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Wong BKC, Veldhuizen S, Minian N, Zawertailo L, Selby P. The effects of alcohol use on smoking cessation treatment with nicotine replacement therapy: An observational study. Addict Behav 2024; 155:108045. [PMID: 38692071 DOI: 10.1016/j.addbeh.2024.108045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/10/2024] [Accepted: 04/26/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Concurrent users of tobacco and alcohol are at greater risk of harm than use of either substance alone. It remains unclear how concurrent tobacco and alcohol use affects smoking cessation across levels of alcohol use and related problems. This study assessed the relationship between smoking cessation and levels of alcohol use problems. METHODS 59,018 participants received nicotine replacement therapy through a smoking cessation program. Alcohol use and related symptoms were assessed using the Alcohol Use Disorders Identification Test (AUDIT-10) and the AUDIT-Concise (AUDIT-C). The primary outcome was 7-day point prevalence cigarette abstinence (PPA) at 6-month follow-up. We evaluated the association between alcohol use (and related problems) and smoking cessation using descriptive methods and mixed-effects logistic regression. RESULTS 7-day PPA at 6-months was lower in groups meeting hazardous alcohol consumption criteria, with the lowest probability of smoking abstinence observed in the highest risk group. The probability of successful tobacco cessation fell with increasing levels of alcohol use and related problems. Adjusted predicted probabilities were 30.3 (95 % CI = 29.4, 31.1) for non-users, 30.2 (95 % CI = 29.4, 31.0) for low-risk users, 29.0 (95 % CI = 28.1, 29.9) for those scoring below 8 on the AUDIT-10, 27.3 (95 % CI = 26.0, 28.6) for those scoring 8-14, and 24.4 (95 % CI = 22.3, 26.5) for those scoring 15 or higher. CONCLUSION Heavy, hazardous alcohol use is associated with lower odds of successfully quitting smoking compared to low or non-use of alcohol. Targeting alcohol treatment to this group may improve tobacco cessation outcomes.
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Affiliation(s)
- Benjamin K C Wong
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Scott Veldhuizen
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Nadia Minian
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, IMHPR, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Laurie Zawertailo
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, IMHPR, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peter Selby
- INTREPID Lab, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, IMHPR, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Vander Weg MW, Howren MB, Grant KM, Prochazka AV, Duffy S, Burke R, Cretzmeyer M, Parker C, Thomas EBK, Rizk MT, Bayer J, Kinner EM, Clark JM, Katz DA. A smoking cessation intervention for rural veterans tailored to individual risk factors: A multicenter randomized clinical trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209191. [PMID: 37866436 DOI: 10.1016/j.josat.2023.209191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/24/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Rates of cigarette use remain elevated among those living in rural areas. Depressive symptoms, risky alcohol use, and weight concerns frequently accompany cigarette smoking and may adversely affect quitting. Whether treatment for tobacco use that simultaneously addresses these issues affects cessation outcomes is uncertain. METHODS The study was a multicenter, two-group, randomized controlled trial involving mostly rural veterans who smoke (N = 358) receiving treatment at one of five Veterans Affairs Medical Centers. The study randomly assigned participants to a tailored telephone counseling intervention or referral to their state tobacco quitline. Both groups received guideline-recommended smoking cessation pharmacotherapy, selected using a shared decision-making approach. The primary outcome was self-reported seven-day point prevalence abstinence (PPA) at three and six months. The study used salivary cotinine to verify self-reported quitting at six months. RESULTS Self-reported PPA was significantly greater in participants assigned to Tailored Counseling at three (OR = 1.66; 95 % CI: 1.07-2.58) but not six (OR = 1.35; 95 % CI: 0.85-2.15) months. Post hoc subgroup analyses examining treatment group differences based on whether participants had a positive screen for elevated depressive symptoms, risky alcohol use, and/or concerns about weight gain indicated that the cessation benefit of Tailored Counseling at three months was limited to those with ≥1 accompanying concern (OR = 2.02, 95 % CI: 1.20-3.42). Biochemical verification suggested low rates of misreporting. CONCLUSIONS A tailored smoking cessation intervention addressing concomitant risk factors enhanced short-term abstinence but did not significantly improve long-term quitting. Extending the duration of treatment may be necessary to sustain treatment effects.
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Affiliation(s)
- Mark W Vander Weg
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Community and Behavioral Health, University of Iowa College of Public Health, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Psychological and Brain Sciences, University of Iowa, United States of America; VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America.
| | - M Bryant Howren
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America; Department of Behavioral Sciences and Social Medicine, Florida State University, United States of America; Florida Blue Center for Rural Health Research & Policy, United States of America
| | - Kathleen M Grant
- VA Nebraska-Western Iowa Health Care System, United States of America; University of Nebraska Medical Center Department of Medicine, United States of America
| | - Allan V Prochazka
- Primary Care, VA Eastern Colorado Health Care System, United States of America; Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), United States of America
| | - Sonia Duffy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States of America; College of Nursing, Ohio State University, United States of America
| | - Randy Burke
- Mental Health Service, G.V. (Sonny) Montgomery VA Medical Center, United States of America; Department of Psychiatry, University of Mississippi School of Medicine, United States of America
| | | | - Christopher Parker
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, United States of America
| | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | | | - Jennifer Bayer
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Ellen M Kinner
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Jennifer M Clark
- Department of Neurology, University of Iowa, Carver College of Medicine, United States of America
| | - David A Katz
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Epidemiology, University of Iowa College of Public Health, United States of America
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Asowata OJ, Okekunle AP, Adedokun B, Akpa OM. Alcohol use patterns and hypertension among adults in the United States: findings from the 2015-2016 NHANES data. Public Health 2023; 225:327-335. [PMID: 37976655 DOI: 10.1016/j.puhe.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES This study assessed the association between alcohol use patterns and the prevalence of hypertension. STUDY DESIGN Data on alcohol use patterns and hypertension among 5918 adults from the 2015-2016 National Health and Nutrition Examination Survey was used for this study. METHODS The association of alcohol use patterns; "ever-used alcohol", "binge drinking", "heavy drinking", and "everyday alcohol use" with hypertension were assessed using multivariable-adjusted logistic regression to estimate the adjusted odds ratio (aOR) and 95% confidence interval (CI) at a two-sided P < 0.05. RESULTS Overall, the mean age of respondents was 48.3 ± 18.5 years, 50.9% (n = 3034) were women, and 44.6% (n = 2132) were hypertensive. Also, 85.9% (n = 4177) had used alcohol in their lifetime, 51.9% (n = 1764) were heavy drinkers, 25.1% (n = 370) engaged in binge drinking, and 17.7% (n = 721) reported everyday alcohol use. Compared to those that have never used alcohol, the aOR (95%CI) of stage II hypertension was 1.570 (1.565, 1.575) for overall alcohol use, 1.370 (1.367, 1.373) for everyday alcohol use, 1.127 (1.125, 1.129) for heavy drinking, and 1.092 (1.087, 1.098) for binge drinking. Among current active smokers, the aOR (95%CI) of stage II hypertension was aggravated for everyday alcohol use; 2.583 (2.576, 2.590). CONCLUSION Alcohol use patterns were associated with a higher prevalence of hypertension, particularly among smokers. A population-based longitudinal study should clarify whether these alcohol use phenotypes are predictive of hypertension at the population level in the United States.
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Affiliation(s)
- O J Asowata
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria
| | - A P Okekunle
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria; Department of Food and Nutrition, College of Human Ecology, Seoul National University, 08826, Seoul, Republic of Korea; Research Institute of Human Ecology, Seoul National University, 08826, Seoul, Republic of Korea
| | - B Adedokun
- Centre for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, IL 60637, United States
| | - O M Akpa
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, 200284, Ibadan, Nigeria; Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, 200284, Nigeria; Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, United States.
