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Effectiveness of Cognitive-Behavioral Therapy for Smokers with Histories of Alcohol Dependence and Depression

Christi A. Patten, John E. Martin, Mark G. Myers, Karen J. Calfas, Carl D. Williams

Objective: Alcohol dependence and major depression have been associated with heavy cigarette use and poor smoking-treatment outcomes. This preliminary study examined the efficacy of a mood management intervention for smoking cessation in abstinent alcoholics with a history of major depression. Method: Participants were 29 (15 female, 14 male) heavy smokers (mean cigs/day = 30.2), with an average of 6.8 years of continuous abstinence from alcohol and drugs, randomized to behavioral counseling (BC) (n = 16) or behavioral counseling + cognitive-behavioral mood management (CBT) (n = 13). A 2 X 5 repeated measures design was used to evaluate the effectiveness of the interventions on smoking outcome at baseline, posttreatment and at 1- , 3- and 12-month-follow-up. Self-reported smoking status was verified with biochemical (COa) and informant report. Results: Verified self-report indicated that significantly more smokers in CBT quit by posttreatment (69.2%; 9 of 13) than in BC (31.3%; 5 of 16) (χ² = 4.14, 1 df, p = .04). These abstinence rates remained unchanged at 1-month follow-up. At 3-month follow-up, differences in smoking abstinence rates were nonsignificant between CBT (46.2%; 6 of 13) and BC (25.0%; 4 of 16) conditions. However, at 12-month follow-up, significantly more participants in CBT were abstinent from smoking (46.2%; 6 of 13) than in BC (12.5%; 2 of 16) (χ² = 4.07, 1 df, p = .04). Conclusions: The results suggest that interventions focused on managing negative mood may benefit these highrisk, comorbid smokers. (J. Stud. Alcohol 59: 327-335, 1998)