Research on Substance Abuse Treatment
Alcohol / Drug / Smoking

Alcohol Treatment Works (and saves money too)!
You think the field would be beyond the basics by this point in history. And yet, the fundamentals continue to be debated. Most notoriously, does treatment work? Well, Holder, Cisler, Longabaugh, Stout, Treno, and Zweben (2000) reported 3 year follow up results on Project MATCH--the most sophisticated study to date on treating problem drinkers. You will recall, in this study, researchers tried to match client characteristics to treatment modalities. The bad news is that it didn't work--the matching that is. The good news is that all treatments worked about equally well. Moreover, in this study, the authors report that at 3 years, all three approaches studied (CBT, 12-step, and MET) resulted in substantial reductions in medical costs!

Holder, H. et al. (2000). Alcoholism treatment and medical care costs from Project MATCH. Addiction, 95, 999-1013.

Tailoring Treatment to the Client's Culture
What works for people with drug and alcohol problems hailing from different cultures. Well, researchers Arroyo and Westererg (1998) found that, " it depends." The only way to find out is to ask and observe. In their study, the researchers found that Latino clients were more likely to seek formal help for alcohol problems while non-Latino white clients were more likely to make use of less formal, supportive treatments such as Alcoholics Anonymous. Both groups of clients improved over time and reported similar drinking patterns.

Arroyo, J.A., Westerberg, V.S., and Tonigan, J.S. (1998). Comparison of treatment utilization and outcome for Hispanics and non-Hispanic Whites. Journal of Studies on Alcohol, 59, 286-291.

Problems with the Disease Model of Addiction: When Clinical Beliefs harm Clinical Reality
In a study of 122 people enrolled in a study to determine the causes of relapse, researcher William Miller found that one of the strongest predictors was belief in the alcoholism-as-a-disease concept. Simply put, the research does not support the belief in alcoholism as a disease. Unfortunately, polls indicate as much as 90% of the American public believe in this idea--a testament to the success of the 12-step movement and the National Council on Alcoholism.

These results confirm calls by pioneering solution-focused practitioners Berg and Miller who in 1992 called for the abandonment of the traditional disease-oriented treatment paradigm and the inclusion of other treatment approaches (see pp. xi-xx, in their book).

Psychology Today, 31(1), 10.

Does Alcoholic's Anonymous Help?
Results from a recent study show that increased affiliation with A.A. was associated with better outcomes in the treatment of people with alcohol problems. The study also showed, however, that there were a cluster of common change factors that existed prior to the initiation of treatment that were likely responsible for people choosing whether to attend. Individuals with greater treatment motivation, appraisal of harm, and commitment to abstinence prior to admission were more likely to affiliate with A.A. and their attendance predicted short-term outcome. In contrast, people initially low on motivation affiliated less with A.A. regardless and their participation in an intensive program did not alter their motivation. Such findings contrast sharply with the current practice of addressing low-motivation through placement in intensive treatment programs and confrontation of denial and suggest that more time and effort be placed on strategies for increasing motivation prior to placement in intensive treatment programs or the use of confrontational techniques. The study also found that A.A. was successful because of common rather than unique change processes. Among those people who are initially highly motivated, A.A. works by: (1) increasing self-efficacy; (2) promoting active coping efforts; and (3) sustaining motivation. In fact, people who were discharged with low self-efficacy had uniformly poorer outcomes independent of motivational level, prior problem severity, or affiliation with A.A.

Morgenstern et al. (1997). Affiliation with A.A. after treatment: A study of therapeutic effects and mechanisms of action. Journal of Consulting and Clinical Psychology, 65(5), 768-777.