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Liu C, Yong HH, Gravely S, East K, Kasza K, Gartner C, Cummings KM, Fong GT. Gender differences in cigarette smoking cessation attempts among adults who smoke and drink alcohol at high levels: Findings from the 2018-2020 International Tobacco Control Four Country Smoking and Vaping Surveys. Addict Behav 2023; 147:107817. [PMID: 37536221 PMCID: PMC10866688 DOI: 10.1016/j.addbeh.2023.107817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND This study examined the association between alcohol consumption and smoking cessation behaviour of adults who smoke in four countries. METHODS Data came from 4275 adults (≥18 years) who smoked tobacco ≥ monthly and participated in the 2018 and 2020 International Tobacco Control Four Country Smoking and Vaping Surveys (Australia: n = 720; Canada: n = 1250; US: n = 1011; England: n = 1294). The 2018 Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) survey data coded into three levels ('never/low', 'moderate' or 'heavy' consumption) were analysed using multivariable logistic regression models to predict any smoking cessation attempts and successful cessation by 2020 survey, and whether this differed by gender and country. RESULTS Compared to never/low alcohol consumers, only those who drink heavily were less likely to have made a quit smoking attempt (40.4 % vs. 43.8 %; AOR = 0.69, 95 % CI = 0.57-0.83, p < .001). The association differed by gender and country (3-way interaction, p < .001), with females who drink heavily being less likely to attempt to quit smoking in England (AOR = 0.27, 95 % CI = 0.15-0.49, p < .001) and Australia (AOR = 0.38, 95 % CI = 0.19-0.77, p = .008), but for males, those who drink moderately (AOR = 2.18, 95 % CI = 1.17-4.06, p = .014) or heavily (AOR = 2.61, 95 % CI = 1.45-4.68, p = .001) were more likely to make a quit attempt in England only. Alcohol consumption did not predict quit success. CONCLUSION Heavy alcohol use among adults who smoke appears to only undermine the likelihood of trying to quit smoking with some variation by gender and country of residence, but not their chances of succeeding if they tried.
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Affiliation(s)
- Chenyang Liu
- School of Psychology, Deakin University, Geelong, Victoria, Australia.
| | - Hua-Hie Yong
- School of Psychology, Deakin University, Geelong, Victoria, Australia.
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada.
| | - Katherine East
- National Addiction Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
| | - Karin Kasza
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Coral Gartner
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada; Ontario Institute for Cancer Research, Toronto, Ontario M5G 0A3, Canada.
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van Amsterdam J, van den Brink W. The effect of alcohol use on smoking cessation: A systematic review. Alcohol 2023; 109:13-22. [PMID: 36690220 DOI: 10.1016/j.alcohol.2022.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/03/2022] [Accepted: 12/29/2022] [Indexed: 01/22/2023]
Abstract
Only a small minority of all attempts to stop smoking are successful, especially among smokers who are heavy drinkers and those with an alcohol use disorder. The current systematic review focuses on the negative effects of alcohol use, either before or during attempts to quit smoking, on the success rate of these attempt(s) in alcohol-drinking tobacco smokers. We conducted a systematic review of naturalistic and experimental studies, which included at least 40 tobacco smokers with a recorded drinking status (non-drinking, heavy drinking, alcohol use disorder) and a clearly documented change in alcohol consumption. We could not conduct a meta-analysis and, thus, used consistency across studies to draw conclusions. The evidence presented here shows that alcohol use is associated with lower rates of success in quitting smoking in 20 out of 27 studies. This includes both lapses and relapses. Similarly, in 19 out of 20 long-term follow-up studies, the duration of smoking abstinence was shorter among persons with higher alcohol consumption. Finally, 12 out of 13 experimental studies showed that exposure of smokers to alcohol cues or to drinking of alcohol induce a strong propensity to smoke. It is, therefore, recommended for smokers who drink alcohol and who intend to quit smoking to use an integrated approach, i.e., to stop or substantially reduce their alcohol consumption before and/or during their attempt to quit smoking.
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Affiliation(s)
- Jan van Amsterdam
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Neuroscience, Research Program Compulsivity, Impulsivity & Attention, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands.
| | - Wim van den Brink
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Neuroscience, Research Program Compulsivity, Impulsivity & Attention, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
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Ray LA, Green R, Enders C, Leventhal AM, Grodin EN, Li G, Lim A, Hartwell E, Venegas A, Meredith L, Nieto SJ, Shoptaw S, Ho D, Miotto K. Efficacy of Combining Varenicline and Naltrexone for Smoking Cessation and Drinking Reduction: A Randomized Clinical Trial. Am J Psychiatry 2021; 178:818-828. [PMID: 34080890 PMCID: PMC8999864 DOI: 10.1176/appi.ajp.2020.20070993] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Pharmacological treatments that can concomitantly address cigarette smoking and heavy drinking stand to improve health care delivery for these highly prevalent co-occurring conditions. This superiority trial compared the combination of varenicline and naltrexone against varenicline alone for smoking cessation and drinking reduction among heavy-drinking smokers. METHODS This was a phase 2 randomized double-blind clinical trial. Participants (N=165) who were daily smokers and drank heavily received either 2 mg/day of varenicline plus 50 mg/day of naltrexone or 2 mg/day of varenicline plus matched placebo pills for 12 weeks. Primary outcomes were 7-day point prevalence of nicotine abstinence (bioverified by a breath CO reading ≤5 ppm) at the 26-week follow-up and number of drinks per drinking day during the 12-week treatment phase. RESULTS Smoking abstinence at week 26 was significantly higher in the varenicline plus placebo condition than in the varenicline plus naltrexone condition (N=37 [45.1%] compared with N=22 [26.5%]). For drinks per drinking day, there was a medication effect favoring the combination of varenicline and naltrexone over varenicline alone across the 12-week treatment phase, although it did not meet the significance threshold. CONCLUSIONS These findings suggest that smoking cessation and drinking reduction can be concomitantly targeted with pharmacotherapy and that while varenicline alone may be sufficient as a smoking cessation aid in heavy-drinking smokers, the combination of varenicline and naltrexone may confer benefits with regard to drinking outcomes, particularly during the 12-week period of active medication treatment.
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Affiliation(s)
- Lara A. Ray
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA,Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA
| | - ReJoyce Green
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Craig Enders
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Adam M. Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Erica N. Grodin
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Gang Li
- Department of Biostatistics, University of California at Los Angeles, Los Angeles, CA
| | - Aaron Lim
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Emily Hartwell
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Alex Venegas
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Lindsay Meredith
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Steven J. Nieto
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Steven Shoptaw
- Department of Family Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Diana Ho
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA
| | - Karen Miotto
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA
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Dermody SS, Hendershot CS, Andrade AK, Novalen M, Tyndale RF. Changes in Nicotine Metabolite Ratio Among Daily Smokers Receiving Treatment for Alcohol Use Disorder. Nicotine Tob Res 2020; 22:256-263. [PMID: 30561731 DOI: 10.1093/ntr/nty265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/13/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Alcohol may influence the nicotine metabolite ratio (NMR), an index of the rate of nicotine metabolism that is associated smoking level and lapses. We examined if NMR changes during alcohol use disorder (AUD) treatment and how changes in NMR relate to reductions in drinking. METHODS Using an observational design, 22 daily smokers [63.64% male, Mage = 46.77 (11.37)] receiving AUD treatment completed baseline and follow-up appointments 3 weeks apart. At each appointment, daily alcohol and cigarette use, salivary and urinary NMR, nicotine exposure via urinary total nicotine equivalents, and carbon monoxide were assessed. Multilevel models examined the change over time in NMR and its within-person relations with changes in drinks per week. Sex differences were evaluated. RESULTS There were significant reductions in both salivary and urinary NMR over time for men (p = .02; p = .01, respectively) but not for women (p = .54; p = .90, respectively). There were no changes over time in total nicotine equivalents (p = .09), carbon monoxide (p = .44), or cigarette use (p = .44) in either sex. Drinks per week were significantly reduced for men (29.12 drink reduction, p < .001) but not for women (2.28 drink reduction, p = .80); however, within-person changes in drinking were not associated with changes in salivary or urinary NMR (p = .99; p = .19). CONCLUSIONS The reduction in alcohol use and NMR in men provides indirect support for alcohol increasing NMR. In contrast, the low baseline drinking and lack of alcohol reduction likely underlie the lack of change in NMR in females. Reasons for NMR reductions during AUD treatment and its effects on smoking require further study. IMPLICATIONS Three weeks of alcohol use disorder treatment among daily smokers coincided with a significant reduction in both alcohol use and NMR for men; however, neither drinking level nor NMR changed for women. The findings indirectly support that heavy drinking increases NMR, which is reversed with reduced drinking. Additional research is needed to establish if these changes in NMR correlate with smoking and cessation outcomes.
