A comparison of the content-, construct- and predictive validity of the cigarette dependence scale and the Fagerström test for nicotine dependence

BACKGROUND: Research showed that the widely used Fagerstrom test for nicotine dependence (FTND) does not cover important aspects of dependence. A new test, the cigarette dependence scale (CDS-12), covers the main elements in DSM-IV and ICD-10 definitions of dependence. We compared the psychometrics of CDS-12, FTND, and CDS-5 and the heaviness of smoking index (HSI), which are short versions of CDS-12 and FTND, respectively. METHODS: Internet survey in 2002-2003. Participants were invited one month after answering the first survey to answer a second survey on smoking status and withdrawal symptoms. RESULTS: Eight hundred two smokers answered both surveys. Cronbach's alpha coefficients were higher for CDS-12 (0.91) and CDS-5 (0.77) than for FTND (0.68) and HSI (0.63). Among 231 smokers who quit smoking at follow-up, higher baseline CDS-12 scores predicted higher withdrawal ratings at follow-up, for all withdrawal symptoms except appetite. FTND and HSI predicted higher craving in quitters, but did not predict the intensity of other withdrawal symptoms. Neither CDS-5, FTND or HSI predicted smoking cessation, but higher CDS-12 scores marginally predicted smoking cessation at follow-up (area under the receiver operating characteristic (ROC) curve = 0.55, 95% confidence interval = 0.51-0.59). CONCLUSIONS: CDS-12 had better content validity and internal consistency than FTND and was a slightly better predictor of withdrawal symptoms. Unexpectedly, higher (not lower) CDS-12 scores predicted subsequent smoking cessation, perhaps because endorsement of some CDS-12 items implies accepting that one is dependent, which in turn could reflect motivation to quit. CDS-12 may represent an alternative to FTND for measuring cigarette dependence.     

Comparing the validity of the Cigarette Dependence Scale and the Fagerström Test for Nicotine Dependence

BACKGROUND: We compared the validity of the Cigarette Dependence Scale (CDS-12) and of the Fagerstr?m Test for Nicotine Dependence (FTND) in daily cigarette smokers. METHODS: Internet survey in 2004-2007. Eight days and 6 weeks after answering these two dependence questionnaires, participants indicated their smoking status and answered the Cigarette Withdrawal Scale and the Smoking Self-Efficacy Questionnaire. We used the Mini International Neuropsychiatric Interview (MINI) to assess nicotine dependence as defined in DSM-IV. RESULTS: There were 13,697 participants at baseline, 1113 (8%) after 8 days and 435 (3%) after 6 weeks. CDS-12, but not FTND, predicted smoking cessation after 8 days (odds ratio=1.20 per standard deviation unit, p=0.03) and 6 weeks (odds ratio=1.34, p=0.01). In participants who had quit smoking after 8 days, CDS-12 was a better predictor of craving (beta=0.30, p<0.001), than FTND (beta=0.14, p<0.01). After 8 days, self-efficacy in quitters was predicted by CDS-12 (beta=-0.16, p=0.02), but not by FTND (beta=-0.05, p=0.3). CDS-12 was more strongly associated than FTND with DSM-defined dependence measured by MINI: area under the Receiver Operating Characteristic (ROC) curve=0.72 (95% confidence interval=0.70-0.73). For FTND, the area under ROC=0.64 (0.63-0.66). CONCLUSIONS: CDS-12 performed better than FTND on tests of predictive and construct validity.     

Intentions to quit smoking among youth in substance abuse treatment

Introduction

Smoking cessation interventions for adolescents in substance abuse treatment have shown promise. However, a better understanding of the correlates of substance use disordered (SUD) youths’ intentions toward smoking cessation will help tailor cessation interventions to this population. The current study examined tobacco use, smoking-related self-efficacy, substance use and intentions to quit using alcohol and illicit drugs as correlates of intentions to quit smoking among youth in SUD treatment.

Methods

Participants were 178 adolescents who were in inpatient (n = 90) or outpatient (n = 88) SUD treatment and had smoked at least once in the past 30 days. The sample was 44% female, 72% non-Hispanic Caucasian, with a mean age of 16.2 years (SD = 1.2). Participants rated the likelihood that they would be nonsmokers in the next year (9-point scale).

