This study is designed to increase understanding of the processes that affect the treatment
outcome of individuals with both alcohol and nicotine dependence. Treatment outcome
methodology will be combined with a computerized self-monitoring methodology to examine the
extent to which smoking serves as a cue for alcohol craving and/or as a response to alcohol
craving in treated alcoholics. Subjects will be veterans participating in the Substance
Abuse Day Programs at the Newington and West Haven campuses of the VA Connecticut Healthcare
System. Nonveteran women will be recruited from the community and enrolled in the day
program. Subjects will be randomly assigned to one of the following two conditions: (1)
intensive smoking cessation therapy (counseling plus nicotine replacement using nicotine
patches) concurrent with alcohol treatment, or (2) brief smoking cessation advice concurrent
with alcohol treatment.
- Meets criteria for alcohol dependence within the past three months, and criteria for
- Smoking at least 10 or more cigarettes per day for the past year.
- Seeking treatment for both alcohol and nicotine dependence.
- Minimum 1 week of alcohol abstinence and substance abuse day treatment attendance.
- Willing to provide names of two individuals who can help locate the subject at
- Willing to provide name of one individual who can provide collateral information
about alcohol and tobacco use.
- Other substance use disorder meeting criteria for dependence.
- Acute medical or psychiatric disorder requiring inpatient treatment.
- Taking medications known to influence alcohol urges (naltrexone, disulfiram).
- Medical problems that would contraindicate nicotine patch use.
- Allergy or hypersensitivity to nicotine or to adhesives used in transdermal delivery
- Use of other nicotine products such as cigars, pipes, or smokeless tobacco.
- Severe generalized skin disorder.
- Myocardial infarction within 3 months prior to study entry.
- Unstable angina.
- Pregnant or lactating females, or females who are not practicing a medically accepted
form of contraception.
- Impaired vision or hearing which would interfere with using a hand-held computer.
- Reading ability below fifth grade level.
- Lack of reliable transportation to the treatment site, or living more than 1 hour
from treatment site.
- Homeless or unstable residence.
- Plan for future admission to residential treatment.