems in 54 treatment agencies in England. The study uses a longitudinal, prospective cohort design. Structured interviews were conducted at treatment intake and at 1-year follow-up. Data were collected about illicit drug use (frequency of use of heroin, non-prescribed methadone, cocaine and amphetamines, and non-prescribed benzodiazepines) and other problems.

FINDINGS

Results failed to support the hypothesis that taking steps should be associated with less frequent use of illicit opiates at follow-up. No statistically significant associations of any kind were found between readiness for change measures and use of opiates or stimulants at follow-up. A negative association was found between taking steps and benzodiazepine misuse. Readiness for change measures were correlated with heroin use and psychiatric symptom scores at treatment intake.

CONCLUSIONS

Readiness for change measures were not associated with illicit drug use outcomes. Of the 12 hypothesized relationships between readiness for change measures and outcomes, our results show only one 'hit' and 11 'misses'.