Concurrent alcohol and smoking use among American Indian and Alaska Native adults participating in a contingency management clinical trial for alcohol use disorder

Introduction The co-use of alcohol and cigarettes is common and associated with poor health outcomes. However, little is known about the prevalence of cigarette smoking among American Indian and Alaska Native (AI/AN) adults seeking treatment for alcohol use disorder (AUD), whether participation in AUD treatment is associated with changes in cigarette smoking or patterns of concurrent alcohol and cigarette use in this population. Methods This study reports a secondary analysis of concurrent alcohol and cigarette use among AI/AN participants in a randomized controlled trial of contingency management (CM) for AUD ( N = 158). Participants completed Timeline Followback assessments of daily cigarette use and alcohol consumption for the 30 days before baseline and throughout the 20-week study period. Generalized linear mixed models were used to evaluate changes in smoking over time and associations between alcohol use, accounting for study period, repeated measures, and recent use behaviors. Results Baseline assessments indicated a high prevalence of cigarette smoking (66.7%, n = 96/144). Across the study period, participants in both conditions demonstrated reductions in cigarette smoking, particularly during the post-baseline phase ( B = −0.54; p 0.01). No statistically significant differences in smoking outcomes were observed between the CM and control conditions. After controlling for recent use patterns, a significant positive association was observed between daily alcohol consumption and same-day cigarette smoking ( B = 0.12; p 0.01). Discussion Two-thirds of AI/AN adults with AUD in this sample also smoked cigarettes. Reductions in smoking were observed over time across both study conditions, including during the pre-randomization observation phase, suggesting that changes were not attributable to the CM intervention. Daily alcohol consumption and cigarette smoking were positively correlated, indicating concurrent substance use. Given these findings, smoking cessation interventions should be provided to AI/AN adults.