Grant: Operating Grant: CCS/CIHR Action Grants

Need for project First-line pharmacotherapies for nicotine dependence yield short-term smoking cessation efficacy but relapse remains high. This is further complicated by the fact that relapse is higher among those with concurrent alcohol use disorder. People who consume tobacco and alcohol have a greater risk of developing certain cancers than those consuming only one substance; therefore, it is important to explore smoking cessation strategies in individuals who may also have concurrent Alcohol Use Disorder. Goal of project To evaluate the tolerability and effectiveness of cytisine as an alternative smoking cessation treatment in individuals who also have co-occuring alcohol use disorder. Our hypothesis is that a treatment of cytisine at recommended dosage will improve smoking outcomes, including continuous abstinence, during the duration of the study and at post-treatment follow up. A secondary hypothesis is that cytisine will also improve drinking outcomes during the study duration and at follow up. Project description In a double-blind randomized controlled trial, participants (40 adult smokers with AUD) will be randomized to a placebo (n=20) or cytisine group (n=20). For 14 weeks, participants will take study medication and attend weekly onsite or telephone visits to assess tolerability and smoking (also to be assesed at weeks 18 and 26 follow-up). The main outcomes will be tolerability associated with cytisine and continuous smoking abstinence. Percentage of heavy drinking days will be a secondary outcome. Future impact Risk of unsuccessful quit attempts and smoking relapse is high among individuals who are moderate to heavy drinkers. Evidence also shows that people who smoke are more likely to drink alcohol than are non-smokers, and heavy smokers tend to also consume large amounts of alcohol. Considering side effects for first-line smoking cessation treatments (e.g. varenicline) impact compliance and a similar finding has been shown for common AUD medications (e.g. oral naltrexone), the results of this study are expected to address a need to identify effective smoking-cessation strategies in a population with co-occuring alcohol use disorder.