Support for Solution-Focused Therapy in the Treatment of Alcohol Problems
In 1992 and again in 1994, solution-focused therapists Miller and Berg postulated in their books Working with the Problem Drinker and The Miracle Method that substance abuse counseling need not make substances the sole focus of therapy in order to be effective. Indeed, they suggested that therapists and clients should work together to reinforce other prosocial changes in clients' lives. Doing so, Miller and Berg argued, would ultimately lead to a reduction in the amount and/or problems with substances. Now, researchers Iguchi et al (1997) have provided research support for this controversial idea. Basically, these researchers examined the role of either urine testing, standard chemical dependency treatment, or reinforcement of the completion of prosocial, nonsubstance abuse related life changes on abstinence from drugs. They found that only the reinforcement condition resulted in a reduction of illicit drug use--a finding which was maintained through follow-up and continued even after the reinforcement contingencies were discontinued! The implications for treatment are clear: treatment should focus less on making clients stop using and more on helping and encouraging them to engage in other life activities!

Iguchi, M.Y., Belding, M.A., Morral, A.R., Lamb, R.J., Husband, S.D. (1997). Reinforcing operants other than abstinence in drug abuse treatment: An effective alternative for reducing drug use. Journal of Consulting and Clinical Psychology, 65(3), 421-428.

What Works in Alcohol Treatment? Give them prizes for not drinking! Seriously . . .
Researchers Petry, Martin, Cooney, and Kranzler have an interesting idea: give prizes to problem drinkers for staying in treatment and working toward therapeutic objectives. What's more, their study shows that it works . . . BETTER THAN TRADITIONAL TREATMENT! That's right, these researchers compared "treatment as usual" (intensive outpatient oriented around the 12-step approach) to the same treatment plus an opportunity to draw slips from a bowl containing prizes ranging from nothing, to a dollar, to a television set. Importantly, those participating in the program were much more likely to stay in and complete treatment (84% versus 22%). They were also less likely to have used alcohol (31% versus 61%).

Petry, N.M., Martin, B., Cooney, J.L., & Kranzler, H.R. (2000). Give them prizes and they will come: Contingency management for treatment of alcohol dependence. Journal of Consulting and Clinical Psychology, 68(2), 250-257.

What Works in Alcohol Treatment? DON'T let them hit bottom!
It's been a standard belief for some time: people have to "hit bottom" before they're likely to realize their drinking is a problem and make a concerted effort to change. Now, a long term study of problem drinking shows that this belief may have tragic consequences. Timko and colleagues (1999) followed problem drinkers over nearly a decade and found that the best outcomes were associated with those who entered treatment early! In other words, rather than bemoaning the fact that some people deny their problems

Timko, C. et al. (1999). Long-term treatment careers and outcomes of previously untreated alcoholics. Journal of Studies on Alcohol, 60, 437-447.

What Works with Drugs

What's the Difference in Outcome between Residential and Day Treatment? NOT Much!
Researchers Guydish et al. report a follow-up of their earlier study, reporting the outcome of treatment in day and residential treatment at 12 and 18 months after termination. The results? Well, other than cost, improvement among residential clients was not significantly different from those in day treatment. Indeed, with regard to drug use, there was no difference for the more extensive and expensive treatment option! It's time for the old tradition of thinking that drug and alcohol clients must first go to residential treatment in order to be successful to go the way of the horse and buggy and Edsel!

Guydish, J. et al. (1999). A randomized trial comparing day and residential drug abuse treatment: 18 month outcomes. Journal of Consulting and Clinical Psychology, 67(3), 428-434.

The Use of the Therapeutic Alliance as a Predictor of Outcome in the Treatment of Cocaine Dependence
Researchers Barber et al. used two measures of the therapeutic alliance to test the correlation with outcome from drug treatment. The measure predicted outcome from treatment at one month but not at six months. However: (1) the measure did predict improvement in depressive symptoms at both one and six months; and (2) client ratings--consistent with previous studies--were better predictors of outcome than therapists! When evaluating the results of this study, it is important to note that the measures employed assessed a restricted range of the therapeutic alliance which may have limited the ability to show effects of the alliance on outcome. Future studies and clinical practice await measures of the alliance which will allow both clinicians and researchers to gain better feedback about the quality of the therapeutic relationship. In the meantime, therapists must supplement their use of the measure with discussion with their clients--especially when their is a lack of progress in the early stages of treatment.

