in spite of evidence that tobacco-cessation treatment does not impede alcohol-use outcomes (Burling et al., 2001; Gulliver et al., 2006).

Concurrent treatment for tobacco use and alcohol dependence or abuse has been studied, but results are mixed. Some studies have shown that cessation rates tend to increase with length of sobriety if the two treatments are delivered concurrently (Heffner et al., 2007). Tobacco-cessation rates were about 3 times as great in people with 3 months of sobriety or more as in people with shorter sobriety, although both groups relapsed at about the same rate. At 3–6 months of sobriety, tobacco-cessation rates resembled those of alcohol nonusers, and 1-year cessation rates were as high as 46% in people who had been sober for several years (Sussman, 2002). Other studies of concurrent treatment found greater participation rates in tobacco-cessation treatment; however, long-term cessation rates did not differ significantly from those seen when smoking intervention was delayed for 6 months after alcohol treatment indicating that optimal timing has yet to be determined (Joseph et al., 2002). Sequential treatments may be preferred for some people (Kodl et al., 2006). Ellingstad et al. (1999) suggested that tobacco cessation may improve alcohol-treatment outcomes because it removes a cue for alcohol use (Ellingstad et al., 1999).

In a study of outpatients in alcohol treatment, the longer the period of alcohol abstinence, the more receptive to quitting smoking were those with low scores on the Center for Epidemiologic Studies Depression Scale (Hitsman et al., 2002). Patten et al. (2002) assessed the use of behavioral therapy alone or behavioral therapy with cognitive-behavioral mood-management training for tobacco abstinence in depressive smokers with a history of alcohol dependence. Behavioral therapy alone was more effective in helping smokers with low scores on the Hamilton Rating Scale for Depression to achieve short-term tobacco abstinence, whereas the mood-management training was more effective in increasing abstinence in smokers with high depression scores (Patten et al., 2002). Those studies suggest that treating people who have both depression and alcohol dependence for tobacco use requires assessing both disorders in addition to nicotine addiction. Ait-Daoud et al. (2006) found that the preponderance of evidence suggests that concurrent treatment for depression and tobacco use is preferable to treating either disorder alone, even in people who have alcohol dependence, and that a combination of pharmacotherapies and cognitive-behavioral therapy was most advantageous (Ait-Daoud et al., 2006).



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