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Affiliation(s)
- Sarah S Dermody
- School of Psychological Science, Oregon State University, Corvallis, OR
| | - Christian S Hendershot
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Allyson K Andrade
- Department of Psychology, University of Guelph, Guelph, Ontario, Canada
| | - Maria Novalen
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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Kahler CW, Cohn AM, Costantino C, Toll BA, Spillane NS, Graham AL. A Digital Smoking Cessation Program for Heavy Drinkers: Pilot Randomized Controlled Trial. JMIR Form Res 2020; 4:e7570. [PMID: 32348286 PMCID: PMC7308890 DOI: 10.2196/formative.7570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/29/2020] [Accepted: 03/29/2020] [Indexed: 11/29/2022] Open
Abstract
Background Heavy drinking (HD) is far more common among smokers compared with nonsmokers and interferes with successful smoking cessation. Alcohol-focused smoking cessation interventions delivered by counselors have shown promise, but digital versions of these interventions—which could have far greater population reach—have not yet been tested. Objective This pilot randomized controlled trial aimed to examine the feasibility, acceptability, and effect sizes of an automated digital smoking cessation program that specifically addresses HD using an interactive web-based intervention with an optional text messaging component. Methods Participants (83/119, 69.7% female; 98/119, 82.4% white; mean age 38.0 years) were daily smokers recruited on the web from a free automated digital smoking cessation program (BecomeAnEX.org, EX) who met the criteria for HD: women drinking 8+ drinks/week or 4+ drinks on any day and men drinking 15+ drinks/week or 5+ drinks on any day. Participants were randomized to receive EX with standard content (EX-S) or an EX with additional content specific to HD (EX-HD). Outcomes were assessed by web-based surveys at 1 and 6 months. Results Participants reported high satisfaction with the website and the optional text messaging component. Total engagement with both EX-S and EX-HD was modest, with participants visiting the website a median of 2 times, and 52.9% of the participants enrolled to receive text messages. Participants in both the conditions showed substantial, significant reductions in drinking across 6 months of follow-up, with no condition effects observed. Although smoking outcomes tended to favor EX-HD, the condition effects were small and nonsignificant. A significantly smaller proportion of participants in EX-HD reported having a lapse back to smoking when drinking alcohol (7/58, 16%) compared with those in EX-S (18/61, 41%; χ21=6.2; P=.01). Conclusions This is the first trial to examine a digital smoking cessation program tailored to HD smokers. The results provide some initial evidence that delivering such a program is feasible and may reduce the risk of alcohol-involved smoking lapses. However, increasing engagement in this and other web-based interventions is a crucial challenge to address in future work. Trial Registration ClinicalTrials.gov NCT03068611; https://clinicaltrials.gov/ct2/show/NCT03068611
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Affiliation(s)
- Christopher W Kahler
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Amy M Cohn
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | | | - Benjamin A Toll
- Medical University of South Carolina, Charleston, SC, United States
| | - Nichea S Spillane
- Department of Psychology, University of Rhode Island, South Kingston, RI, United States
| | - Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, United States.,Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, United States
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Unequal interactions between alcohol and nicotine co-consumption: suppression and enhancement of concurrent drug intake. Psychopharmacology (Berl) 2020; 237:967-978. [PMID: 31858160 PMCID: PMC7124972 DOI: 10.1007/s00213-019-05426-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/06/2019] [Indexed: 12/26/2022]
Abstract
RATIONALE Alcohol and nicotine addiction are prevalent conditions that co-occur. Despite the prevalence of co-use, factors that influence the suppression and enhancement of concurrent alcohol and nicotine intake are largely unknown. OBJECTIVES Our goals were to assess how nicotine abstinence and availability influenced concurrent alcohol consumption and to determine the impact of quinine adulteration of alcohol on aversion-resistant alcohol consumption and concurrent nicotine consumption. METHODS Male and female C57BL/6J mice voluntarily consumed unsweetened alcohol, nicotine, and water in a chronic 3-bottle choice procedure. In experiment 1, nicotine access was removed for 1 week and re-introduced the following week, while the alcohol and water bottles remained available at all times. In experiment 2, quinine (100-1000 μM) was added to the 20% alcohol bottle, while the nicotine and water bottles remained unaltered. RESULTS In experiment 1, we found that alcohol consumption and preference were unaffected by the presence or absence of nicotine access in both male and female mice. In experiment 2a, we found that quinine temporarily suppressed alcohol intake and enhanced concurrent nicotine, but not water, preference in both male and female mice. In experiment 2b, chronic quinine suppression of alcohol intake increased nicotine consumption and preference in female mice without affecting water preference, whereas it increased water and nicotine preference in male mice. CONCLUSIONS Quinine suppression of alcohol consumption enhanced the preference for concurrent nicotine preference in male and female mice, suggesting that mice compensate for the quinine adulteration of alcohol by increasing their nicotine preference.