Barber, J.P. et al. (1999). Therapeutic alliance as a predictor of outcome in treatment of cocaine dependence. Psychotherapy Research, 9(1), 54-73.

Reading their way to Recovery . . .
Old beliefs die hard. Substance abuse professionals are still decrying the disappearance of the favored (and now almost mythological) 28 day inpatient stay. There was just something magical about that number of days when it came to treating people with alcohol problems. Any yet, recent research suggests that such programs didn't die soon enough. Researcher Kavanagh has been using "bibliotherapy" to help people battle problems with alcohol. His findings? Merely sending people letters covering such topics as self-monitoring, goal setting, problem solving, and relapse prevention reduced alcohol consumption by 48% from pretreatment. In this study, participants received four mailings over a period of 6 weeks. The authors point out the applicability of such an approach for people living in rural settings. Members of ISTC think the study has much broader implications for the wired world in which people are now living!

Kavanagh, D.J. (1999). An evaluation of brief correspondence programs for problem drinkers. Behavior Therapy, 30, 641-656.

What Works in the Treatment of Cocaine Use? Some good news . . . and a surprise.
The first reports from the National, multi-site study of community treatments for people struggling with cocaine problems are in and the results are compelling in a number of ways. First and foremost, the study found treatment to be effective. Weekly use dropped from nearly 75% prior to treatment to 23% following intervention. What's more, less than a quarter returned to weekly use in the year following their participation in treatment. Furthermore, the decrease in use was accompanied by reductions in criminal behavior and problematic use of alcohol as well. One surprising result from the study--surprising, that is, to academic types--was that clients of doctoral level practitioners had poorer outcomes that drug counselors!

Crits-Christoph, P. et al. (1999). Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Archives of General Psychiatry, 56, 493-502.

Simpson, D.D. et al. (1999). A National Evaluation of Treatment outcomes for cocaine dependence. Archives of General Psychiatry, 56, 507-514.

So you want to know "What Works" in Drug and Alcohol Treatment?
Treatment of substance problems is "big business" in the United States. The data say, however, that it is cost-effective. For every dollar spent on treatment, four to seven are saved in the cost of drug-related crimes, criminal justice costs, and theft. Now, the NIDA has just released the first ever science-based guide to the treatment of drug addiction. Based on a 30 year review of the data, this guide identifies 13 core principles of effective practice. Here they are:

	No single treatment works for everyone.
	Treatment needs to be readily available.
	Effective treatment attends to multiple needs of the individual, not just his or her drug use.
	An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person's changing needs.
	Remaining in treatment for an adequate period of time is critical for effectiveness.
	Counseling is critical for the treatment of addictions.
	Medications are an important element of treatment for many.
	People with mental health and substance problems should be treated in an integrated way.
	Medical detox does little to change long-term drug use.
	Treatment need not be voluntary to be effective.
	Possible drug use must be monitored during treatment.
	Treatment should include assessment for HIV/AIDS, Hepatitis, TB, and other infectious diseases.
	Recovery frequently requires multiple treatment episodes.

National Institute on Drug Abuse (2000). Principles of Drug Addiction Treatment. Washington, D.C.: NIDA.

D.A.R.E. to Give Up: What to do when a Politically Popular Idea Just Doesn't Work?
The politicians love it and alcohol and drug treatment professionals support it: the D.A.R.E. program (Drug Abuse Resistance Education). The data from this 10 year follow-up of kids in the program compared to those who received a standard drug education curriculum, however, show that the program simply doesn't work. Researchers Lyman, et al (1999) found NO differences between the two groups in actual drug use, drug attitudes, self-esteem, or on any other measure of successful outcome. The authors suggest that the reason for the continued popularity of the approach in spite of a lack of support is that the program is a "feel-good" approach that everyone can support. In spite of a lack of efficacy, in other words, it seems like something is being done.

