Smoking cessation may boost success of alcohol treatment

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Brief counselling on smoking cessation may have an interesting side effect for people completing treatment for alcohol problems -- it may help them stay on the wagon.

A small group of studies have suggested that quitting smoking may actually enhance, not threaten, the process of alcohol recovery," writes Janet Kay Bobo of the Department of Preventive and Societal Medicine at the University of Nebraska Medical Center. She discussed the topic recently at the Addiction Research Foundation's Clinical and Research Seminar series.

To test that suggestion, Bobo and colleagues undertook a pilot study in which half of the subjects were randomly selected to receive a 15 - minute stop-smoking counselling session prior to discharge from an alcohol treatment centre. They also were given National Cancer Institute pamphlets on how to quit. Control subjects didn't receive stop - smoking counselling or information. A total of 90 patients were enrolled from four residential alcohol treatment centres in rural Nebraska, and were followed for six months. Intervention subjects and controls were carefully matched for age, gender, ethnic background and smoking and drug histories.

At the end of the six - month follow - up, [alcohol] relapse rates among intervention group patients were less than one - half of those observed among controls," writes Dr. Bobo in a published monograph of the pilot study. Specifically, only 17 per cent of intervention patients reported having had at least one alcoholic drink, compared to 35 per cent of those who received no smoking cessation counselling.

Again at six months, just seven per cent of the group who'd received the stop - smoking counselling reported that they had drunk heavily on one or more days, versus 17 per cent of the control group. Intervention patients also were significantly less likely to report any use of illicit drugs at six months (10 per cent) than those in the control group (25 per cent).

The stop - smoking intervention had more modest success on tobacco use. "Intervention participants were somewhat more likely than controls to report having quit smoking for 48 hours or more and to be current nonsmokers at the one month follow - up, but not at the six - month assessment," Bobo said in an interview. At six months, some three per cent of the intervention group werenon - smokers, versus eight per cent in the controls.

Effects of such a brief counseling program on short - term quit rates for smoking were clearly weak, and probably not surprising. To evaluate whether more intensive counselling would improve quit rates, and to confirm the positive effects of counselling on alcohol recovery, a much larger trial is now underway. Subjects are 600 recovering alcoholics at 12 residential treatment facilities in Nebraska, Iowa and Kansas. Subjects have been randomized to receive either more intensive smoking cessation counselling -- offered at both discharge and again at 8, 12 and 16 weeks post - treatment -- or no counselling on smoking cessation.

Interim results are similar to what we saw in the pilot study, in that people in the intervention centres have lower relapse rates than those in the controls," said Bobo. She would not speculate on the reason behind these difference in relapse. However, based on interim results, it's clear that encouraging alcoholic patients to quit smoking has no negative effects on recovery, and may, indeed, enhance it.

We can also say the preliminary data suggest that encouraging smoking cessation modestly increases tobacco quit rates during the first six months after discharge from alcohol treatment," Bobo said. She added: "Because these are only interim results, it's still an open question. But there may be people out there who might really benefit from being encouraged to stop smoking. We'll know more when we're finished from the larger trial." Final results from the larger study are expected some time in 1997, after patients have been followed for an average of 18 months.