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Green R, Bujarski S, Lim AC, Venegas A, Ray LA. Naltrexone and alcohol effects on craving for cigarettes in heavy drinking smokers. Exp Clin Psychopharmacol 2019; 27:257-264. [PMID: 30628813 PMCID: PMC7227763 DOI: 10.1037/pha0000252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Naltrexone has been extensively studied for the treatment of alcohol use disorder. However, less is known about the effects of naltrexone on smoking outcomes in the context of alcohol use among East Asian individuals who have been suggested to differ in response to alcohol and to naltrexone. The present study is a secondary analysis that used a double-blind placebo-controlled design (n = 31) to examine the (a) effects of alcohol on basal craving for cigarettes, (b) effects of naltrexone on cigarette craving and alcohol craving during alcohol administration, and (c) relationship between craving for alcohol and cigarettes. Heavy drinking smokers of East Asian descent completed two counterbalanced intravenous alcohol administration sessions, one after taking naltrexone (50 mg) for five days and one after taking a placebo for five days. Self-reported subjective craving for cigarettes and for alcohol was recorded during each experimental session. Craving for cigarettes and alcohol increased significantly throughout the intravenous alcohol administration. A significant breath alcohol concentration (BrAC) × Medication interaction revealed that naltrexone blunted cigarette craving during alcohol administration, compared to placebo. Naltrexone significantly reduced craving for alcohol during alcohol administration in this group of heavy drinking smokers. Alcohol craving significantly predicted cigarette craving, however this effect did not vary across rising alcohol administration or by medication. These findings demonstrate that naltrexone reduces the urge to smoke and to drink during alcohol administration. Clinical studies are needed to further ascertain whether naltrexone may be of benefit to this distinct subgroup of heavy drinking smokers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- ReJoyce Green
- Department of Psychology, University of California, Los Angeles
| | | | - Aaron C Lim
- Department of Psychology, University of California, Los Angeles
| | | | - Lara A Ray
- Department of Psychology, University of California, Los Angeles
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11
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Lim AC, Roche DJO, Ray LA. Distress Tolerance and Craving for Cigarettes Among Heavy Drinking Smokers. J Stud Alcohol Drugs 2018; 79:918-928. [PMID: 30573023 PMCID: PMC6308171 DOI: 10.15288/jsad.2018.79.918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/23/2018] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVE Heavy drinking smokers experience significant difficulties with smoking cessation. Craving is closely tied to relapses during cessation attempts, and alcohol consumption increases cigarette craving among heavy drinking smokers. To date, however, few moderators of the relationship between craving and relapse have been identified. Individuals' capacity for distress tolerance predicts smoking cessation outcomes and may be connected to craving. Relatedly, pharmacotherapies like varenicline and naltrexone reduce cigarette and alcohol cravings, respectively. No studies have examined the interrelationships among distress tolerance, craving, and pharmacotherapy effects. This study therefore examines distress tolerance as a moderator of the relationship between overnight abstinence-induced cigarette craving and subsequent alcohol- and cigarette-induced changes in craving among heavy drinking smokers. This study also examines the impact of varenicline and naltrexone on these relationships. METHOD A total of 120 non-treatment-seeking heavy drinking smokers were randomized and titrated to one of the following conditions: (a) placebo, (b) varenicline, (c) naltrexone, or (d) varenicline + naltrexone. Participants then completed a laboratory paradigm after overnight abstinence that included consumption of alcohol (target .06 g/dl breath alcohol concentration) and one cigarette. Craving was assessed as abstinence-induced (Time 1), alcohol-induced (Time 2), and cigarette-induced (Time 3). RESULTS Within varenicline + naltrexone, low distress tolerance individuals exhibited higher increases from abstinence- to alcohol-induced cigarette craving relative to high distress tolerance individuals. Across medications, low distress tolerance individuals reported flatter decreases from abstinence- to cigarette-induced cigarette craving relative to high distress tolerance individuals. CONCLUSIONS Distress tolerance may differentially predict alcohol-induced cigarette craving when titrated to pharmacotherapy, as well as moderate decreases in craving after cigarette consumption. Future exploration of the identified interactive effects could elucidate specific conditions in which cravings are more proximally related to abstinence-induced smoking.
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Affiliation(s)
- Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Daniel J O Roche
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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12
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Lim AC, Roche DJO, Ray LA. Distress Tolerance and Craving for Cigarettes Among Heavy Drinking Smokers. J Stud Alcohol Drugs 2018; 79:918-928. [PMID: 30573023 PMCID: PMC6308171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE Heavy drinking smokers experience significant difficulties with smoking cessation. Craving is closely tied to relapses during cessation attempts, and alcohol consumption increases cigarette craving among heavy drinking smokers. To date, however, few moderators of the relationship between craving and relapse have been identified. Individuals' capacity for distress tolerance predicts smoking cessation outcomes and may be connected to craving. Relatedly, pharmacotherapies like varenicline and naltrexone reduce cigarette and alcohol cravings, respectively. No studies have examined the interrelationships among distress tolerance, craving, and pharmacotherapy effects. This study therefore examines distress tolerance as a moderator of the relationship between overnight abstinence-induced cigarette craving and subsequent alcohol- and cigarette-induced changes in craving among heavy drinking smokers. This study also examines the impact of varenicline and naltrexone on these relationships. METHOD A total of 120 non-treatment-seeking heavy drinking smokers were randomized and titrated to one of the following conditions: (a) placebo, (b) varenicline, (c) naltrexone, or (d) varenicline + naltrexone. Participants then completed a laboratory paradigm after overnight abstinence that included consumption of alcohol (target .06 g/dl breath alcohol concentration) and one cigarette. Craving was assessed as abstinence-induced (Time 1), alcohol-induced (Time 2), and cigarette-induced (Time 3). RESULTS Within varenicline + naltrexone, low distress tolerance individuals exhibited higher increases from abstinence- to alcohol-induced cigarette craving relative to high distress tolerance individuals. Across medications, low distress tolerance individuals reported flatter decreases from abstinence- to cigarette-induced cigarette craving relative to high distress tolerance individuals. CONCLUSIONS Distress tolerance may differentially predict alcohol-induced cigarette craving when titrated to pharmacotherapy, as well as moderate decreases in craving after cigarette consumption. Future exploration of the identified interactive effects could elucidate specific conditions in which cravings are more proximally related to abstinence-induced smoking.
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Affiliation(s)
- Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Daniel J O Roche
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, California.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
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13
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Lim AC, Courtney KE, Moallem NR, Allen VC, Leventhal AM, Ray LA. A Brief Smoking Cessation Intervention for Heavy Drinking Smokers: Treatment Feasibility and Acceptability. Front Psychiatry 2018; 9:362. [PMID: 30147661 PMCID: PMC6095957 DOI: 10.3389/fpsyt.2018.00362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 07/20/2018] [Indexed: 12/01/2022] Open
Abstract
Approximately 20-25% of regular smokers report heavy drinking. Abstinent smokers are five times as likely to experience a smoking lapse during drinking episodes. Current efforts seek to improve treatments for this subgroup of heavy-drinking smokers. This study tested the feasibility and acceptability of addressing alcohol use in a brief, single session smoking cessation intervention (SMK+A) compared to smoking cessation counseling only (SMK); these interventions were grounded in a motivational interview framework and included personalized feedback, decisional balance, quit day setting, and tailored skills building (e.g., breathing techniques, coping with urges, dealing with social pressures) to maintain abstinence. Descriptive outcomes included reported helpfulness of intervention skills, readiness to change scores, and feasibility of participant recruitment and retention. We also assessed 7-day point prevalence of smoking cessation, and smoking and drinking reduction at 1-month follow-up. Participants (N = 22) were community-based treatment-seeking daily smokers (≥5 cigarettes/day) who were also heavy drinkers (≥14 drinks/week for men, ≥ 7 drinks/week for women; or ≥5 drinks on one episode in past week for men, ≥4 for women). Twenty five percent of interested individuals were eligible after initial phone screen, and all randomized participants were retained through follow up. All skills demonstrated high acceptability (i.e., rated between moderately and very helpful), and a significant proportion of participants in each condition reported taking action to reduce cigarette smoking and/or alcohol use at 1-month post-quit. Three participants in each condition (27.3%) attained bioverified (CO ≤ 4 parts per million and cotinine ≤ 3 ng/mL) smoking quit at follow-up. Given the modified intervention's acceptability and flexibility, larger studies may help to elucidate this intervention's effects on readiness to change, smoking cessation, and alcohol reduction.