Results

SUD youth intention to quit smoking averaged 4.9 out of 10 (SD = 3.2), comparable to intention to quit drinking (M = 5.3, SD = 3.6), but lower than their intention to quit using drugs (M = 6.0, SD = 3.4). Teens’ intentions to quit smoking were associated with nicotine dependence (r = −.30, p < .01) and smoking cessation related self-efficacy (r = .36, p < .01), but not with pretreatment substance use severity (r = −.15). Controlling for nicotine dependence, teens’ intentions to quit smoking were positively related to smoking cessation self-efficacy (pr = .26, p < .01) and intention to quit using illicit drugs (pr = .15, p < .05), but unrelated to intention to quit drinking.

Discussion

Findings highlight the appropriateness of addressing adolescent tobacco use during SUD treatment, but emphasize the importance of assessing intention and other cognitions for each substance, as they may differ markedly.     

A self-administered questionnaire to measure dependence on cigarettes: the cigarette dependence scale.

A valid measure of dependence on cigarettes is a useful tool for clinicians and researchers. The aim of this study was to develop a new, self-administered measure of cigarette dependence, and to assess its validity. The content of the instrument was generated in qualitative surveys. A long version (114 items) was tested on the internet in 3009 smokers. Subsamples provided retest data after 18 days (n=578), follow-up data after 45 days (n=990) and saliva cotinine (n=105). The study resulted in a 12-item scale labelled the Cigarette Dependence Scale (CDS-12), and in a 5-item version of this scale (CDS-5). Except for tolerance, CDS-12 covers the main components of DSM-IV and ICD-10 definitions of dependence: compulsion, withdrawal symptoms, loss of control, time allocation, neglect of other activities, and persistence despite harm. CDS-5 has similar measurement properties but less comprehensive content. Both scales had a high test-retest reliability (r>or=0.83), and a high internal consistency (Cronbach's alpha>or=0.84). CDS-12 scores were higher in daily smokers than in occasional smokers (+1.3SD units), and were associated with the strength of the urge to smoke during the last quit attempt (R(2)>or=0.25), and with saliva cotinine (R(2)>or=0.17). CDS-12 and CDS-5 scores decreased in daily smokers who switched to occasional smoking at 18-day retest. Dependence scores did not predict smoking abstinence at follow-up. In conclusion, CDS-12 and CDS-5 are reliable measures of cigarette dependence which fulfill several criteria of content validity and construct validity and are sensitive to change over time.     

A measure of nicotine dependence for smokeless tobacco users

The objective of the present study was to examine the properties of a modification of the Fagerström Test of Nicotine Dependence in a large sample of smokeless tobacco (ST) users. The subjects for this study included 256 males who were recruited for a tobacco cessation intervention that involved a visit with a dentist and advice to quit smoking during the exam. At baseline, the modified dependence scale was administered to the participants and a saliva sample was collected to measure cotinine. The correlation between the total score and salivary cotinine was moderate among the ST only users (r = 0.34), whereas it was lower (r = 0.19) among the ST + cigarette users. Among ST only users, the coefficient alpha was 0.40; however it was considerably higher among the ST + cigarettes group (alpha = 0.61). In both cases, the coefficient alpha was lower than the recommended value of 0.70. Future research should focus on refining questionnaires that more precisely measure nicotine dependence in smokeless tobacco users.     

Testing the Cigarette Dependence Scale in 4 samples of daily smokers: Psychiatric clinics,smoking cessation clinics,a smoking cessation website and in the general population

Aim

To assess the properties of the Cigarette Dependence Scale (CDS-12) in various samples of daily smokers and to provide reference scores in a general population sample.

Methods

Surveys in 4 samples of daily cigarette smokers: psychiatric out-patients in Geneva, Switzerland (n = 226), clients of smoking cessation clinics in France (n = 370), visitors of a French-language smoking cessation website (n = 13,697) and a representative sample of the general population of Geneva (n = 292).

Results

In all 4 samples, Cronbach's alpha coefficients were > 0.87 and factor analyses indicated that CDS-12 was unidimensional. CDS-12 was slightly skewed towards higher values, and it was associated with expired carbon monoxide, but this association was not strong (9% of variance explained, p < 0.001). CDS-12 scores were highest in clients of smoking cessation clinics (mean = 47.7, SD = 10.2), followed by psychiatric patients (mean = 44.4, SD = 8.4), visitors of smoking cessation websites (mean = 43.3, SD = 11.6) and the general population sample (mean = 36.9, SD = 12.3). Except for tolerance, each element in the DSM-IV and ICD-10 definitions of dependence is reflected by at least one item in CDS-12, even though the match with these definitions is sometimes indirect.

