Field Test of a Dialectical Behavior Therapy Skills Training–Based Intervention for Smoking Cessation and Opioid Relapse Prevention in Methadone Treatment

Abstract

Objective: Almost all individuals in methadone treatment for opioid dependence smoke cigarettes, and half of people in methadone treatment have an opioid relapse within six months. Dialectical behavior therapy (DBT) skills training has shown promise for addressing substance use and a variety of health behaviors and conditions; however, it has never been evaluated for smoking cessation in any population. The objective of this study was to field test a DBT skills training–based intervention for tobacco dependence and opioid relapse prevention (DBT-Quit) among people in methadone treatment.

Methods: We recruited seven individuals in methadone treatment to participate in a field test of DBT-Quit. Participants attended 12 weekly 90-minute DBT skills training groups, focusing on mindfulness, emotion regulation, and distress tolerance skills. Participants received nicotine patches for eight weeks and completed assessments at baseline, 6 weeks (mid-treatment), and 12 weeks (post-treatment).

Results: All but one participant (86%, n = 6) attended at least 50% of intervention sessions. Participants were “very” or “mostly” satisfied with the intervention. At 12 weeks, all but one (86%, n = 6) had made a quit attempt, and one (14%) had seven-day point prevalence abstinence. Participants were smoke-free for 24 hours (14%, n = 1), 7 to 14 days (43%, n = 3), and 30 to 59 days (29%, n = 2). Participants smoked significantly fewer cigarettes per day at 6 weeks and 12 weeks as compared to baseline. No participants used illicit drugs. As compared to baseline, at follow-up there were no significant differences in difficulties with emotion regulation, distress tolerance, or mindfulness.

Conclusions: A DBT skills training–based intervention for individuals who smoke and have an opioid use disorder is feasible and acceptable in methadone treatment and may help this population prevent drug relapse, attempt to quit smoking, experience smoke-free days, and cut down on their smoking. More research is needed to determine the optimal structure and components of a DBT skills–based intervention for drug relapse prevention and smoking cessation. Further, a randomized controlled trial of DBT-Quit is needed to determine the efficacy of DBT skills training for smoking cessation and drug relapse prevention in this population.

Keywords:

• dialectical behavior therapy
• methadone
• opioid
• tobacco
• cigarette
• smoking
• relapse prevention
• skills training

Acknowledgments

The authors thank the staff and clients at the New Brunswick Counseling Center for their help implementing this study. Results from this study were presented at the Association for Behavioral and Cognitive Therapies (ABCT) Convention, New York, NY, October 27–30, 2016.

Disclosures

Dr. Cooperman and Mr. Hughes declare that they have no conflicts of interest. Dr. Rizvi receives compensation as a trainer and consultant for Behavioral Tech, LLC, a DBT training company. Dr. Rizvi also serves on the scientific advisory board of Pacifica, LLC. Dr. Williams received grant support from and served on an advisory board for Pfizer, Inc.