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Affiliation(s)
- Aaron C Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kelly E Courtney
- Department of Psychology, University of California, San Diego, San Diego, CA, United States
| | - Nathasha R Moallem
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Vincent C Allen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Adam M Leventhal
- Department of Preventive Medicine and Psychology, University of Southern California, Los Angeles, CA, United States
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Sells JR, Waters AJ, MacLean RR. Evaluating the influence of at-risk alcohol use on factors associated with smoking cessation: Combining laboratory and ecological momentary assessment. Drug Alcohol Depend 2017; 179:267-270. [PMID: 28822262 PMCID: PMC5630265 DOI: 10.1016/j.drugalcdep.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 05/26/2017] [Accepted: 06/01/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Most smokers want to quit but most cessation attempts end in failure. Alcohol consumption is associated with smoking behavior and relapse. We examined the associations between severity of drinking and psychological processes during a cessation attempt in the laboratory and during a quit attempt. METHODS Smokers (N=209) enrolled in a smoking cessation study were followed from 2 weeks pre-quit through 4 weeks post-quit. Participants scoring 0-7 and 8-15 on the Alcohol Use Disorders Identification Test (AUDIT) were classified as low-risk and high-risk drinkers, respectively. Participants attended one pre-quit laboratory session before which they were required to abstain from smoking and another pre-quit session before which they smoked normally. Craving was assessed in the laboratory with the Questionnaire for Smoking Urges (QSU). A subsample of the participants also completed a 1-week ecological momentary assessment (EMA) study starting on the quit day. During EMA, craving for cigarettes was assessed, and attentional bias was assessed using a smoking Stroop task (n=119). RESULTS High (vs. low) risk participants reported greater abstinence-induced increases in craving in the laboratory, and also exhibited greater attentional bias on the smoking Stroop task during EMA. CONCLUSIONS High-risk drinkers exhibited a stronger increase in desire to smoke in abstinence and greater attentional bias to smoking cues early in a quit attempt, both of which may motivate continued smoking behaviors. High-risk drinkers may require more intensive or different smoking cessation interventions.
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Affiliation(s)
- Joanna R Sells
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
| | - R Ross MacLean
- Department of Psychiatry, Yale University, 300 George Street, Suite 901, New Haven, CT 06511, USA; VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
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15
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Cohn AM, Zhao K, Cha S, Wang X, Amato MS, Pearson JL, Papandonatos GD, Graham AL. A Descriptive Study of the Prevalence and Typology of Alcohol-Related Posts in an Online Social Network for Smoking Cessation. J Stud Alcohol Drugs 2017; 78:665-673. [PMID: 28930053 DOI: 10.15288/jsad.2017.78.665] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Alcohol use and problem drinking are associated with smoking relapse and poor smoking-cessation success. User-generated content in online social networks for smoking cessation provides an opportunity to understand the challenges and treatment needs of smokers. This study used machine-learning text classification to identify the prevalence, sentiment, and social network correlates of alcohol-related content in the social network of a large online smoking-cessation program, BecomeAnEX.org. METHOD Data were analyzed from 814,258 posts (January 2012 to May 2015). Posts containing alcohol keywords were coded via supervised machine-learning text classification for information about the user's personal experience with drinking, whether the user self-identified as a problem drinker or indicated problem drinking, and negative sentiment about drinking in the context of a quit attempt (i.e., alcohol should be avoided during a quit attempt). RESULTS Less than 1% of posts were related to alcohol, contributed by 13% of users. Roughly a third of alcohol posts described a personal experience with drinking; very few (3%) indicated "problem drinking." The majority (70%) of alcohol posts did not express negative sentiment about drinking alcohol during a quit attempt. Users who did express negative sentiment about drinking were more centrally located within the network compared with those who did not. CONCLUSIONS Discussion of alcohol was rare, and most posts did not signal the need to quit or abstain from drinking during a quit attempt. Featuring expert information or highlighting discussions that are consistent with treatment guidelines may be important steps to ensure smokers are educated about drinking risks.
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Affiliation(s)
- Amy M Cohn
- Battelle Memorial Institute, Arlington, Virginia.,Department of Oncology, Georgetown University Medical Center, Washington, DC
| | - Kang Zhao
- Department of Management Sciences, Tippie College of Business, The University of Iowa, Iowa City, Iowa
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | - Xi Wang
- School of Information, Central University of Finance and Economics, Beijing, China
| | - Michael S Amato
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
| | - Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - George D Papandonatos
- Center for Statistical Sciences, Brown University School of Public Health, Brown University, Providence, Rhode Island
| | - Amanda L Graham
- Department of Oncology, Georgetown University Medical Center, Washington, DC.,Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC
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16
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Kahler CW, Cioe PA, Tzilos GK, Spillane NS, Leggio L, Ramsey SE, Brown RA, O'Malley SS. A Double-Blind Randomized Placebo-Controlled Trial of Oral Naltrexone for Heavy-Drinking Smokers Seeking Smoking Cessation Treatment. Alcohol Clin Exp Res 2017; 41:1201-1211. [PMID: 28401564 DOI: 10.1111/acer.13396] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/06/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Post hoc analyses of 2 randomized controlled trials suggest naltrexone may reduce alcohol use and improve smoking cessation outcomes among heavy drinkers receiving smoking cessation treatment. However, no studies have been conducted specifically to examine naltrexone for this purpose or to test whether naltrexone has benefit when added to smoking cessation counseling that explicitly addresses heavy drinking. METHODS We recruited heavy-drinking smokers from the community and randomized them to receive 10 weeks of either (i) 50 mg naltrexone (n = 75) or (ii) placebo (n = 75) daily. Participants received 6 weeks of transdermal nicotine patch and 6 sessions of counseling that addressed both heavy drinking and smoking. Participants were followed for 26 weeks after their target quit smoking date. RESULTS Across medication conditions, there were substantial reductions at follow-up in percent heavy drinking days (primary outcome) and average drinks per week (secondary outcome). However, participants receiving naltrexone did not differ significantly from those receiving placebo on percent heavy drinking days (effect size d = -0.04, 95% CI [-0.30, 0.22], p = 0.76) or average drinks per week (d = -0.09, 95% CI [-0.35, 0.18], p = 0.54) during follow-up. Naltrexone compared to placebo was not associated with a significant increase in smoking abstinence rates during follow-up, odds ratio = 0.93, 95% CI [0.46, 1.86], p = 0.83. The effect of naltrexone on these outcomes was not significantly moderated by current alcohol dependence or gender. CONCLUSIONS Results indicate that heavy-drinking smokers, including those with current alcohol dependence, can make substantial reductions in drinking in the context of smoking cessation treatment. However, this study provided no evidence that naltrexone is efficacious for enhancing reductions in drinking or improving smoking cessation in this population. Limitations of this study included lower-than-desired sample size and modest adherence to study medication.
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Affiliation(s)
- Christopher W Kahler
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Patricia A Cioe
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
| | - Golfo K Tzilos
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nichea S Spillane
- Department of Psychology, University of Rhode Island, South Kingston, Rhode Island
| | - Lorenzo Leggio
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island.,Section on Clinical Psychoneuroendocrinology and Neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, Bethesda, Maryland
| | - Susan E Ramsey
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island.,Department of Medicine, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island
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17
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Norman H, D'Souza MS. Endogenous opioid system: a promising target for future smoking cessation medications. Psychopharmacology (Berl) 2017; 234:1371-1394. [PMID: 28285326 DOI: 10.1007/s00213-017-4582-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/24/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Nicotine addiction continues to be a health challenge across the world. Despite several approved medications, smokers continue to relapse. Several human and animal studies have evaluated the role of the endogenous opioid system as a potential target for smoking cessation medications. METHODS In this review, studies that have elucidated the role of the mu (MORs), delta (DORs), and kappa (KORs) opioid receptors in nicotine reward, nicotine withdrawal, and reinstatement of nicotine seeking will be discussed. Additionally, the review will discuss discrepancies in the literature and therapeutic potential of the endogenous opioid system, and suggest studies to address gaps in knowledge with respect to the role of the opioid receptors in nicotine dependence. RESULTS Data available till date suggest that blockade of the MORs and DORs decreased the rewarding effects of nicotine, while activation of the MORs and DORs decreased nicotine withdrawal-induced aversive effects. In contrast, activation of the KORs decreased the rewarding effects of nicotine, while blockade of the KORs decreased nicotine withdrawal-induced aversive effects. Interestingly, blockade of the MORs and KORs attenuated reinstatement of nicotine seeking. In humans, MOR antagonists have shown benefits in select subpopulations of smokers and further investigation is required to realize their full therapeutic potential. CONCLUSION Future work must assess the influence of polymorphisms in opioid receptor-linked genes in nicotine dependence, which will help in both identifying individuals vulnerable to nicotine addiction and the development of opioid-based smoking cessation medications. Overall, the endogenous opioid system continues to be a promising target for future smoking cessation medications.
