Combined Behavioral Treatment Analog Trial for the Treatment of Alcohol and Nicotine Co-Addiction
WSU Office of Research
9/1/2014 – Ongoing
Through the Program of Excellence in Addictions Research (PEAR) at WSU, research is being done focused on comorbid tobacco smoking and alcohol/stimulant addiction. Combined, nicotine and alcohol cause more illness, kill more people, has higher social impact, and costs more in healthcare dollars than any other public health problem worldwide. Some smoking prevalence estimates are reported to be as high as 80% among clinical populations with an alcohol use disorder. Together, nicotine and alcohol kill more than a half a million people living in the United States every year, and addiction to these substances represent the leading causes of preventable death. There is also a synergistic risk when both of these substances are used concurrently which multiplies many health risks already at work when each substance is used independently. Comorbid alcohol and nicotine use constitute a public health crisis in desperate need of an innovative, integrated treatment modality. Contingency management (CM) is one of the most effective and well-studied behavioral treatments for abuse of illicit and non-illicit drugs. Until recently, CM has not been widely applied as a behavioral treatment for alcohol dependence given the difficulty of detecting abstinence using standard breath alcohol test procedures. Because breath tests cannot detect alcohol use between clinical assessments, their use leads to inconsistent delivery of interventions. Our study will address this critical methodological barrier by using a CM paradigm based on a superior alcohol measure, ethyl glucuronide (EtG) urine tests, which can detect alcohol use 3 or more days after it has occurred. Further, we will do this in an alcohol use disorder population with a co-occurring nicotine use disorder and target alcohol (primary) and nicotine (secondary) with CM to increase smoking and alcohol abstinence. Given previous evidence of the synergistic biochemical relationship between alcohol and nicotine, we believe matching such with a synergistic therapy will provide for an effective, dual treatment approach. We will investigate a behavioral treatment designed to increase alcohol abstinence (using the EtG biomarker) and smoking abstinence (using the cotinine biomarker) in a small population of non-treatment-seeking, alcohol and nicotine use disorder (AN-UD) participants in a CM treatment analog investigation. The early stage PI has surrounded himself with a research team that has extensive experience conducting behavioral pharmacology experiments, RCTs of CM for nicotine and alcohol use disorders, and CM treatment analog investigations in various populations. The goal of this study is to perform a 2×2 treatment analog trial to evaluate the ability of a combined behavioral intervention to increase alcohol (primary) and smoking (secondary) abstinence among AN-UD, non-treatment-seeking adults. These individuals will be randomized into 1 of 4 trial arms that will receive: 1) CM for alcohol and nicotine use (CM-A + CM-N), 2) CM for alcohol plus non-contingent control for nicotine (CM-A + NC-N), 3) Non-contingent control for alcohol plus CM for nicotine (NC-A + CM-N), or 4) Non-contingent control for both alcohol and nicotine (NC-A + NC-N).