title: Alcohol and marijuana use in the context of tobacco dependence treatment: impact on outcome and mediation of effect.
abstract: BACKGROUND
  Alcohol and marijuana are among the most commonly used substances together with tobacco worldwide, but their relationship to smoking cessation is unclear. Although alcohol use decreases the likelihood of abstinence from tobacco, mechanisms of this effect have not been identified. Moreover, a small literature has yielded inconsistent findings regarding the effect of marijuana use on tobacco dependence treatment outcome. The aims of this study were to test increased positive-reinforcement smoking urge as a mediator of the relationship between alcohol and cigarette use and evaluate the impact of marijuana use on abstinence from tobacco.
  
  
  METHODS
  Participants were adult cigarette smokers (N = 739) from 3 randomized clinical trials of smoking cessation treatment. Alcohol consumption and marijuana use were assessed at pretreatment and postcessation. Biochemically verified, 7-day point prevalence smoking abstinence was determined at Weeks 12, 24, 36, and 52, as were urges to smoke as measured by the Questionnaire of Smoking Urges.
  
  
  RESULTS
  Increased positive-reinforcement urge mediated the effect of postcessation alcohol use on smoking abstinence. Although pretreatment alcohol use was associated with a decreased likelihood of abstinence from tobacco, increased positive-reinforcement urge did not account for this relationship. Marijuana use was not associated with abstinence from tobacco.
  
  
  CONCLUSIONS
  Smoking cessation treatments should provide those who drink during a quit attempt techniques designed to mitigate positive-reinforcement urge to smoke. Additional research is needed to determine how pretreatment alcohol consumption exerts its effect on cigarette use. Modifying the use of marijuana might not be critical to the success of tobacco interventions.
authors.affiliation: Department of Health Behavior, University of Alabama at Birmingham, 227 Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL 35294, USA. phendricks@uab.edu
authors.forename: Peter S
authors.initials: PS
authors.lastname: Hendricks
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Delucchi
authors.forename: Gary L
authors.initials: GL
authors.lastname: Humfleet
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Hall
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology*; D016739:Behavior, Addictive / Q000523:psychology*; D002755:Choice Behavior / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008385:Marijuana Smoking / Q000523:psychology*; D015999:Multivariate Analysis; D012907:Smoking / Q000523:psychology / Q000628:therapy*; D016540:Smoking Cessation / Q000523:psychology*; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome