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DrugandAlcoholDependence126 (2012) 279–285
ContentslistsavailableatSciVerseScienceDirect
Drug and Alcohol Dependence
j our na l h o me p a g e :w w w . e l s e v i e r . c o m / l o c a t e / d r u g a l c d e p
Cognitive behavioral smoking cessation during alcohol detoxification treatment:
A randomized, controlled trial
S.E.Mueller∗,S.A.Petitjean,G.A.Wiesbeck
DivisionofSubstanceUseDisorders,PsychiatricHospitaloftheUniversityofBasel,CH-4012Basel,Switzerland
a r t i c l e i n f o
Articlehistory:
Received22January2012
Receivedinrevisedform18May2012 Accepted19May2012
Available online 20 June 2012
Keywords:
Alcohol Tobacco Nicotine Smokingcessation Harmreduction
Cognitivebehavioraltreatment
a b s t r a c t
Background:Amongalcohol-dependentsubjectstobaccosmokingisverycommonandcausesavarietyof healthrisks.Therefore,itisnecessarytoreachthishigh-riskpopulationearlywithappropriatesmoking interventions.
Methods:Smokersinalcoholdetoxificationtreatmentwereofferedtoparticipateinasmokingces- sationstudy.Atotalof103patientswasenrolledandrandomlyassignedtoeithertheexperimental group(EG)receivingacognitivebehavioralsmokingcessationtreatment(CBT)orthecontrolgroup (CG)receivingautogenictraining.Smokingoutcomesweremeasuredbyself-reportandcarbonmonox- idelevels,directlyafterinterventionand6monthslater,whereadditionallyalcoholoutcomeswere recorded.
Results:Therewerenodifferencesinsmokingquitratesdirectlyafterintervention.However,patientsin theEGweresignificantlymorelikelytoreducetheirdailycigaretteusecomparedtoCG(p=.046).Sub- groupanalysesrevealedthatheavysmokers(FTNDscore≥7)seemedtoprofitmostintheEGregarding cigarettereduction.After6months,thesepositiveeffectshadleveledout.Noevidencewasfoundthat smokingcessationmightjeopardizealcoholoutcomes.
Conclusions:Resultssuggestthatalcohol-dependentsmokersareinterestedinsmokinginterventions evenduringalcoholdetoxification.CBTispromisinginshort-termsmokingoutcomesandintheapproach ofharmreduction,however,long-termeffectsaredesirable.Thesefindingsunderlinethefeasibility andtheimportancetoprovidesmokingcessationinterventionstopatientsinalcoholdetoxification treatments.
© 2012 Elsevier Ireland Ltd. All rights reserved.
1. Introduction
Tobaccosmokingisrelatedtoanumberofseverevascularhealth risksand carcinoma(Schmidt etal.,2006).Alcohol dependence onits ownis harmful, butin combination withtobacco smok- inghealthrisksontheupperaero-digestivetractaresynergistic (Pelucchietal.,2006).Alcohol-dependentheavysmokerssustain a35foldhigherrisktogetcarcinomainpharynxorlarynx(Zeka etal.,2003).Everyalcohol-attributabledeathisaccompaniedby about30yearsoflifelost(CDCP,2004).Amongalcohol-dependent patients70–95%haveacomorbidtobaccodependence(Bateletal., 1995;BienandBurge,1990;BurlingandZiff,1988;Johnetal.,2003) comparedto25–30%ingeneralpopulation(WHO,2011).Increased smokingisconnectedtoincreasedalcoholdrinkingandviceversa
∗Correspondingauthorat:DivisionofSubstanceUseDisorders,PsychiatricHos- pitaloftheUniversityofBasel,WilhelmKlein-Str.27,CH-4012Basel,Switzerland.
Tel.:+41613255333;fax:+41613255583.
E-mailaddress:Sandra.Mueller@upkbs.ch(S.E.Mueller).
(Barrettetal.,2006;BurtonandTiffany,1997;Daeppenetal.,2000) indicatingthestronginterconnectionofthetwosubstances.
Despite these alarming consequences, this problem gained onlylittleinterestinresearchbecauseofthemyththatalcohol- dependentpatientsarelessmotivatedtoquitsmoking.Literature givesevidencethatalcohol-dependentsmokersfinditmoredif- ficulttostopsmokingthansmokerswithoutanalcoholproblem (Burlingetal.,1997;Cooneyetal.,2007;Haysetal.,1999;Hughes andKalman,2006).Theassumptionthedifferencemaybethemoti- vationtoquitsmokingcanbedenied.Inaself-reportstudy81%of alcohol-dependentstriedtoquitsmokingbutsucceededinonly7%
comparedto49%ofsmokerswithoutanalcoholproblem(DiFranza andGuerrera,1990).Furthermore,tobaccosmokingissuggestedto bethelesserevilthanalcoholism(Gulliveretal.,2006).Infact, tobacco smokingexhibits almostnoharmfulshort-termconse- quencesbutmostalcoholicsdieduetotobaccorelatedlong-term consequences(Hurtet al.,1996).Anothermyth isthatsmoking cessationissuggestedtoimpedealcoholsobriety(Gulliveretal., 2006).However,literaturepredominantlyconcludesthatthereare nonegativeeffectsofsmokinginterventionsforthreateningabsti- nence(Cooneyetal.,2007;Hurtetal.,1994;Metzetal.,2005a;
0376-8716/$–seefrontmatter© 2012 Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.drugalcdep.2012.05.026