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Affiliation(s)
- Haval Norman
- Department of Pharmaceutical and Biomedical Sciences, The Raabe College of Pharmacy, Ohio Northern University, 525 S Main Street, Ada, OH, 45810, USA
| | - Manoranjan S D'Souza
- Department of Pharmaceutical and Biomedical Sciences, The Raabe College of Pharmacy, Ohio Northern University, 525 S Main Street, Ada, OH, 45810, USA.
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18
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Long-term abstinence and predictors of tobacco treatment uptake among hospitalized smokers with serious mental illness enrolled in a smoking cessation trial. J Behav Med 2017; 40:750-759. [PMID: 28349344 DOI: 10.1007/s10865-017-9844-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 03/18/2017] [Indexed: 10/19/2022]
Abstract
Hospital patients with serious mental illness (SMI) have high rates of smoking. There are few post-discharge treatment models available for this population and limited research on their treatment uptake following discharge. This study is a secondary analysis of an RCT that compared multi-session intensive telephone counseling versus referral to state quitline counseling at two safety net hospitals in New York City. For this analysis, we selected all trial participants with a history of schizophrenia, schizoaffective disorder or bipolar disorder (N = 384) and used multivariable logistic regression to compare groups on self-reported 30-day abstinence at 6 months and to identify patient factors associated with use of tobacco treatment. Analyses found no significant group differences in abstinence 6 months (28% quitline vs. 29% intervention, p > 0.05), use of cessation medications (42% quitline vs. 47% intervention, p > 0.05) or receipt of at least one counseling call (47% quitline vs. 42% intervention, p > 0.05). Patients with hazardous drinking (p = 0.04) or perceived good health (p = 0.03) were less likely to use cessation medications. Homeless patients were less likely to use counseling (p = 0.02). Most patients did not use cessation treatment after discharge, and the intensive intervention did not improve abstinence rates over quitline referral. Interventions are needed to improve use of cessation treatment and long-term abstinence in patients with SMI.
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Correa-Fernández V, Díaz-Toro EC, Reitzel LR, Guo L, Chen M, Li Y, Calo WA, Shih YCT, Wetter DW. Combined treatment for at-risk drinking and smoking cessation among Puerto Ricans: A randomized clinical trial. Addict Behav 2017; 65:185-192. [PMID: 27825036 PMCID: PMC5358923 DOI: 10.1016/j.addbeh.2016.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/29/2016] [Accepted: 10/20/2016] [Indexed: 11/19/2022]
Abstract
Tobacco and alcohol use are linked behaviors that individually and synergistically increase the risk for negative health consequences. This study was a two-group, randomized clinical trial evaluating the efficacy of a behavioral intervention, "Motivation And Problem Solving Plus" (MAPS+), designed to concurrently address smoking cessation and the reduction of at-risk drinking. Targeted interventions may promote coaction, the likelihood that changing one behavior (smoking) increases the probability of changing another behavior (alcohol use). Puerto Ricans (N=202) who were smokers and at-risk drinkers were randomized to standard MAPS treatment focused exclusively on smoking cessation (S-MAPS), or MAPS+, focused on cessation and at-risk drinking reduction. Drinking outcomes included: number of at-risk drinking behaviors, heavy drinking, binge drinking, and drinking and driving. MAPS+ did not have a significant main effect on reducing at-risk drinking relative to S-MAPS. Among individuals who quit smoking, MAPS+ reduced the number of drinking behaviors, the likelihood of meeting criteria for heavy drinking relative to S-MAPS, and appeared promising for reducing binge drinking. MAPS+ did not improve drinking outcomes among individuals who were unsuccessful at quitting smoking. MAPS+ showed promise in reducing at-risk drinking among Puerto Rican smokers who successfully quit smoking, consistent with treatment enhanced coaction. Integrating an alcohol intervention into cessation treatment did not reduce engagement in treatment, or hinder cessation outcomes, and positively impacted at-risk drinking among individuals who quit smoking. Findings of coaction between smoking and drinking speak to the promise of multiple health behavior change interventions for substance use treatment and chronic disease prevention.
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Affiliation(s)
- Virmarie Correa-Fernández
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, United States.
| | - Elba C Díaz-Toro
- Division of Cancer Control and Population Sciences, University of Puerto Rico, Comprehensive Cancer Center, PMB 371, PO Box 70344, San Juan, PR 00936-8344, Puerto Rico.
| | - Lorraine R Reitzel
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, United States.
| | - Lin Guo
- Department of Psychology, Rice University, 6500 Main St, Bioscience Research Collaborative, Houston, TX 77030, United States.
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Unit 1411, P.O. Box 301402, Houston, TX 77230, United States.
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Unit 1411, P.O. Box 301402, Houston, TX 77230, United States.
| | - William A Calo
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1102-F McGavran-Greenberg Bldg, CB 7411, Chapel Hill, NC 27599-7411, United States.
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Unit 1444, P.O. Box 301402, Houston, TX 77230, United States.
| | - David W Wetter
- Department of Population Health Sciences and The Huntsman Cancer Institute, University of Utah, Salt Lake City, UT 84108, United States.
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20
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Roche DJO, Ray LA, Yardley MM, King AC. Current insights into the mechanisms and development of treatments for heavy drinking cigarette smokers. CURRENT ADDICTION REPORTS 2016; 3:125-137. [PMID: 27162709 PMCID: PMC4859339 DOI: 10.1007/s40429-016-0081-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is a strong association between cigarette smoking and alcohol use at the epidemiological, behavioral, and molecular levels, and this co-use creates substantial impediments to smoking cessation among smokers who are also heavy drinkers. Compared with individuals who only smoke, those who both drink and smoke heavily experience more severe health consequences and have greater difficulty in quitting smoking. During smoking abstinence, greater alcohol use is associated with decreased odds of smoking cessation, and smokers are substantially more likely to experience a smoking lapse during drinking episodes. As heavy drinking smokers are less responsive to the currently available pharmacological treatments, this subgroup of high-risk substance users possesses a unique clinical profile and treatment needs. Thus, treatment development for heavy drinking smokers represents a significant and understudied research area within the field of smoking cessation. This review will briefly describe findings from epidemiological, behavioral, and molecular studies illustrating alcohol and tobacco co-use and identify how the behavioral and neurobiological mechanisms underlying the interaction of alcohol and nicotine may inform the development of targeted treatments for this unique population of smokers.
