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Randomized Controlled Trial
. 2016 May;18(5):1196-201.
doi: 10.1093/ntr/ntv121. Epub 2015 Jun 5.

Evaluating Nicotine Craving, Withdrawal, and Substance Use as Mediators of Smoking Cessation in Cocaine- and Methamphetamine-Dependent Patients

Joshua C Magee  1 , Daniel F Lewis  2 , Theresa Winhusen  2
Affiliations
Randomized Controlled Trial

Evaluating Nicotine Craving, Withdrawal, and Substance Use as Mediators of Smoking Cessation in Cocaine- and Methamphetamine-Dependent Patients

Joshua C Magee et al. Nicotine Tob Res. 2016 May.

Abstract

Introduction: Smoking is highly prevalent in substance dependence, but smoking-cessation treatment (SCT) is more challenging in this population. To increase the success of smoking cessation services, it is important to understand potential therapeutic targets like nicotine craving that have meaningful but highly variable relationships with smoking outcomes. This study characterized the presence, magnitude, and specificity of nicotine craving as a mediator of the relationship between SCT and smoking abstinence in the context of stimulant-dependence treatment.

Methods: This study was a secondary analysis of a randomized, 10-week trial conducted at 12 outpatient SUD treatment programs. Adults with cocaine and/or methamphetamine dependence (N = 538) were randomized to SUD treatment as usual (TAU) or TAU+SCT. Participants reported nicotine craving, nicotine withdrawal symptoms, and substance use in the week following a uniform quit attempt of the TAU+SCT group, and self-reported smoking 7-day point prevalence abstinence (verified by carbon monoxide) at end-of-treatment.

Results: Bootstrapped regression models indicated that, as expected, nicotine craving following a quit attempt mediated the relationship between SCT and end-of-treatment smoking point prevalence abstinence (mediation effect = 0.09, 95% CI = 0.04% to 0.14%, P < .05, 14% of total effect). Nicotine withdrawal symptoms and substance use were not significant mediators (Ps > .05, <1% of total effect). This pattern held for separate examinations of cocaine and methamphetamine dependence.

Conclusions: Nicotine craving accounts for a small but meaningful portion of the relationship between smoking-cessation treatment and smoking abstinence during SUD treatment. Nicotine craving following a quit attempt may be a useful therapeutic target for increasing the effectiveness of smoking-cessation treatment in substance dependence.

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Conflict of interest statement

None declared .

Figures

Figure 1.
Figure 1.
Path diagrams of nicotine craving, withdrawal symptoms, stimulant-free days, and drug-free days as mediators of the relationship between smoking-cessation treatment and smoking point prevalence abstinence (PPA). Bold values with an asterisk indicate significance at P < .05. Samples sizes were N = 496 for the models examining nicotine craving and nicotine withdrawal symptoms and N = 521 for the models examining stimulant-free days and drug-free days.
See this image and copyright information in PMC

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