title: A randomized trial of concurrent smoking-cessation and substance use disorder treatment in stimulant-dependent smokers.
abstract: OBJECTIVE
  To evaluate the impact of concurrent treatments for substance use disorder and nicotine-dependence for stimulant-dependent patients.
  
  
  METHODS
  A randomized, 10-week trial with follow-up at 3 and 6 months after smoking quit date conducted at 12 substance use disorder treatment programs between February 2010 and July 2012. Adults meeting DSM-IV-TR criteria for cocaine and/or methamphetamine dependence and interested in quitting smoking were randomized to treatment as usual (n = 271) or treatment as usual with smoking-cessation treatment (n = 267). All participants received treatment as usual for substance use disorder treatment. Participants assigned to treatment as usual with concurrent smoking-cessation treatment received weekly individual smoking cessation counseling and extended-release bupropion (300 mg/d) during weeks 1-10. During post-quit treatment (weeks 4-10), participants assigned to treatment as usual with smoking-cessation treatment received a nicotine inhaler and contingency management for smoking abstinence. Weekly proportion of stimulant-abstinent participants during the treatment phase, as assessed by urine drug screens and self-report, was the primary outcome. Secondary measures included other substance/nicotine use outcomes and treatment attendance.
  
  
  RESULTS
  There were no significant treatment effects on stimulant-use outcomes, as measured by the primary outcome and stimulant-free days, on drug-abstinence, or on attendance. Participants assigned to treatment as usual with smoking-cessation treatment, relative to those assigned to treatment as usual, had significantly better outcomes for drug-free days at 6-month follow-up (χ(2)(1) = 4.09, P <.05), with a decrease in drug-free days from baseline of -1.3% in treatment as usual with smoking-cessation treatment and of -7.6% in treatment as usual. Participants receiving treatment as usual with smoking-cessation treatment, relative to those receiving treatment as usual, had significantly better outcomes on smoking point-prevalence abstinence (25.5% vs 2.2%; χ(2)(1) = 44.69, P < .001; OR =18.2).
  
  
  CONCLUSIONS
  These results suggest that providing smoking-cessation treatment to illicit stimulant-dependent patients in outpatient substance use disorder treatment will not worsen, and may enhance, abstinence from nonnicotine substance use.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01077024.
authors.affiliation: University of Cincinnati, 3210 Jefferson Ave, Cincinnati, OH 45220 winhusen@carc.uc.edu.
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Winhusen
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Brigham
authors.forename: Frankie
authors.initials: F
authors.lastname: Kropp
authors.forename: Robert
authors.initials: R
authors.lastname: Lindblad
authors.forename: John G
authors.initials: JG
authors.lastname: Gardin
authors.forename: Pat
authors.initials: P
authors.lastname: Penn
authors.forename: Candace
authors.initials: C
authors.lastname: Hodgkins
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kelly
authors.forename: Antoine
authors.initials: A
authors.lastname: Douaihy
authors.forename: Michael
authors.initials: M
authors.lastname: McCann
authors.forename: Lee D
authors.initials: LD
authors.lastname: Love
authors.forename: Eliot
authors.initials: E
authors.lastname: DeGravelles
authors.forename: Ken
authors.initials: K
authors.lastname: Bachrach
authors.forename: Susan C
authors.initials: SC
authors.lastname: Sonne
authors.forename: Bob
authors.initials: B
authors.lastname: Hiott
authors.forename: Louise
authors.initials: L
authors.lastname: Haynes
authors.forename: Gaurav
authors.initials: G
authors.lastname: Sharma
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Lewis
authors.forename: Paul
authors.initials: P
authors.lastname: VanVeldhuisen
authors.forename: Jeff
authors.initials: J
authors.lastname: Theobald
authors.forename: Udi
authors.initials: U
authors.lastname: Ghitza
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000150:complications / Q000188:drug therapy / Q000628:therapy; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D016642:Bupropion / Q000627:therapeutic use; D019970:Cocaine-Related Disorders / Q000150:complications / Q000188:drug therapy / Q000628:therapy; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D012907:Smoking / Q000188:drug therapy / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods*; D019966:Substance-Related Disorders / Q000150:complications / Q000188:drug therapy* / Q000628:therapy; D061485:Tobacco Use Cessation Devices; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion