Opiate dependent persons who are successfully engaged in the treatment of their primary drug of addiction often continue to use other drugs such as nicotine. With the high prevalence of smoking in this population, treatment providers are recognizing that many of those they help recover are now dying of smoking-related illnesses, including cancer. Recent surveys indicate that persons enrolled in methadone maintenance treatment programs are interested in receiving smoking cessation treatment, particularly as treatment facilities go smoke-free through voluntary efforts or JCAHO mandates. The long-term aim of our proposal is to advance knowledge and produce interventions to help achieve optimal dissemination of stroking cessation strategies for those usually deprived of such programs with dual diagnosis of opioid dependence and nicotine dependence. Using a two-group design, we will enroll 408 methadone-maintained cigarette smokers from two methadone treatment programs in Rhode Island. The specific aims are: A.1. To test, in combination with the nicotine patch, the incremental efficacy of a maximal, tailored and sustained behavioral treatment over a minimal treatment in the setting of a methadone maintenance program. The defined population comprises low income, less educated smokers who will vary in their level of motivation to quit smoking. Patients will be randomly assigned to one of two treatments.(a) Nicotine patch prescription plus brief nurse advice and follow-up .(minimal treatment; and (b) Nicotine patch prescription, brief nurse advice and follow-up, with the addition of a tailored motivational intervention, a behavioral skills counseling session for smoking cessation, and continued telephone counseling (maximal treatment). We hypothesize that 6 month 7-day point prevalence quit rates will be 4% and 12% in each of the two treatment groups, respectively. A2. To test the effects of the treatments on intermediate variables including motivation to quit smoking, cognitive behavioral mediators of motivation and intention to quit (e.g. self-efficacy, pros and cons of smoking, perceived vulnerability to illness, and perceived ability to prevent illness by quitting smoking), frequency of patch use, and number of quit attempts. We hypothesize that these variables will improve from baseline to 6 months as a function of treatment intensity. A3. To test the effects of the treatments on methadone treatment outcomes including methadone dose changes and continued use of illicit drugs, as measured by urine toxicologies.
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