Motivational interviewing versus brief advice for cigarette smokers in residential alcohol treatment

Abstract

Residential treatment for substance use disorders (SUD) provides opportunity for smoking intervention. A randomized controlled trial compared: (1) motivational interviewing (MI) to brief advice (BA), (2) in one session or with two booster sessions, for 165 alcoholics in SUD treatment. All received nicotine replacement (NRT). MI and BA produced equivalent confirmed abstinence, averaging 10% at 1 month, and 2% at 3, 6 and 12 months. However, patients with more drug use pretreatment (>22 days in 6 months) given BA had more abstinence at 12 months (7%) than patients in MI or with less drug use (all 0%). Boosters produced 16-31% fewer cigarettes per day after BA than MI. Substance use was unaffected by treatment condition or smoking cessation. Motivation to quit was higher after BA than MI. Thus, BA plus NRT may be a cost-effective way to reduce smoking for alcoholics with comorbid substance use who are not seeking smoking cessation.

Keywords: Alcoholics; Brief advice; Motivational interviewing; Smoking cessation; Substance abuse.

Figure 1

Flow chart of recruitment and retention.

Figure 2

Percent of participants confirmed abstinent from smoking at each follow-up period by assignment to MI versus BA treatment (top panel) and by booster condition assignment (lower panel). No main or interaction effects are significant; presentation of conditions separately permits easier detection of trends. Standard errors are so small that standard error bars are not visible.

Figure 3

Percent of participants confirmed abstinent from smoking at each follow-up period by assignment to MI versus BA treatment and by low versus high pretreatment number of drug use days (dichotomized by median split at 22.5 days). Significant differences are indicated by asterisks. Standard errors are so small that standard error bars are not visible.

Figure 4

Contemplation Ladder scale score (motivation to quit smoking) at pretreatment and 1-month outcome assessments by assignment to MI versus BA treatment (means and standard error bars). Significant differences are indicated by asterisks.

Figure 5

Percent of participants reporting using nicotine replacement products during the 0-1 and 1-3 month follow-up intervals by booster condition assignment. Significant differences are indicated by asterisks. Standard errors are so small that standard error bars are not visible.