Biomedical subjects

Robert M McCool

Publications and source records attributed to Robert M McCool.

4 recordsLinked to original sources

PubMed2005

Dual pharmacotherapy and motivational interviewing for tobacco dependence among drug treatment patients.

This pilot study is the first to examine the feasibility and outcomes of dual pharmacotherapy for smoking cessation among drug treatment patients. The intervention consisted of 7 weeks of bupropion (300 mg), 12 weeks of nicotine gum, and 6 sessions of motivational interviewing. The trial was conducted among 28 patients recruited from 5 methadone clinics and employed a pretest-posttest design. At 6 months post quit date, 14% of participants met criteria for biochemically-verified abstinence. Among those still smoking, number of cigarettes smoked decreased significantly and most (88%) had made at least 1 serious quit attempt. Participation rates were excellent and no adverse effects on alcohol or illicit drug use were found. Although not a definitive test of the intervention, findings suggest that a multi-component approach to tobacco dependence is feasible and potentially effective in helping drug treatment patients achieve smoking cessation well beyond the end of treatment and that a large-scale randomized trial is warranted.

Administration, Topical↗

PubMed2004

Smoking cessation services in U.S. methadone maintenance facilities.

OBJECTIVES: Most patients in drug treatment smoke cigarettes. This study established the prevalence and types of nicotine dependence services offered in methadone and other opioid treatment clinics in the United States. METHODS: A cross-sectional survey was conducted of all outpatient methadone maintenance clinics in the United States. One person in a leadership position from each clinic was surveyed. The 20-minute survey was collected by phone, fax, or mail, according to responder preference. RESULTS: Fifty-nine percent of the clinics (408 of 697 clinics) responded. The sample was very similar to all outpatient methadone maintenance clinics in the United States in size, region, and ownership. In the 30 days before the survey, respondents reported that their clinics provided the following services to at least one patient: 73 percent provided brief advice to quit, 18 percent offered individual or group smoking cessation counseling, and 12 percent prescribed nicotine replacement therapy. However, the services were provided to very few patients. Clinics with written guidelines that required them to address smoking were much more likely to provide services than those without guidelines. Private for-profit clinics were significantly less likely than public or private nonprofit clinics to treat nicotine dependence. Most respondents (77 percent) reported that their staff were interested in receiving training in nicotine dependence treatment, and more than half (56 percent) had at least one staff member ("champion") with a strong interest in treating nicotine dependence. CONCLUSIONS: A vast majority of methadone patients smoke; yet in the 30 days before the survey only one out of three facilities provided counseling to any patients and only one out of ten prescribed nicotine replacement therapy to any patients. A dual strategy of requiring clinics to provide comprehensive nicotine dependence services and training staff to provide these services may provide the incentive and support necessary for the widespread adoption of treatment for nicotine dependence in methadone facilities.

Adult↗

PubMed2003

Why do so many drug users smoke?

To better understand why most persons in drug treatment smoke, we explored patients' views of the relationship between their smoking, methadone, and drug use. Recruiting from four methadone clinics, we held seven focus groups with 68 current smokers, and 10 individual interviews with former smokers. Sessions were audio-taped, transcribed, and coded. Participants were > or =18 years old, smoked > or =5 cigarettes per day, and had used prescription methadone for > or =2 years. Most patients linked smoking, methadone, and drug use in three ways. First, patients said smoking and drug use were complementary. Examples included smoking to reduce methadone after taste and using drugs to reduce smoking-related throat pain. Second, smoking and drug use were similar because they shared cues and withdrawal symptoms. Third, smoking differed from drug use because it had fewer acute consequences. Because smoking, methadone, and drug use are closely interrelated, future addictions research and treatment protocols should address them in combination.

Adult↗

PubMed2002

Patients' views on smoking cessation and tobacco harm reduction during drug treatment.

Efforts to help smokers in drug treatment quit smoking have met with little success. To explore barriers to quitting and interest in tobacco harm reduction we conducted focus groups and interviews among 78 patients from five Methadone Maintenance Treatment (MMT) sites. Measures included a written survey and open-ended questions on (a) motivation for quitting, (b) what quit methods worked and what didn't work, and (c) interest in smoking reduction and nicotine maintenance as an alternative to complete cessation. Discussions were audiotaped, transcribed, and coded using computer-based qualitative software; our interobserver reliability was 83%. Successful quitters used in general a combination of quit methods such as prayer, nicotine gum, keeping busy, quitting 'one day at a time,' nicotine patches, deep breathing, and avoidance of triggers. Nicotine craving, rather than withdrawal, was cited as the biggest challenge to staying quit. Some current smokers feared quitting smoking would divert them from their goal of quitting illicit drug use or tapering off MMT. Current smokers were interested in smoking reduction as an alternative to quitting; however, those who had tried but failed to reduce smoking preferred complete cessation. Nicotine maintenance was favored by only a few participants with major health problems who didn't hold out hope for quitting. Findings suggest combination pharmacotherapy could help patients control withdrawal and acute episodes of craving. Patients have a number of skills from coping with illicit drug dependence that are useful in combating nicotine dependence. Behavioral methods and short-term pharmacotherapy to help patients reduce tobacco exposure should be explored.

Adult↗