Lyman, D.R. et al. (1999). Project DARE. Journal of Consulting and Clinical Psychology, 67(4), 590-3.

Clients say, "Substance Abuse Treatment Works WELL"

Five years after drug abuse treatment, substance abuse and criminal behavior are reduced! In a study of nearly 1800 former clients who had participated in inpatient, outpatient, and residential care, client reported:

	21% reduction in illicit drug use
	14% decrease in alcohol use
	48% decline in cocaine use
	17% reduction in crack use
	14% reduction in heroin use
	23-38% decline in criminal behavior (e.g., prostitution to robbery)

Many respondents reported improved quality of life, including a shift toward regaining and retaining child custody and finding better housing and employment opportunities.

APA Monitor (November 1998), p. 7.

Alliance not technique is What Matters Most in Alcohol Treatment!
Researchers Connors, Caroll, DiClemente, Longabaugh, and Donovan (1997) investigated the role of the therapeutic alliance in the outpatient and aftercare treatment of adult alcoholics and found that ratings of the alliance were significant predictors of treatment participation and drinking behavior during the treatment and 12-month post-treatment periods. These findings are particularly important in the field of alcohol and drug treatment since they question some traditional practices (e.g., confrontation, intervention, etc.) which may actually harm or decrease the alliance. Like treatment for other problems, the treatment of people with alcohol problem needs to build an alliance based on mutually and collaboratively determined goals, objectives, and treatment methods. To do otherwise is to risk affecting participation in the very treatment a person needs.

Conners, G.J., Carroll, K.M., DiClemente, C.C., Longabaugh, R., and Donovan, D.M. (1997). The therapeutic alliance and its relationship to alcoholism treatment participation and outcome. Journal of Consulting and Clinical Psychology, 65(4), 588-598.

Day Treat as Effective as Residential? Bah Humbug or what?
Oh the good ole' days when people with drug and alcohol problems were able to go to a residential treatment center for the 21-day therapeutic fix. Right? Well, most of these clinical beliefs from the good ole' days seem not to hold up under scientific scrutiny. Consider a study by Guydish, Werdegar, Sorenson, Clark, and Acampora of clients in a therapeutic community matched on a variety of experimental variables. These researchers found that day treatment clients (read:less expensive) had an overall level of improvement not significantly different from those in the more intensive residential treatment.

Guydish, J., Werdegar, D., Sorenson, J., Clark, W., and Acampora, A. (1988). Drug abuse day treatment: A randomized clinical trial comparing day and residential treatment programs. Journal of Consulting and Clinical Psychology, 66(2), 280-289.

Do Women Learn Problematic Drinking from their Problem Drinking Partners?
Contrary to longstanding clinical beliefs, research shows that men do not generally influence their partner's drinking patterns. Women tracked in a long-term study of 1100 women, researchers Sharon and Richard Wilsnack found that women were not influenced by their male partner's drinking. Neither were women more likely to drink if they had to juggle several roles at one time. However, women who worked in traditionally male dominated fields do tend to drink more than women in more traditionally female occupations.

Wilsnack, S., and Wilsnack, R. (1997). Gender and Alcohol. New York: Rutgers Center of Alcohol Studies.

Do Bad Kids Drive their Parents to Drink? Yes and No.
Researchers Pelham et al. (1998) investigated the effect of deviant children on parental drinking patterns. Briefly, they found that parents with a family history of alcohol problems were more likely to drink in response to deviant behavior. Indeed, they drank 48% more in response to the bad behavior. Parents with no family history were equally distressed by their children's bad behavior but were unlikely to drink problematically as a result. Indeed, they actually decreased their alcohol consumption by nearly 60%! Perhaps we should study what skills and resources these latter parents use when dealing with their troubling children and teach those skills to parents at risk for problematic alcohol consumption.

Pelham, W.E. et al. (1998). Effects of deviant child behavior on parental alcohol consumption. American Journal of Addiction, 7, 103-114.

Successful Treatment Need Not Be Lengthy Treatment!
In this controlled study, researchers examined the effects of a brief intervention comprised of two 15 minute counseling sessions with a primary healthcare worker on nearly 800 problem drinkers. The counseling session were structured according to a scripted workbook which covered current health behaviors, the adverse effects of alcohol, drinking cues, a drinking diary, and a drinking contract. In comparison to a control group that received general health information booklet, those who received the brief intervention experienced, at 12 month follow-up, significant reductions in 7-day alcohol use, fewer episodes of binge drinking in the previous month, and a decrease in the frequency of excessive drinking in the previous week. Those who received the brief intervention also had shorter hospital stays than those in the control group.

Fleming, M.F. et al. (April 2, 1977). Brief physician advise for problem alcohol drinkers. Journal of the American Medical Association, 277, 1039-1045.

The Positive Effects of Religiosity on Recovery from Alcohol Abuse
Using the Virginia Twin Registry as a data base, researcher Kendler (1997) investigated the effects of personal involvement in religion on substance use and dependence. The study found that personal devotion acted as a buffer against life stress and that personal religious conservatism was inversely related to the amount of current alcohol use and lifetime risk of smoking. Membership in a conservative religious institution was further associated with a decreased lifetime risk of major depression. For years, beginning in earnest with Freud and continuing in its most malignant form with figures like Albert Ellis, members of the psychology community have attributed all manner of psychological and social ills to religion. Clearly, this research suggests that the opposite may be true and that religion may play a helpful role in protecting people from life stress and risk of substance abuse.

Kendler, K.S. (1997). Religion, psychopathology, and substance use and abuse: A multimeasure, genetic, epidemiologic study. American Journal of Psychiatry, 154, 322-329.

Which Alcohol Treatment is Most Effective? A Comparison of Traditional, Cognitive-Behavioral and Miller's Motivational Interviewing Approach
In the largest clinical study of psychotherapies ever conducted on the treatment of people with alcohol problems, researchers have found that traditional 12-step, cognitive-behavioral therapy, and the more recent Motivational Interviewing model are equally effective regardless of the characteristics of the particular client being treated. Researchers at the NIAAA randomly assigned 1726 people who met criteria for alcohol dependence to one of the three treatments and followed them for one year after termination. The results disconfirm several smaller studies and a lot of theorizing from different model developers which suggested that certain types of clients would do better when matched with certain kinds of therapies.

In a separate study, researchers Ouimette, Finney, and Moos (1997). also found that cognitive-behavioral therapy and 12-step approaches achieved equal results. Moreover, these researchers found that the results were the same for the different approaches whether the clients had a pure substance abuse diagnosis, a co-existing mental disorder, or were mandated to treatment! The only difference in terms of equivalence of outcomes between the treatment conditions was that those in the 12-step program were most likely to be abstinent a year after treatment than the CBT group.

As has been shown over and over again throughout the history of the field of psychotherapy, it would appear that the similarities rather than the differences between various treatment approaches are responsible for change in treatment. It would also strongly suggest that the current trend toward "designer" treatments--specific therapies for specific problems--is, at best, misguided, and at worst, motivated by factors other than empirical support. Given these results, one is left to wonder, as did researcher Kazdin (1986), "What makes it so difficult to admit that the absence of treatment differences reflects the true state of affairs" (p. 102)?

American Psychological Association. (February, 1997). Tailoring treatments for alcoholics is not the answer. APA Monitor, 6.

Ouimette, P.C., Finney, J.W., and Moos, R.H. (1997). Twelve-step and cognitive-behavioral treatment for substance abuse. Journal of Consulting and Clinical Psychology, 65(2), 230-240.

