Smoking cessation in methadone maintenance

FRANÇAIS :
L'étude compare chez 175 patients de 3 centres de traitement méthadone de Los Angeles l'efficacité de 4 protocoles de traitement de désintoxication du tabac : patch nicotinique seul ou patch associé à un programme comportemental de prévention de la rechute ou à un programme de gestion des contingences (fondé sur le principe de la récompense) ou aux 2 programmes. La gestion des contingences augmente les résultats des traitements substitutifs à la nicotine, mais ses effets ne durent pas à long terme. D'autre part, il existe un lien entre la réduction de consommation de cigarettes et la réduction de consommation de drogues au cours du traitement.
ENGLISH :
Aims: To evaluate relapse prevention (relapse prevention) and contingency management (contingency management) for optimizing smoking cessation outcomes using nicotine replacement therapy for methadone-maintained tobacco smokers. Design: Experimental, 2 (relapse prevention)x2 (contingency management) repeated measures design using a platform of nicotine replacement therapy featuring a 2-week baseline period, followed by randomization to 12 weeks of treatment, and 6- and 12-month follow-up visits. Setting: Three narcotic treatment Centers in Los Angeles. Participants: One hundred and seventy-five participants who met all inclusion and no exclusion criteria. Intervention: Participants received 12 weeks of nicotine replacement therapy and assignment to one of four conditions: patch-only, relapse prevention + patch, contingency management + patch and relapse prevention + contingency management + patch. Measurements: Thrice weekly samples of breath (analyzed for carbon monoxide) and urine (analyzed for metabolites of opiates and cocaine) and weekly self-reported numbers of cigarettes smoked. Findings: Participants (73.1%) completed 12 weeks of treatment. During treatment, those assigned to receive contingency management showed statistically higher rates of smoking abstinence than those not assigned to receive contingencies (F 3,4680 = 6.3, P = 0.0003), with no similar effect observed for relapse prevention. At follow-up evaluations, there were no significant differences between conditions. Participants provided more opiate and cocaine-free urines during weeks when they met criteria for smoking abstinence than during weeks when they did not meet these criteria (F 1,2054 = 14.38, P=0.0002; F 1,2419 = 16.52, P<0.0001). Conclusions: Contingency management optimized outcomes using nicotine replacement therapy for reducing cigarette smoking during treatment for opiate dependence, although long-term effects are not generally maintained. Findings document strong associations between reductions in cigarette smoking and reductions in illicit substance use during treatment. (Author' s abstract)