Conclusions

This paper presents reference scores and validity and reliability tests for CDS-12 in a diversity of samples of daily smokers. This information should be useful to clinicians and researchers.     

Assessment of nicotine dependence among adolescent and young adult smokers: A comparison of measures

Introduction

Tobacco use often starts in adolescence, yet assessment of dependence among adolescent smokers remains a challenge, particularly given the potential discord between self-reports of smoking behavior and actual use. We could find no prior study, among adolescents, that directly compares the association between objective biomarkers of tobacco exposure (e.g., cotinine) and multiple measures of dependence. This study examined the concurrent validity of two common dependence measures: the Fagerström Test for Nicotine Dependence (FTND) and the Hooked on Nicotine Checklist (HONC). We further examined the FTND by removing the one item on cigarettes smoked per day.

Methods

Based within a parent clinical trial for adolescent smoking cessation, eligible participants were 12–21 years old, smoking ≥ 5 cigarettes per day on average, and with urine cotinine > 100 ng/ml at baseline. Results are based on participants who completed each measure and who provided a urine cotinine sample at baseline (N = 73).

Results

Results showed that the FTND was associated with cotinine (p < 0.001; R² = 0.25), and that this relationship held true for the revised FTND as well (p < 0.001; R² = 0.18). However, the HONC was only marginally associated with cotinine (p = 0.06; R² = 0.09).

Discussion

Our results suggest that the FTND may be better associated with actual smoking behavior in adolescents as compared to the HONC. Pending replication, our data provide caution with regard to assessment of nicotine dependence at least among established adolescent smokers who have more entrenched smoking behavior.     

Attempts to quit smoking and relapse: Factors associated with success or failure from the ATTEMPT cohort study

Objective

To identify predictors of attempts to stop smoking and predictors of relapse.

Methods

This study included 2431 smokers from pre-existing Internet panels in the United States, United Kingdom, Canada, France, and Spain. These panel members are Internet users who have registered voluntarily and agreed to participate in various online research studies. Respondents were aged 35–65 years, smoked ≥ five cigarettes per day and intended to stop smoking in the next 3 months. They were followed every 3 months for up to 18 months via Internet contact on measures relating to quit attempts, smoking status, motivation to quit, nicotine cue, weight and weight concern, health-related factors, withdrawal symptoms, and smoking cessation aids.

Results

In this study, recent quit attempts strongly predicted future attempts, but also predicted subsequent relapse. Motivation to quit was predictive of future attempts but not of relapse/abstinence following the attempts. Relapse to smoking was associated with nicotine dependence, exposure to smoking cues, craving, withdrawal symptoms, and lack of smoking cessation aids.

Conclusions

The findings lend support to a model of cessation in which level of motivation to stop generates quit attempts but plays little role in relapse. Dependence, social smoking cues, and a recently failed quit attempt are important factors in relapse.     

The commitment to quitting smoking scale: initial validation in a smoking cessation trial for heavy social drinkers

We tested the psychometric properties and predictive validity of a newly developed 8-item measure of commitment to quitting smoking, conceptualized as the state of being personally bound or obligated to persist in quitting smoking despite potential difficulties, craving and discomfort. Participants were 157 heavy drinking smokers enrolled in a clinical trial of smoking cessation treatments. The measure showed strong unidimensionality, good internal consistency, and moderate stability from baseline to quit date. Commitment significantly increased from baseline to quit date. Higher commitment to quitting at baseline predicted greater odds of abstinence at post-treatment and 16 and 26 weeks after quit date. Commitment predicted smoking outcome over and above level of tobacco dependence, self-reported importance of quitting smoking, and self-efficacy for remaining abstinent. Results suggest that commitment is a highly relevant construct for smoking cessation, which can be reliably assessed with the Commitment to Quitting Smoking Scale and which may be an excellent target for smoking cessation treatments.     

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

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.     