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Affiliation(s)
- Daniel J O Roche
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, 90095, USA
| | - Lara A Ray
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, 90095, USA; University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, 90095, USA
| | - Megan M Yardley
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA, 90095, USA
| | - Andrea C King
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL 60637, USA
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21
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Quitline Use and Outcomes among Callers with and without Mental Health Conditions: A 7-Month Follow-Up Evaluation in Three States. BIOMED RESEARCH INTERNATIONAL 2015; 2015:817298. [PMID: 26273647 PMCID: PMC4529922 DOI: 10.1155/2015/817298] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Revised: 05/06/2015] [Accepted: 05/06/2015] [Indexed: 12/05/2022]
Abstract
Objectives. To examine abstinence outcomes among tobacco users with and without a reported mental health condition (MHC) who enrolled in state tobacco quitline programs. Methods. Data were analyzed from a 7-month follow-up survey (response rate: 41% [3,132/7,459]) of three state-funded telephone quitline programs in the United States that assessed seven self-reported MHCs at quitline registration. We examined 30-day point prevalence tobacco quit rates for callers with any MHC versus none. Data were weighted to adjust for response bias and oversampling. Multivariable logistic regression was used to examine cessation outcomes. Results. Overall, 45.8% of respondents reported ≥1 MHC; 57.4% of those reporting a MHC reported ≥2 MHCs. The unadjusted quit rate for callers with any MHC was lower than for callers with no MHC (22.0% versus 31.0%, P < 0.001). After adjusting for demographics, nicotine dependence, and program engagement, callers reporting ≥1 MHC were less likely to be abstinent at follow-up (adjusted OR = 0.63, 95% CI = 0.51–0.78, P < 0.001). Conclusions. More intensive or tailored quitline programs may need to be developed among callers with MHCs as their quit rates appear to be lower than callers without MHCs.
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Toll BA, Martino S, O'Malley SS, Fucito LM, McKee SA, Kahler CW, Rojewski AM, Mahoney MC, Wu R, Celestino P, Seshadri S, Koutsky J, Hyland A, Cummings KM. A randomized trial for hazardous drinking and smoking cessation for callers to a quitline. J Consult Clin Psychol 2015; 83:445-54. [PMID: 25419583 PMCID: PMC5996380 DOI: 10.1037/a0038183] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study evaluated whether tobacco quitline telephone coaches can be trained to counsel hazardous-drinking smokers to improve smoking cessation success and to limit or abstain from alcohol use. METHOD Smokers (N = 1,948) who called the New York State Smokers' Quitline and reported hazardous drinking (exceeding sex-specific weekly limits [14 drinks for men, 7 drinks for women] or meeting/exceeding daily drinking limits [5 drinks for men, 4 drinks for women] at least once in the past year) were randomized to receive either brief motivational counseling to limit or abstain from alcohol plus an alcohol reduction booklet added to standard care (Alcohol + Tobacco Counseling; ATC), or only smoking cessation counseling plus a smoking cessation booklet added to standard care (Tobacco-Only Counseling; TOC). RESULTS Acceptable coach adherence was achieved. The intention-to-treat (ITT) analysis showed that ATC was associated with a significantly higher rate of smoking abstinence at 7-month follow-up (13.5%) compared with TOC (10.3%; p = .03). The respondent analysis (ATC= 26.2%; TOC = 20.4%) paralleled the ITT findings. When controlling for treatment condition, participants who did not report any heavy drinking were significantly more likely to quit smoking than those who reported any heavy drinking (OR = 1.87, 95% CI [1.29, 2.71]; p = .001). CONCLUSIONS A brief alcohol intervention plus standard care via a telephone quitline resulted in significantly higher smoking cessation rates for hazardous-drinking callers. Given that quitline coaches were trained to provide the intervention with acceptable adherence, the potential to extend this intervention for wide-scale implementation and impact is promising.
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Affiliation(s)
| | - Steve Martino
- Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare Center
| | | | | | | | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavior and Social Sciences, Brown University School of Public Health
| | | | | | | | - Paula Celestino
- Department of Health Behavior, Roswell Park Cancer Institute
| | | | - James Koutsky
- Department of Health Behavior, Roswell Park Cancer Institute
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina
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23
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Gilchrist G, Davidson S, Middleton A, Herrman H, Hegarty K, Gunn J. Factors associated with smoking and smoking cessation among primary care patients with depression: a naturalistic cohort study. ADVANCES IN DUAL DIAGNOSIS 2015. [DOI: 10.1108/add-10-2014-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– People with a history of depression are more likely to smoke and less likely to achieve abstinence from smoking long term. The purpose of this paper is to understand the factors associated with smoking and smoking cessation among patients with depression.
Design/methodology/approach
– This paper reports on smoking prevalence and cessation in a cohort of 789 primary care attendees with depressive symptoms (Centre for Epidemiologic Studies Depression Scale score of=16) recruited from 30 randomly selected Primary Care Practices in Victoria, Australia in 2005.
Findings
– At baseline, 32 per cent of participants smoked. Smokers were more likely to be male, unmarried, receive government benefits, have difficulty managing on available income, have emphysema, a chronic illness, poor self-rated health, to have more severe depressive and anxiety symptoms, to be taking anti-depressants, to be hazardous drinkers, to report suicidal ideation and to have experienced childhood physical or sexual abuse. At 12 months, 20 participants reported quitting. Females and people with good or better self-rated health were significantly more likely to have quit, while people with a chronic illness or suicidal ideation were less likely to quit. Smoking cessation was not associated with increases in depression or anxiety symptoms. Only six participants remained quit over four years.
Practical implications
– Rates of smoking were high, and long-term cessation was low among primary care patients with depressive symptoms. Primary care physicians should provide additional monitoring and support to assist smokers with depression quit and remain quit.
Originality/value
– This is the first naturalistic study of smoking patterns among primary care attendees with depressive symptoms.
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Abstract
There is a high prevalence of comorbid tobacco use and alcohol use disorder (AUD), affecting more than 6 million people in the US. Globally, tobacco and alcohol use rank fourth and fifth, respectively, for disability-adjusted life-years lost. Levels of alcohol use are higher in smokers than nonsmokers, and the prevalence of smoking is higher in heavy drinkers compared with nondrinkers. This relationship is driven by many different factors, including genetics, neurobiological mechanisms, conditioning processes, and psychosocial influences. Although this unique population tends to experience more negative health consequences, more severe AUD, and poorer response to treatment than those with either AUD or tobacco use disorder alone, there are currently no available treatment protocols tailored to this comorbid condition. In this review, we provide a comprehensive review of ongoing clinical research into smoking cessation options for heavy-drinking smokers (HDS) through an evaluation of the effect of promising novel pharmacotherapies as well as combination therapies, including varenicline, naltrexone, the combination of varenicline and naltrexone, and the combination of naltrexone and nicotine replacement therapy (NRT). These treatments are considered in light of the standard of care for smoking cessation, and seek to improve upon the available guidelines for this sizeable subgroup of smokers, namely those smokers who drink heavily.
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Affiliation(s)
- Megan M Yardley
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Michael M Mirbaba
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA.
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
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25
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Danielsson AK, Eriksson AK, Allebeck P. Technology-based support via telephone or web: a systematic review of the effects on smoking, alcohol use and gambling. Addict Behav 2014; 39:1846-68. [PMID: 25128637 DOI: 10.1016/j.addbeh.2014.06.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/03/2014] [Accepted: 06/13/2014] [Indexed: 11/27/2022]
Abstract
A systematic review of the literature on telephone or internet-based support for smoking, alcohol use or gambling was performed. Studies were included if they met the following criteria: The design being a randomized control trail (RCT), focused on effects of telephone or web based interventions, focused on pure telephone or internet-based self-help, provided information on alcohol or tobacco consumption, or gambling behavior, as an outcome, had a follow-up period of at least 3months, and included adults. Seventy-four relevant studies were found; 36 addressed the effect of internet interventions on alcohol consumption, 21 on smoking and 1 on gambling, 12 the effect of helplines on smoking, 2 on alcohol consumption, and 2 on gambling. Telephone helplines can have an effect on tobacco smoking, but there is no evidence of the effects for alcohol use or gambling. There are some positive findings regarding internet-based support for heavy alcohol use among U.S. college students. However, evidence on the effects of internet-based support for smoking, alcohol use or gambling are to a large extent inconsistent.
