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Randomized Controlled Trial
. 2011 Nov 1;118(2-3):111-8.
doi: 10.1016/j.drugalcdep.2011.03.005. Epub 2011 Apr 19.

Incremental efficacy of adding bupropion to the nicotine patch for smoking cessation in smokers with a recent history of alcohol dependence: results from a randomized, double-blind, placebo-controlled study

David Kalman  1 , Lawrence Herz, Peter Monti, Christopher W Kahler, Marc Mooney, Stephanie Rodrigues, Kathryn O'Connor
Affiliations
Randomized Controlled Trial

Incremental efficacy of adding bupropion to the nicotine patch for smoking cessation in smokers with a recent history of alcohol dependence: results from a randomized, double-blind, placebo-controlled study

David Kalman et al. Drug Alcohol Depend. .

Abstract

Aims: The primary aim of this study was to compare the efficacy of smoking cessation treatment using a combination of nicotine patch and bupropion vs. nicotine patch and placebo bupropion. A secondary aim was to investigate whether the efficacy of bupropion is moderated by belief about whether one is receiving active or placebo medication.

Methods: Participants were recruited from a residential substance abuse treatment program and the community. We randomly assigned 148 smokers with between 2 and 12 months of alcohol abstinence to nicotine patch plus bupropion or nicotine patch plus placebo. All participants also received seven counseling sessions.

Results: At follow up, differences between medication conditions were not significant. Seven-day point prevalence quit rates in the patch plus bupropion vs. patch plus placebo conditions at week 24 were 6% and 11%, respectively. Differences between groups on prolonged abstinence and time to first smoking lapse were also not significant. However, among participants who received bupropion, those who accurately "guessed" that they were receiving bupropion were more likely to remain abstinent than those who incorrectly believed they were receiving placebo.

Conclusions: Findings do not support combining nicotine patch and bupropion for smoking cessation in this population. However, findings support previous studies suggesting the importance of assessing the blind in smoking cessation studies and its possible moderating effect on medication efficacy. Future directions for enhancing smoking cessation outcome in these smokers include investigations of intensive behavioral and pharmacological interventions, including studies of potential interactions between individual genetic differences and medication efficacy.

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Figures

Figure 1
Figure 1
Participant Flow Diagram
Figure 2
Figure 2
The moderating effect of participants’ beliefs about medication they received on medication efficacy *p Note. One week after starting study medication, participants were asked, “What medication do you think you are receiving?” White bar on far left represents the percentage of participants in the placebo condition who incorrectly believed they received active medication. The black bar on far left represents the percentage of participants in the placebo condition who correctly believed they received placebo medication. White bar on right represents the percentage of participants in the bupropion condition who incorrectly believed they received active medication. The black bar on right represents the percentage of participants in the bupropion condition who correctly believed they received bupropion medication. Outcome data on the Y axis are the percent abstinent at end of treatment based on 7-day point prevalence. Judgement accuracy significantly moderated the effect of medication assignment on abstinence for participants in the bupropion condition, χ2 (1) = 5.07, p = 0.02, OR = 7.01, 95% C.I. (1.29, 38.20).
Figure 3
Figure 3
The effect of trying to quit smoking on ability to stay clean and sober
See this image and copyright information in PMC

References

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