Predictors of reduced smoking quantity among recovering alcohol dependent men in a smoking cessation trial

IntroductionAdults with alcohol dependence (AD) have exceptionally high smoking rates and poor smoking cessation outcomes. Discovery of factors that predict reduced smoking among AD smokers may help improve treatment. This study examined baseline predictors of smoking quantity among AD smokers in a pharmacotherapy trial for smoking cessation.MethodsThe sample includes male, AD smokers (N = 129) with 1–32 months of alcohol abstinence who participated in a 12-week trial of medication (topiramate vs. placebo) and adjunct counseling with 6 months of follow-up. Baseline measures of nicotine dependence, AD severity, psychopathology, motivation to quit smoking, and smoking-related cognitions were used to predict smoking quantity (cigarettes per day) at post-treatment and follow-up.ResultsOverall, the sample had statistically significant reductions in smoking quantity. Greater nicotine dependence (Incidence rate ratios (IRRs) = 0.82–0.90), motivation to quit (IRRs = 0.65–0.85), and intrinsic reasons for quitting (IRRs = 0.96–0.98) predicted fewer cigarettes/day. Conversely, greater lifetime AD severity (IRR = 1.02), depression severity (IRRs = 1.05–1.07), impulsivity (IRRs = 1.01–1.03), weight-control expectancies (IRRs = 1.10–1.15), and childhood sexual abuse (IRRs = 1.03–1.07) predicted more cigarettes/day.ConclusionsSmokers with AD can achieve large reductions in smoking quantity during treatment, and factors that predict smoking outcomes in the general population also predict greater smoking reductions in AD smokers. Treatment providers can use severity of nicotine dependence and AD, motivation to quit, smoking-related cognitions, and severity of depression to guide treatment and improve outcomes among AD smokers.     

Pre-quit depression level and smoking expectancies for mood management predict the nature of smoking withdrawal symptoms in college women smokers

We assessed smoking withdrawal symptoms over a six-day period of abstinence among 21 female college students who were daily cigarette smokers [M = 20.3 (4.4); cigarettes per day] and were in the preparation stage of change for quitting smoking. We predicted that reported withdrawal symptoms would covary with baseline depression scores and baseline outcome expectancies for cigarette smoking as a mood management tool. Depression scores at baseline significantly predicted mood-related smoking withdrawal symptoms of Depression–Dejection and Vigor from the Profile of Mood States (POMS). Smoking outcome expectancies for relief of negative affect measured at baseline significantly predicted symptoms of Confusion–Bewilderment and Anger–Hostility. Neither baseline depression nor baseline smoking expectancies for mood management predicted smoking withdrawal symptoms measured by the Smoking Withdrawal Questionnaire (SWQ; [Shiffman, S. M., & Jarvik, M. E. (1976). Smoking withdrawal symptoms in two weeks of abstinence. Psychopharmacology, 50, 35–39]). Results imply that women smokers with baseline depressive symptomatology and expectancies for smoking to relieve negative mood endure greater abstinence-induced mood disturbance, but similar levels of other smoking withdrawal symptoms during initial abstinence. These results may inform smoking cessation efforts.     

An investigation of cigarette smoking behavior and nicotine dependence among Chinese opiate addicts

To explore the characteristics of nicotine dependence among Chinese opiate addicts, a survey was conducted among 357 opiate addicts in Drug Detoxification and Rehabilitation Center from 4 different provinces by using a self-designed questionnaire and Fagerström Test for Nicotine Dependence (FTND). Among the 357 opiate addicts, 355 (99.4%) had the history of cigarette smoking and the mean cigarette smoked per day were 19.1, 34.9, 21.5 and 21.5 sticks during the time of before drug taking, addiction phase, abstinence period and after abstinence respectively. Among 347 smokers with FTND score, 67.2% were severe nicotine dependence (FTND score ≥ 7.0). The lower education degree, injection, poly-drug use and 3 or more relapse were dependently associated with the severe nicotine dependence, and the adjusted odds ratio (OR) were 3.8 (1.5–10.0), 2.3 (1.3–4.0), 3.7 (2.1–6.5) and 1.9 (1.1–3.4) respectively. This study exhibited high rate of cigarette smoking in Chinese opiate addicts and the majority had severe nicotine dependence and suggested that a comprehensive intervention of cigarette smoking should be paid attention to during substance abuse treatment in China.     

