title: Cigarette smoking predicts differential benefit from naltrexone for alcohol dependence.
abstract: BACKGROUND
  Identifying factors that modify responsiveness to pharmacotherapies for alcohol dependence is important for treatment planning. Cigarette smoking predicts more severe alcohol dependence and poorer treatment response in general. Nevertheless, there is limited research on cigarette smoking as a potential predictor of differential response to pharmacological treatment of alcoholism.
  
  
  METHODS
  We examined the association between cigarette smoking and drinking outcomes in the COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) study, a randomized, double-blind placebo-controlled 16-week trial comparing combinations of medications (i.e., acamprosate and naltrexone) and behavioral interventions (i.e., medical management, combined behavioral therapy) in 1383 alcohol-dependent individuals.
  
  
  RESULTS
  Smokers (i.e., more than one half the sample) significantly differed from nonsmokers on several demographic and drinking-related variables at baseline and generally had poorer treatment outcomes than nonsmokers. However, smokers who received naltrexone had better drinking outcomes than smokers who received placebo, whereas alcohol use among nonsmokers did not vary by naltrexone assignment. This pattern of findings occurred independent of whether patients received combined behavioral intervention or medical management and remained after controlling for alcoholism typology and baseline demographic differences. Approximately 9% of smokers quit smoking, and an additional 10% reduced their cigarette intake during treatment. Reductions in smoking did not vary by treatment assignment.
  
  
  CONCLUSIONS
  These results suggest that naltrexone might be particularly beneficial for improving alcohol use outcomes in alcohol-dependent smokers.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA. lisa.fucito@yale.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Fucito
authors.forename: Aesoon
authors.initials: A
authors.lastname: Park
authors.forename: Suzy Bird
authors.initials: SB
authors.lastname: Gulliver
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Mattson
authors.forename: Ralitza V
authors.initials: RV
authors.lastname: Gueorguieva
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: O'Malley
mesh_terms: D000077443:Acamprosate; D000328:Adult; D000427:Alcohol Deterrents / Q000008:administration & dosage / Q000493:pharmacokinetics; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D015897:Comorbidity; D004347:Drug Interactions; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009271:Naltrexone / Q000008:administration & dosage / Q000493:pharmacokinetics; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000493:pharmacokinetics; D012907:Smoking / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D013654:Taurine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D016896:Treatment Outcome
chemical_list: D000427:Alcohol Deterrents; D009292:Narcotic Antagonists; D013654:Taurine; D009271:Naltrexone; D000077443:Acamprosate