Alcohol and tobacco cessation in alcohol-dependent smokers: analysis of real-time reports

Research design/methodology

TYPE: Quasi-randomized clinical trial

VALIDITY: This study has a limited design, using a quasi-random method of allocating participants to the different essay writing service forms of intervention. There is a greater risk of selection bias in quasi-random trials where allocation is not adequately concealed as compared to randomized controlled trials. However, the study used the Ecological Momentary Assessment methodology, which is well suited to examine alcohol–tobacco interactions as they occur in the natural environment. Data collection was real-time with the participants using an ED throughout the day, enhancing ecological validity as data are collected in the natural environment. Problems of faked compliance were avoided because each record <ais>="" 4-line,="" 20-character="" lcd="" screen;="" a="" real-time="" clock="" calendar;="" an="" audio="" speaker;="" and="" data-recording="" capability.=""></ais>

ENVIRONMENT: Two intensive outpatient substance abuse programs at the VA Connecticut Healthcare System with non-veteran women recruited from the community.

Research question

Relevant to handheld computing, this article raises the question, can electronic diaries (ED) be useful in establishing profiles of alcohol and tobacco cessation in alcohol-dependent smokers? 

Patient/Problem/Population definition

PATIENT: Adults (mean age 46-7 years-old), 87% male, 67% white, 72% unemployed, 29% married, all participants meet the DSM-IV criteria for alcohol and nicotine dependence

PROBLEM: Assessment of alcohol and tobacco cessation using an ED

POPULATION: Adult alcohol and nicotine dependent patients

Intervention

A three week intensive outpatient substance abuse treatment program located at one of two VA sites in Connecticut. Within 1 week of program admission, participants completed baseline assessment measures.    

Comparison

Patients were randomized to either intensive smoking cessation treatment, consisting of behavioral counseling and transdermal nicotine replacement, or to brief smoking cessation advice without nicotine replacement. These interventions were delivered concurrently with the 3-week intensive outpatient program.

Outcome

ED data revealed an increase in frequency of alcohol urges after smoking episodes. Drinking relapse episodes were predicted by prior ED ratings of low self-efficacy to resist drinking and high urges to smoke. Smoking relapse episodes were predicted by high urge to smoke and high negative, high arousal mood. 

Application of results to patient care

Use of ED may be useful to improving in settings where patients need to record self-reported measurements during or after an intervention.

Further areas for research

• Assess the difference between ED instruments as well compare to other hardware and software options for patient diaries.
• Test the applicability of these results in other clinical settings.