Associations between Cloninger's temperament dimensions and acute tobacco withdrawal

This study examined associations between three temperament dimensions measured by the Temperament and Character Inventory-125 [Cloninger, C.R. (1992). The Temperament and Character Inventory-125 (TCI-125; Version 1.)] and tobacco abstinence effects. Smokers (N=203, >/= 15 cigarettes/day) attended two laboratory sessions, one following 12 h of abstinence and the other following ad libitum smoking (order counterbalanced). Participants completed measures of withdrawal symptoms, cigarette urges, and affect. Smokers high in Novelty Seeking reported greater abstinence-induced increases in several nicotine withdrawal symptoms, negative affect, and cigarette craving. Smokers high in Harm Avoidance reported greater abstinence-induced increases in negative affect and urges to smoke to relieve distress. Reward Dependence was not associated with abstinence effects. Novelty Seeking and Harm Avoidance showed independent predictive associations with negative affect and urges, and their associations with abstinence effects persisted when controlling for FTND scores. Smokers with different temperaments display different patterns of acute tobacco withdrawal, and may benefit from treatments matched to their particular abstinence profile.     

The alternative five-factor model of personality, nicotine dependence and relapse after treatment for smoking cessation

Personality is one of several factors that have been related to the initiation, maintenance and cessation of smoking. This paper aims to analyze the relationship between the alternative five-factor model of personality (AFFM), nicotine dependence (ND), nicotine use (NU) and cessation after twelve months of a cognitive–behavioral therapy combined with medication. In this prospective study, a sample of 103 smokers who were taking part in a workplace smoking cessation intervention, answered the Zuckerman–Kuhlman Personality Questionnaire. ND and NU were measured with the Fagerström Test for the Nicotine Dependence (FTND) and the number of cigarettes smoked per day (CPD), respectively. Tobacco cessation was self-reported at twelve months follow-up and biologically confirmed. Results varied according to gender. In men, low scores on Sociability predicted high ND and large number of CPD. In addition, low scores on Sensation Seeking and high scores on Impulsivity predicted also a high smoking rate at baseline. No personality traits were found to explain ND in women, but high Impulsivity–Sensation Seeking and General Activity predicted high CPD. Predictors of cessation also differed by gender. Apart from FTND level, high levels on Impulsivity predicted relapse in males. In women, high levels on Sociability predicted relapse. This model correctly classified two thirds of abstainers and relapsers for men and three fourths for women at 12 months. Furthermore an interaction between personality and gender was observed. The AFFM appears to have a substantial power for predicting cessation. Personality assessment when beginning treatment for smoking cessation could allow incorporating strategies to improve outcomes.     

Do Electronic Cigarettes Have a Role in Tobacco Cessation?

Tobacco use continues to be a major cause of morbidity and mortality. Even with behavioral and pharmacologic treatment, long‐term tobacco cessation rates are low. Electronic nicotine delivery systems, commonly referred to as electronic cigarettes or e‐cigarettes, are increasingly used for tobacco cessation. Because e‐cigarettes are widely used in this setting, health care professionals need to know if they are safe and effective. The purpose of this article is to review literature regarding use of e‐cigarettes as a tool for tobacco cessation in patients who are ready to quit, as well as those who are not ready to quit, along with some selected patient populations. The safety and clinical implications of e‐cigarette use are also reviewed. Small, short‐term studies assessing smokers’ use of e‐cigarettes suggest that e‐cigarettes may be well tolerated and modestly effective in achieving abstinence. High‐quality studies are lacking to support e‐cigarettes use for cessation in patients with mental health issues. One small prospective cohort study concluded that patients with mental health issues reduced cigarette use with e‐cigarette use. Although one study found that patients with cancer reported using e‐cigarettes as a tobacco‐cessation strategy, e‐cigarettes were not effective in supporting abstinence 6 and 12 months later. Additional research is needed to evaluate the use of e‐cigarettes for smoking cessation in patients with pulmonary diseases. No data exist to describe the efficacy of e‐cigarettes for smoking cessation in pregnant women. Although study subjects report minimal adverse effects with e‐cigarettes and the incidence of adverse effects decreases over time, long‐term safety data are lacking. Health care providers should assess e‐cigarette use in their patients as part of the tobacco cessation process.     

Cognitive behavioral smoking cessation during alcohol detoxification treatment: A randomized,controlled trial

Background

Among alcohol-dependent subjects tobacco smoking is very common and causes a variety of health risks. Therefore, it is necessary to reach this high-risk population early with appropriate smoking interventions.

Methods

Smokers in alcohol detoxification treatment were offered to participate in a smoking cessation study. A total of 103 patients was enrolled and randomly assigned to either the experimental group (EG) receiving a cognitive behavioral smoking cessation treatment (CBT) or the control group (CG) receiving autogenic training. Smoking outcomes were measured by self-report and carbon monoxide levels, directly after intervention and 6 months later, where additionally alcohol outcomes were recorded.