Recent Research on Drug Treatment

Is Methadone a must for treating the heroin user?
According to an NIH panel, methadone treatment in combination with psychosocial treatment, significantly enhance positive clinical outcomes. The panel members stress that treatment of cravings with methadone is a necessary precursor to successful psychosocial treatment. The panel also stresses that longer, more intensive treatments are not necessarily more effective than shorter treatments. For example, requiring five visits per week was no more effective than seeing clients only 2 times per week. In addition, rewarding clients for non-drug behavior with vouchers for food, housing, etc. significantly increased the chances that clients would continue in the treatment program.

Simpson, et al (1998). Psychology of Addictive Behaviors, 11(4).

At the same time, the Clinton administration ignored research findings and denied federal funds for needle-exchange programs which have been shown to decrease the spread of HIV by as much as 33% in some areas. These programs have also been shown to serve as a crucial bridge to treatment with as many as 60% of those in exchange programs joining a treatment program within six months.

USA Today (April 22, 1998). Sticking it to needles. 13A.

Being a "Good" Parents may make your child use drugs!
It true! Being a good parent may make your kid more likely to use drugs, drink alcohol, or smoke--that is, if you (the parent) use drugs, drink alcohol, or smoke. Researchers Andrews, Hops, and Duncan found that kids who have good relationships with their parents are more likely to use drugs if those parents use drugs themselves. In contrast, kids with poor relationships with their parents are less likely to emulated the parent's bad behavior. What does it all mean? If you don't want your child doing drugs, drinking, or smoking then you must: (a) continue to use yourself but make them dislike you; or (b) stop using and do whatever you can to promote a good relationship with your kids!

Andrews, J., Hops, H., & Duncan, S. Journal of Family Therapy. Reported in Family Therapy Networker, 22(2), 15.

D.A.R.E. to Work: The Failure of American Drug Prevention Programs
It would be nice if it worked--but it doesn't! In spite of broad public support for the harem-scarem approach to drug abuse prevention, two recent studies demonstrate that the school-wide program simply doesn't keep kids off drugs. However, parents, the schools, and even President Clinton like the program --a fact which virtually guarantees that it will continue to make up the anti-drug/drug prevention curriculum of most public schools. Sadly, other effective alternatives exist. In contrast to the DARE education and drug resistance approach, research suggests that psychosocial skills programs offer kids best chances of staying away from drugs. Such approaches teach kids the risk factors for drug abuse as well as practical skills for dealing with feelings of alienation and anxiety and improving self-esteem and assertiveness.

Murray, B. (September, 1997). Why aren't anti-drug programs working. APA Monitor, 28(9), 30.

Health Education and Behavior (1997), 24(2), 165-176.

American Journal of Public Health (1994), 84(9), 1394-1401.

Family Therapy the Treatment of Choice for Substance Abuse
Stanton (1997) conducted a meta-analysis of 15 controlled outcome studies examining various approaches for the treatment of both adolescent and adult substance use problems. The data, which assessed the outcome of over 1500 clients, found that family and/or couples therapy consistently resulted in significantly greater improvement than individual, peer group, or psycho-education! In addition, the couples and families therapy approaches required fewer sessions to attain improvement and had lower drop-out rates than the other approaches. Finally, treatment gains were generally maintained for the family and couples approaches at follow-up. Overall, the family and couples approaches resulted in significant cost savings for both the individuals being treated as well as social agencies when compared to the other modalities.

These results confirm calls by pioneering solution-focused practitioners Berg and Miller who in 1992 called for the abandonment of the traditional individually-oriented treatment paradigm and the inclusion of the non-abusing family members in the treatment process (see pg. 64 in their book).

Stanton, M.D. and Shadish, W.R. (1997). Outcome, attrition, and family-couples treatment for drug abuse: A meta-analysis and review of the controlled, comparative studies. Psychological Bulletin, 122, 170-191.

