Smoking Cessation Treatment among Patients in Community-Based Substance Abuse Rehabilitation Programs: Exploring Predictors of Outcome as Clues Toward Treatment Improvement

Abstract

Background: Predictors of smoking cessation (SC) treatment outcome were explored in a multisite clinical trial of SC treatment at community-based, outpatient, substance abuse rehabilitation programs affiliated with the National Drug Abuse Treatment Clinical Trials Network. Objectives: To explore baseline demographic and clinical predictors of abstinence during treatment. Methods: Cigarette smokers from five methadone maintenance programs and two drug and alcohol dependence treatment programs were randomly assigned to SC treatment as an adjunct to substance abuse treatment as usual or to substance abuse treatment as usual. SC treatment consisted of group counseling (weeks 1–8) plus transdermal nicotine patch treatment (21 mg/day, weeks 1–6; 14 mg/day, weeks 7–8). Demographic and clinical predictors of smoking abstinence were evaluated among those patients assigned to the active SC condition (N = 153) using logistic regression. Results: Abstinence during treatment was positively associated with younger age, Hispanic or Caucasian (as opposed to African American) ethnicity/race, employment or student status, fewer cigarettes per day at baseline, lower severity of the primary substance problem at baseline, and higher methadone doses (among the subsample in methadone treatment). Conclusions and Scientific Significance: During future efforts to improve SC treatments among drug- and alcohol-dependent patients, consideration should be given to adequate treatment to reduce the severity of the primary drug or alcohol problem, tailoring treatments for patients with greater severity of smoking and of the primary substance problem, and culturally sensitive interventions. Analysis of predictors of outcome may be a useful tool for treatment development.

• smoking cessation
• substance abuse
• nicotine
• treatment outcome
• predictors

ACKNOWLEDGMENTS

Cooperative agreements from NIDA supported the design, implementation, and analyses within the NIDA Clinical Trials Network: New York Node (U10 DA13046), Long Island Node (U10 DA13035), South Carolina Node (U10 DA13727), North Carolina Node (U10 DA13711), Great Lakes Node (U10 DA13710), and K24 DA022412 (Dr. Nunes). We acknowledge the support and participation of the NY Node Coordinator, Patricia Novo; assistance with counseling manual development and training from Sharon Hall, Ricardo Munoz, Gary Humfleet, and Kim Norman of University of California, San Francisco; and the clinical and research staff in the NIDA-CTN-0009 participating programs. We also thank the following programs: Mt. Sinai Hospital, Narcotics Rehabilitation Center, New York, NY, USA; Bridge Plaza Narco Freedom, New York, NY, USA; St. Luke’s-Roosevelt Hospital Methadone and Alcohol Treatment Programs, New York, NY, USA; Psychiatry and Behavioral Medical Professionals, Detroit, MI, USA; Coastal Horizons Center, Wilmington, NC, USA; Daymark Recovery Services, Concord, NC, USA; and Behavioral Health Services of Pickens County, Pickens, SC, USA.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this paper.