A randomized trial of concurrent smoking-cessation and substance use disorder treatment in stimulant-dependent smokers.

This is the primary outcomes article for CTN-0046.

The purpose of this study, National Drug Abuse Treatment Clinical Trials Network protocol CTN-0046, was to evaluate the impact of concurrent treatments for substance use disorder and nicotine-dependence for stimulant-dependent patients. It was a randomized, 10-week trial with follow-up at 3 and 6 months after smoking quit date, conducted at 12 substance use disorder treatment programs between February 2010 and July 2012. Adults meeting DSM-IV-TR criteria for cocaine and/or methamphetamine dependence and interested in quitting smoking were randomized to treatment as usual (TAU) (n=271) or TAU with smoking-cessation treatment (n=267). All participants received TAU for substance use disorder treatment. Participants assigned to TAU with concurrent smoking-cessation treatment received weekly individual smoking cessation counseling and extended-release bupropion (300mg/d) during weeks 1-10. During post-quit treatment (weeks 4-10), participants assigned to TAU with smoking-cessation treatment received a nicotine inhaler and contingency management for smoking abstinence. The primary outcome was weekly proportion of stimulant-abstinent participants during the treatment phase, as assessed by urine drug screens and self-report. Secondary measures included other substance/nicotine use outcomes and treatment attendance.

There were no significant treatment effects on stimulant-use outcomes, as measured by the primary outcome and stimulant-free days, on drug-abstinence, or on attendance. Overall, participants assigned to treatment as usual with smoking-cessation treatment averaged 77.2% stimulant-abstinent weeks compared to 78.1% stimulant-abstinent weeks for participants assigned to treatment as usual. There was a similar lack of significant treatment effect on stimulant abstinence at 3-month and 6-month follow-ups. Participants receiving TAU with smoking cessation treatment, relative to those receiving TAU alone, however, had significantly better outcomes on smoking point-prevalence abstinence. Additionally, participants receiving TAU with smoking cessation treatment, relative to those receiving TAU alone, had significantly better outcomes for drug-free days (abstinence from all illicit substances, not just stimulants) at 6-month follow-up.

Conclusions: Providing smoking-cessation treatment to cocaine- and/or methamphetamine-dependent patients in outpatient substance use disorder treatment had no effect on stimulant-use outcomes or treatment attendance, but significantly improved smoking-abstinence outcomes and outcomes for drug-free days at 6-month follow-up. Concurrent smoking-cessation and substance use disorder treatment can significantly improve smoking-abstinence outcomes and do not negatively impact non-nicotine outcomes.

Related protocols: CTN-0046