The Effects of Disability Benefits for Substance Abusers: The Jury is Out
Fearing that the money will be used for drugs or alcohol, public and much clinical opinion is dead set against the payment of disability benefits to people with substance use problems. Recent research suggests, however, that the relationship between such benefits and problematic use of substance is more complex than conventional wisdom may imply. For example, in a study of nearly 2500 homeless veterans, researchers Frisman and Rosenbeck (1997) found no significant association between the receipt of disability benefits and days of problematic use of substances--even among those frequent users. In another smaller study, however, researchers found that payment of disability benefits may affect compliance with substance abuse treatment programs. In yet another study, researchers found that paying cocaine users for negative urine tests resulted in a decrease in both the severity and frequency of problematic use. No information was presented in this study about the nature of cocaine use once payments were stopped. Taken together, the studies suggest that disability benefits are not likely to appreciably increase substance use but rather help them maintain a person's use of substances at their preferred pre-payment level.

Nicotine Affects Substance Abuse Recovery
Researcher Stuyt (1977) compared the recovery rates of smokers and nonsmokers following their participation in an inpatient substance abuse treatment program and found that nonsmokers had significantly better recovery rates and longer periods of sobriety than the smokers. Interestingly, those smokers who stopped using tobacco (nicotine) products also had longer periods of sobriety than those who continued to smoke.

Stuyt, E.B. (Spring, 1977). Recovery rates after treatment for alcohol.drug dependence. American Journal of Addiction, 6, 159-167.

Research Reviews on Smoking

"What Works" in Smoking Cessation
"Effective interventions for smoking are available and every patient who smokes should be offered treatment," concludes researchers Skaar et al (1997). Nearly half a million Americans die each year from smoking and yet little treatment is offered and clients are rarely confronted in psychotherapy about the dangerous effects of nicotine use. Much more time and effort is spent treating people for problems that, when combined, pale in comparison to the dangers of smoking (e.g., drugs, alcohol, HIV, etc.). Let's face it, smoking cessation is not dramatic or glamorous. Here are the facts:

	28 % of American men and 23% of women smoke.
	Approximately 70% of those who current smoke have a desire to quit.
	50% of those who have ever smoked have been able to stop.
	Success rates for any single attempt at cessation are extremely low.
	Cessation rates from a single attempt using assisted methods are generally much higher than unassisted attempts.

The characteristics of successful cessation:

	High number of clinical contacts (4-7 in person sessions are especially effective). Interventions that provide support as well as general problem-solving and skills-training are more effective.
	Interventions which include: general information on smoking and the quitting process, encouragement and reinforcement for continued attempts to quit, identification of high-risk situations, and practice of problem-solving and coping skills.
	Nicotine replacement therapy only when the smoker is prepared and likely to quit completely!

What does not matter:

The professional discipline or theoretical model of the healthcare professional.

Skaar, K.L., Tsoh, J.Y., McClure, J.B., Cincirpini, P.M., Friedman, K. Wetter,D.W., and Gritz, E.R. (1997). Smoking cessation: An overview of research. Behavioral Medicine, 23, 5-13.

Hospitalization for Smoking Cessation! Really but not exactly!
A particularly good time to help people stop smoking is when they have been hospitalized for some non-smoking related issue. In a study of over 300 smokers at the San Francisco Veteran's Hospital, researchers found that participants in an active smoking cessation program consisting of counseling, self-help, and nicotine replacement therapy were twice as likely to quit smoking as those in a control group consisting of a 10-minute counseling session conducted at discharge. At 12 month follow-up, 27% of the treatment group were abstinent as compared to 13% of the controls. Results were confirmed with serum and saliva nicotine levels.

Simon, J.A. et al. (June 23, 1997). Smoking cessation after surgery. Archives of Internal Medicine, 157:1371-6.