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26
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Bujarski S, Ray LA. Negative affect is associated with alcohol, but not cigarette use in heavy drinking smokers. Addict Behav 2014; 39:1723-9. [PMID: 25117849 DOI: 10.1016/j.addbeh.2014.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 06/30/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
Abstract
Co-use of alcohol and cigarettes is highly prevalent, and heavy drinking smokers represent a large and difficult-to-treat subgroup of smokers. Negative affect, including anxiety and depressive symptomatology, has been associated with both cigarette and alcohol use independently, but less is known about the role of negative affect in heavy drinking smokers. Furthermore, while some studies have shown negative affect to precede substance use, a precise biobehavioral mechanism has not been established. The aims of the present study were twofold. First, to test whether negative affect is associated with alcohol and cigarette use in a large community sample of heavy drinking smokers (n=461). And second, to examine craving as a plausible statistical mediator of the association between negative affect and alcohol and/or cigarette use. Hypothesis testing was conducted using a structural equation modeling approach with cross-sectional data. Analysis revealed a significant main effect of negative affect on alcohol use (β=0.210, p<0.05), but not cigarette use (β=0.131, p>0.10) in this sample. Mediational analysis revealed that alcohol craving was a full statistical mediator of this association (p<0.05), such that there was no direct association between negative affect and alcohol use after accounting for alcohol craving. These results are consistent with a negative reinforcement and relief craving models of alcohol use insofar as the experience of negative affect was associated with increased alcohol use, and the relationship was statistically mediated by alcohol craving, presumably to alleviate negative affect. Further longitudinal or experimental studies are warranted to enhance the causal inferences of this mediated effect.
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27
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Gates P. The effectiveness of helplines for the treatment of alcohol and illicit substance use. J Telemed Telecare 2014; 21:18-28. [PMID: 25331545 DOI: 10.1177/1357633x14555643] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
While tobacco helplines (quitlines) are thought to be effective, helplines which treat other substance use do not have an established evidence base. A review was conducted of the literature on illicit drug or alcohol (IDA) helplines. The literature search was conducted in five databases. Studies prior to 2014 were included if published in English, and involved the use of a telephone counselling helpline for the treatment of illicit drug or alcohol use. Review papers, opinion pieces, letters or editorials, case studies, published abstracts and posters were excluded. Initial searching identified 2178 articles and after removing duplicates and those meeting the exclusion criteria, there were 36 publications for review. A total of 29 articles provided descriptive information about 19 different IDA helplines which operated in the US (42%), Europe (21%), Australia (21%), Asia (11%) and Canada (5%). These services reported monthly call rates from 3.7 to over 23,000 calls per month. A total of nine articles provided evaluative information on eight different IDA helplines: four articles included a comparison of treatment outcomes against a control group and five articles included information on treatment satisfaction or service utilisation. Together they provide some evidence that these services are effective. Although there was little consistency in the measures used between articles which assessed helpline satisfaction, all but one reported high satisfaction. Although the evidence is mainly supportive of IDA helplines, further work is required to compare treatment outcomes in randomized groups.
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Affiliation(s)
- Peter Gates
- National Cannabis Prevention and Information Centre, University of New South Wales, Sydney, Australia
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28
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Ray LA, Courtney KE, Ghahremani DG, Miotto K, Brody A, London ED. Varenicline, low dose naltrexone, and their combination for heavy-drinking smokers: human laboratory findings. Psychopharmacology (Berl) 2014; 231:3843-53. [PMID: 24733235 PMCID: PMC4161630 DOI: 10.1007/s00213-014-3519-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 02/26/2014] [Indexed: 01/20/2023]
Abstract
RATIONALE Heavy-drinking smokers constitute a sizeable and hard-to-treat subgroup of smokers, for whom tailored smoking cessation therapies are not yet available. OBJECTIVES The present study used a double-blind, randomized, 2 × 2 medication design, testing varenicline alone (VAR; 1 mg twice daily), low dose naltrexone alone (L-NTX; 25 mg once daily), varenicline plus naltrexone, and placebo for effects on cigarette craving and subjective response to alcohol and cigarettes in a sample (n = 130) of heavy-drinking daily smokers (≥10 cigarettes/day). METHODS All participants were tested after a 9-day titration period designed to reach a steady state on the target medication. Testing was completed at 12 h of nicotine abstinence, after consuming a standard dose of alcohol (target breath alcohol concentration = 0.06 g/dl) and after smoking the first cigarette of the day. RESULTS The combination of VAR + L-NTX was superior to placebo, and at times superior to monotherapy, in attenuating cigarette craving, cigarette and alcohol "high," and in reducing ad-lib consumption of both cigarettes and alcohol during the 9-day medication titration period. CONCLUSIONS These preliminary findings indicate that clinical studies of the combination of VAR + L-NTX for heavy drinkers trying to quit smoking are warranted and may ultimately improve clinical care for this sizeable and treatment-resistant subgroup of smokers.
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Affiliation(s)
- Lara A Ray
- Department of Psychology, University of California, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA,
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29
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Ray LA, Courtney KE, Ghahremani DG, Miotto K, Brody A, London ED. Varenicline, naltrexone, and their combination for heavy-drinking smokers: preliminary neuroimaging findings. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2014; 41:35-44. [PMID: 24949564 DOI: 10.3109/00952990.2014.927881] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
RATIONALE Heavy drinking smokers constitute a sizeable and hard-to-treat subgroup of smokers, for whom tailored smoking cessation therapies are not yet available. OBJECTIVE The present study used a double-blind, randomized, 2 × 2 medication design, testing varenicline alone (VAR; 1 mg twice daily), naltrexone alone (NTX; 25 mg once daily), varenicline plus naltrexone, and placebo for effects on neural activation to cigarette cues in a sample (n = 40) of heavy drinking daily smokers (≥10 cigarettes/day). METHODS All participants were tested after a 10-12-day titration period designed to reach steady state on the target medication. Participants underwent functional neuroimaging (fMRI) for examination of brain responses to visual smoking-related (vs. neutral) cues. RESULTS Region of interest (ROI) analyses of brain responses to Cigarette vs. Neutral Cues indicated that the combination of VAR + NTX was associated with reduced activation of the bilateral anterior cingulate cortex as compared to placebo and to NTX alone. Exploratory whole-brain analyses also indicated significant differences in brain activation during cigarette cues in the active medications versus placebo condition. All medications suppressed left nucleus accumbens activation relative to placebo, suggesting the possibility that both medications, either alone or in combination, reduce neural signals associated with appetitive behavior. CONCLUSIONS Although preliminary, these neuroimaging findings indicate that clinical studies of the combination of VAR + NTX for heavy drinkers trying to quit smoking may be warranted.
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30
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McKee SA, Weinberger AH. How can we use our knowledge of alcohol-tobacco interactions to reduce alcohol use? Annu Rev Clin Psychol 2012; 9:649-74. [PMID: 23157448 DOI: 10.1146/annurev-clinpsy-050212-185549] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Currently, 8.5% of the US population meets criteria for alcohol use disorders, with a total cost to the US economy estimated at $234 billion per year. Alcohol and tobacco use share a high degree of comorbidity and interact across many levels of analysis. This review begins by highlighting alcohol and tobacco comorbidity and presenting evidence that tobacco increases the risk for alcohol misuse and likely has a causal role in this relationship. We then discuss how knowledge of alcohol and tobacco interactions can be used to reduce alcohol use, focusing on whether (a) smoking status can be used as a clinical indicator for alcohol misuse, (b) tobacco policies reduce alcohol use, and (c) nicotinic-based medications can be used to treat alcohol use disorders.
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Affiliation(s)
- Sherry A McKee
- Department of Psychiatry and Women's Health Research at Yale, Yale University School of Medicine, and Cancer Prevention and Control Research Program, Yale Cancer Center, New Haven, Connecticut 06519, USA.
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