The Effect of Varenicline on Smoking and Drinking Outcomes among Black and White Adults with Alcohol Use Disorder and Co-Occurring Cigarette Smoking: A Secondary Analysis of Two Clinical Trials

Abstract Introduction Varenicline is an FDA–approved medication for smoking cessation and has demonstrated promise in reducing alcohol use. This study sought to compare the efficacy of varenicline in reducing smoking and drinking among Black and White people seeking alcohol treatment. Methods Linear mixed modeling was conducted using data from two multi-site placebo-controlled randomized clinical trials examining the effects of varenicline for treatment of Alcohol Use Disorder (AUD; O’Malley et al., 2018 , Litten et al., 2013 ) among Black and White adults with AUD and co-occurring cigarette smoking. The primary analyses were conducted in a sample of 117 adults (O’Malley trial: 29.1% female, 55.2% Black), and replicated in an independent sample of 73 adults (Litten trial: 23.3% female, 45.2% Black). Results Black participants smoked fewer cigarettes per day compared to White participants (O’Malley trial: F1,116 = 8.95, p = .003; Litten trial: F1,68.9 = 4.74 p = .03). Linear mixed models revealed a marginal effect of varenicline on reducing cigarettes smoked per day regardless of race in the O’Malley trial (F1,109 = 3.34, p = .07), which was replicated in the Litten trial (F1,67.1 = 20.77 p Conclusions Our adjusted model findings suggest varenicline reduced smoking among Black and White people with AUD and co-occurring cigarette smoking. However, these findings should be replicated in a larger sample.