Addressing heavy drinking in smoking cessation treatment: a randomized clinical trial

Abstract

Heavy alcohol use frequently co-occurs with cigarette smoking and may impede smoking cessation. This clinical trial examined whether smoking cessation treatment that incorporates brief alcohol intervention can improve smoking cessation outcomes (7-day verified point prevalence abstinence) and reduce drinks consumed per week. Heavy drinkers seeking smoking cessation treatment were assigned by urn randomization to receive, along with 8 weeks of nicotine replacement therapy, either a 4-session standard smoking cessation treatment (ST, n = 119) or standard treatment of equal intensity that incorporated brief alcohol intervention (ST-BI, n = 117). Across follow-ups over 26 weeks, participants in ST-BI reported approximately 20% fewer drinks per week (p < .027) and greater smoking abstinence (adjusted odds ratio = 1.56; 95% confidence interval = 1.01, 2.43) than did those in ST; however, effects on smoking were primarily evident at 2 weeks after quit date and were essentially absent by 16 weeks. The effect of ST-BI on smoking outcome was most robust among moderately heavy drinkers compared with that on very heavy drinkers. Integrating brief alcohol intervention into smoking cessation treatment appears feasible, but further development is needed to yield lasting effects on smoking.

Figure 1

CONSORT flowchart of eligibility, randomization, treatment, follow-up, and inclusion in analyses. ST = standard smoking cessation treatment. ST-BI = standard smoking cessation that integrates a brief alcohol intervention.

Figure 2

Raw (undadjusted) 7-day point prevalence smoking abstinence at 2, 8, 16, and 26 weeks after quit date by treatment condition and level of drinking. Participants are classified as moderately heavy or very heavy drinkers using a gender-based median split on mean number of drinks consumed per week at baseline. Median drinks per week for men was 18.4 and for women was 8.8. ST = standard smoking cessation treatment. ST-BI = standard smoking cessation that integrates a brief alcohol intervention.

Figure 3

Mean number of drinks consumed per week over the 26 weeks after quit date. Drinks per week are averaged across thirteen 2-week intervals and graphed by treatment condition. Raw (unadjusted) data are shown. ST = standard smoking cessation treatment. ST-BI = standard smoking cessation that integrates a brief alcohol intervention. Those in ST-BI, compared to those in ST, drank significantly fewer drinks per week, exp(B) = 0.81, 95% CI= 0.67-0.98, p = .027.