Results

There were no differences in smoking quit rates directly after intervention. However, patients in the EG were significantly more likely to reduce their daily cigarette use compared to CG (p = .046). Sub-group analyses revealed that heavy smokers (FTND score ≥ 7) seemed to profit most in the EG regarding cigarette reduction. After 6 months, these positive effects had leveled out. No evidence was found that smoking cessation might jeopardize alcohol outcomes.

Conclusions

Results suggest that alcohol-dependent smokers are interested in smoking interventions even during alcohol detoxification. CBT is promising in short-term smoking outcomes and in the approach of harm reduction, however, long-term effects are desirable. These findings underline the feasibility and the importance to provide smoking cessation interventions to patients in alcohol detoxification treatments.     

The association between probable personality disorders and smoking cessation and maintenance

Introduction

Although it has been suggested that persons with psychopathological disorders experience greater difficulty in quitting smoking, the few studies that have analyzed personality disorders in smokers have failed to produce conclusive results. The aim of this study was to examine whether the presence of probable personality disorders was associated with the achievement of abstinence at the end of a smoking cessation treatment, as well as the maintenance of abstinence at 6 and 12 months of follow-up.

Methods

The sample comprised 290 smokers (41% men and 59% women) who participated in a psychological smoking cessation treatment and who were followed for a year. Abstinence was tested by measuring carbon monoxide in exhaled air.

Results

Participants with a probable borderline, antisocial or avoidant personality disorder were less likely to quit smoking at the end of the treatment, whereas probable schizoid personality disorder predicted better maintenance of abstinence at 6 and 12 months. In addition, smoking 25 or more cigarettes before starting the treatment decreased the likelihood of maintaining abstinence at 6 and 12 months of follow-up.

Conclusions

This study revealed differential (and opposing) relationships between specific personality disorders and smoking cessation outcomes, illustrating the need to consider Axis II disorders separately when predicting treatment outcomes.     

Cigarette smoking and short-term addiction treatment outcome

Cigarette smoking is common among patients in cocaine and opioid dependence treatment, and may influence treatment outcome. We addressed this issue in a secondary analysis of data from an outpatient clinical trial of buprenorphine treatment for concurrent cocaine and opioid dependence (13 weeks, N = 200). The association between cigarette smoking (lifetime cigarette smoking status, number of cigarettes smoked per day prior to study entry) and short-term treatment outcome (% of urine samples positive for cocaine or opioids, treatment retention) was evaluated with analysis of covariance, bivariate correlations, and multivariate linear regression. Nicotine-dependent smokers (66% of participants) had a significantly higher percentage of cocaine-positive urine samples than non-smokers (12% of participants) (76% vs. 62%), but did not differ in percentage of opioid-positive urine samples or treatment retention. Number of cigarettes smoked per day at baseline was positively associated with percentage of cocaine-positive urine samples, even after controlling for baseline sociodemographic and drug use characteristics, but was not significantly associated with percentage of opioid-positive urine samples or treatment retention. These results suggest that cigarette smoking is associated with poorer short-term outcome of outpatient treatment for cocaine dependence, but perhaps not of concurrent opioid dependence, and support the importance of offering smoking cessation treatment to cocaine-dependent patients.     

Expectancies for smoking cessation among drug-involved smokers: Implications for clinical practice

Drug-involved smokers may be less motivated to quit smoking because they expect smoking cessation to occasion adverse outcomes (e.g., exacerbation of drug use). Non-treatment-seeking adult smokers from the community (N = 507) reported drug involvement, expectancies for smoking abstinence via the Smoking Abstinence Questionnaire (SAQ), and motivation to quit smoking (desire to quit and abstinence goal). Mediation analyses evaluated the indirect effects of binge drinking, marijuana, cocaine, other stimulant, opiate, and barbiturate/other sedative involvement on motivation to quit smoking through the SAQ Adverse Outcomes scale. Adverse outcomes expectancies accounted for a reduced desire to quit smoking and a lower likelihood of endorsing a goal of complete smoking abstinence among those involved with binge drinking, marijuana, cocaine, other stimulants, opiates, and barbiturates/other sedatives. Drug-involved smokers' greater expectancies for adverse outcomes upon quitting smoking may deter smoking quit attempts. Interventions are encouraged to counteract the notion that smoking cessation jeopardizes sobriety.