Smoking cessation in methadone maintenance

Authors

  • Steve Shoptaw,

    Corresponding author
    1. Friends Research Institute, Los Angeles, CA1, UCLA, Department of Psychiatry, Los Angeles, CA2,SDSU/UCSD Joint Doctoral Program in Clinical Psychology, Los Angeles, CA3and UCLA Department of Biostatistics, Los Angeles, CA, USA4
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  • 1,2 Erin Rotheram-Fuller,

    1. Friends Research Institute, Los Angeles, CA1, UCLA, Department of Psychiatry, Los Angeles, CA2,SDSU/UCSD Joint Doctoral Program in Clinical Psychology, Los Angeles, CA3and UCLA Department of Biostatistics, Los Angeles, CA, USA4
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  • 1 Xiaowei Yang,

    1. Friends Research Institute, Los Angeles, CA1, UCLA, Department of Psychiatry, Los Angeles, CA2,SDSU/UCSD Joint Doctoral Program in Clinical Psychology, Los Angeles, CA3and UCLA Department of Biostatistics, Los Angeles, CA, USA4
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  • 4 Dominick Frosch,

    1. Friends Research Institute, Los Angeles, CA1, UCLA, Department of Psychiatry, Los Angeles, CA2,SDSU/UCSD Joint Doctoral Program in Clinical Psychology, Los Angeles, CA3and UCLA Department of Biostatistics, Los Angeles, CA, USA4
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  • 1,3 Debbie Nahom,

    1. Friends Research Institute, Los Angeles, CA1, UCLA, Department of Psychiatry, Los Angeles, CA2,SDSU/UCSD Joint Doctoral Program in Clinical Psychology, Los Angeles, CA3and UCLA Department of Biostatistics, Los Angeles, CA, USA4
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  • 1 Murray E. Jarvik,

    1. Friends Research Institute, Los Angeles, CA1, UCLA, Department of Psychiatry, Los Angeles, CA2,SDSU/UCSD Joint Doctoral Program in Clinical Psychology, Los Angeles, CA3and UCLA Department of Biostatistics, Los Angeles, CA, USA4
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  • 1,2 Richard A. Rawson,

    1. Friends Research Institute, Los Angeles, CA1, UCLA, Department of Psychiatry, Los Angeles, CA2,SDSU/UCSD Joint Doctoral Program in Clinical Psychology, Los Angeles, CA3and UCLA Department of Biostatistics, Los Angeles, CA, USA4
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  • and 1,2 Walter Ling 1,2

    1. Friends Research Institute, Los Angeles, CA1, UCLA, Department of Psychiatry, Los Angeles, CA2,SDSU/UCSD Joint Doctoral Program in Clinical Psychology, Los Angeles, CA3and UCLA Department of Biostatistics, Los Angeles, CA, USA4
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Steven Shoptaw Friends Research Institute, Inc. 11075 Santa Monica Blvd, Suite 200 Los Angeles, CA 90025 USA Tel: +13103120500ext.351 Fax: +13103120552 E-mail: shoptaw@friendsresearch.org

Abstract

Aims  To evaluate relapse prevention (relapse prevention) and contingency management (contingency management) for optimizing smoking cessation outcomes using nicotine replacement therapy for methadone-maintained tobacco smokers.

Design  Experimental, 2 (relapse prevention)×2 (contingency management) repeated measures design using a platform of nicotine replacement therapy featuring a 2-week baseline period, followed by randomization to 12weeks of treatment, and 6- and 12-month follow-up visits.

Setting  Three narcotic treatment centers in Los Angeles.

Participants  One hundred and seventy-five participants who met all inclusion and no exclusion criteria.

Intervention  Participants received 12weeks of nicotine replacement therapy and assignment to one of four conditions: patch-only, relapse prevention + patch, contingency management + patch and relapse prevention + contingency management + patch.

Measurements  Thrice weekly samples of breath (analyzed for carbon monoxide) and urine (analyzed for metabolites of opiates and cocaine) and weekly self-reported numbers of cigarettes smoked.

Findings  Participants (73.1%) completed 12weeks of treatment. During treatment, those assigned to receive contingency management showed statistically higher rates of smoking abstinence than those not assigned to receive contingencies (F3,4680=6.3, P=0.0003), with no similar effect observed for relapse prevention. At follow-up evaluations, there were no significant differences between conditions. Participants provided more opiate and cocaine-free urines during weeks when they met criteria for smoking abstinence than during weeks when they did not meet these criteria (F1,2054=14.38, P=0.0002; F1,2419=16.52, P<0.0001).

Conclusions  Contingency management optimized outcomes using nicotine replacement therapy for reducing cigarette smoking during treatment for opiate dependence, although long-term effects are not generally maintained. Findings document strong associations between reductions in cigarette smoking and reductions in illicit substance use during treatment.

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