A smoking cessation intervention for the methadone-maintained.
OBJECTIVE
To test, in combination with the nicotine patch, the incremental efficacy of a maximal, tailored behavioral treatment over a minimal treatment for smoking cessation.


METHODS
Randomized clinical trial with 6-month follow-up.


METHODS
Five methadone maintenance treatment centers in Rhode Island.


METHODS
Three hundred and eighty-three methadone-maintained smokers.


METHODS
Participants were assigned randomly to nicotine patch (8-12 weeks) plus either (1) a baseline tailored brief motivational intervention, a quit date behavioral skills counseling session and a relapse prevention follow-up session (Max) or (2) brief advice using the National Cancer Institute's 4 As model (Min). An intent-to-treat analysis with those lost to follow-up assumed to smoke was used.


METHODS
Carbon monoxide (CO)-confirmed 7-day point smoking cessation prevalence at 3 and 6 months, and self-reported numbers of cigarettes smoked per day.


RESULTS
Participants had a mean age of 40 years, were 53% male, 78% Caucasian, smoked 26.7 (+/- 12.2) cigarettes/day and had a mean methadone dose of 95.5 mg. At 3 months, 317 (83%) were re-interviewed; at 6 months, 312 (82%) were re-interviewed. The intent-to-treat, 7-day point prevalence estimate of cessation was 5.2% in the Max group and 4.7% in the Min group (P=0.81) at 6 months. In logistic models with treatment condition, age, gender, race, Fagerström Test for Nicotine Dependence and cigarettes per day as covariates, males were more likely to be abstinent at 3 months (OR 4.67; P=0.003) and 6 months (OR 4.01; P=0.015).


CONCLUSIONS
A tailored behavioral intervention did not increase quit rates over patch and minimal treatment. Smoking cessation rates in methadone-maintained smokers are low, with men having greater success.
Rhode Island Hospital, Division of General Internal Medicine, Brown University Medical School, Providence, RI 02903, USA. mstein@lifespan.org
Michael D
MD
Stein
Marjorie C
MC
Weinstock
Debra S
DS
Herman
Bradley J
BJ
Anderson
Jennifer L
JL
Anthony
Raymond
R
Niaura
D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009538:Nicotine / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000150:complications* / Q000534:rehabilitation; D011614:Psychotherapy, Brief / Q000379:methods; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000150:complications* / Q000534:rehabilitation; D016896:Treatment Outcome
D009538:Nicotine; D008691:Methadone