Treatment consisted of four individual counseling sessions over three weeks with the quit date occurring at session 2, one week after session 1. Manuals are available upon request to the first author. All participants received treatment with transdermal nicotine patch with the initial dose starting at 21 mg for four weeks, followed by two weeks of 14 mg patch, and then two weeks of 7 mg patch. Standard treatment was based on recent clinical practice guidelines (Fiore et al., 2000 ) and focused on problem solving regarding high-risk situations for smoking relapse, providing support within the treatment, and encouraging participants to seek support for quitting smoking outside of treatment. Participants in ST were given brief advice to avoid or reduce drinking as much as possible while quitting smoking. In the ST-BI condition, discussion of alcohol use was reserved for the second half of sessions 1 and 2.
Sessions ranged in length from 70 minutes for session 1, 40 minutes for session 2, and 20 minutes for sessions 3 and 4. ST and ST-BI were matched on treatment contact time. In ST, 40 minutes of session 1 and 20 minutes of session 2 were dedicated to teaching progressive muscle relaxation, which has not been shown to improve smoking cessation outcomes (Fiore et al., 2000 ). Sessions 3 and 4 contained 5-minute check-ins regarding use of relaxation skills. In ST-BI, the same amount of time was dedicated to discussion of the participant’s alcohol use.
The first session of ST-BI included open-ended discussion of current drinking and smoking patterns, normative feedback on drinking level and the risk of smoking relapse associated with drinking, and preliminary goal setting. The module used the potential role of alcohol use in smoking relapse as the entry into discussion of possible short and long-term changes in drinking. Regardless of interest in long-term changes in drinking, participants were encouraged to consider abstaining from alcohol for at least two weeks after quitting smoking and preferably to abstain from drinking entirely while on nicotine patch. They also were provided recommendations for moderate drinking limits and informed of the risks associated with combined heavy drinking and smoking. The second session focused on finalizing drinking goals and supporting self-efficacy for change. A brief, 5-minute, check-in regarding achievement of drinking goals was included in sessions 3, and in session 4 recent benefits of changing drinking and longer-term drinking goals were reviewed. The alcohol module of ST-BI was conducted in the nonconfrontational therapeutic style of Motivational Interviewing (Miller & Rollnick, 2002 ), which is intended to minimize patient resistance and stresses personal responsibility for deciding to change.
Sessions ranged in length from 70 minutes for session 1, 40 minutes for session 2, and 20 minutes for sessions 3 and 4. ST and ST-BI were matched on treatment contact time. In ST, 40 minutes of session 1 and 20 minutes of session 2 were dedicated to teaching progressive muscle relaxation, which has not been shown to improve smoking cessation outcomes (Fiore et al., 2000 ). Sessions 3 and 4 contained 5-minute check-ins regarding use of relaxation skills. In ST-BI, the same amount of time was dedicated to discussion of the participant’s alcohol use.
The first session of ST-BI included open-ended discussion of current drinking and smoking patterns, normative feedback on drinking level and the risk of smoking relapse associated with drinking, and preliminary goal setting. The module used the potential role of alcohol use in smoking relapse as the entry into discussion of possible short and long-term changes in drinking. Regardless of interest in long-term changes in drinking, participants were encouraged to consider abstaining from alcohol for at least two weeks after quitting smoking and preferably to abstain from drinking entirely while on nicotine patch. They also were provided recommendations for moderate drinking limits and informed of the risks associated with combined heavy drinking and smoking. The second session focused on finalizing drinking goals and supporting self-efficacy for change. A brief, 5-minute, check-in regarding achievement of drinking goals was included in sessions 3, and in session 4 recent benefits of changing drinking and longer-term drinking goals were reviewed. The alcohol module of ST-BI was conducted in the nonconfrontational therapeutic style of Motivational Interviewing (Miller & Rollnick, 2002 ), which is intended to minimize patient resistance and stresses personal responsibility for deciding to change.
