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Hitsman B, Papandonatos GD, Gollan JK, Huffman MD, Niaura R, Mohr DC, Veluz-Wilkins AK, Lubitz SF, Hole A, Leone FT, Khan SS, Fox EN, Bauer AM, Wileyto EP, Bastian J, Schnoll RA. Efficacy and safety of combination behavioral activation for smoking cessation and varenicline for treating tobacco dependence among individuals with current or past major depressive disorder: A 2 × 2 factorial, randomized, placebo-controlled trial. Addiction 2023; 118:1710-1725. [PMID: 37069490 DOI: 10.1111/add.16209] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/28/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND AND AIMS Treatment of depression-related psychological factors related to smoking behavior may improve rates of cessation among adults with major depressive disorder (MDD). This study measured the efficacy and safety of 12 weeks of behavioral activation for smoking cessation (BASC), varenicline and their combination. DESIGN, SETTING, PARTICIPANTS This study used a randomized, placebo-controlled, 2 × 2 factorial design comparing BASC versus standard behavioral treatment (ST) and varenicline versus placebo, taking place in research clinics at two urban universities in the United States. Participants comprised 300 hundred adult smokers with current or past MDD. INTERVENTIONS BASC integrated behavioral activation therapy and ST to increase engagement in rewarding activities by reducing avoidance, withdrawal and inactivity associated with depression. ST was based on the 2008 PHS Clinical Practice Guideline. Both treatments consisted of eight 45-min sessions delivered between weeks 1 and 12. Varenicline and placebo were administered for 12 weeks between weeks 2 and 14. MEASUREMENTS Primary outcomes were bioverified intent-to-treat (ITT) 7-day point-prevalence abstinence at 27 weeks and adverse events (AEs). FINDINGS No significant interaction was detected between behavioral treatment and pharmacotherapy at 27 weeks (χ2 (1) = 0.19, P = 0.67). BASC and ST did not differ (χ2 (1) = 0.43, P = 0.51). Significant differences in ITT abstinence rates (χ2 (1) = 4.84, P = 0.03) emerged among pharmacotherapy arms (16.2% for varenicline, 7.5% for placebo), with results favoring varenicline over placebo (rate ratio = 2.16, 95% confidence interval = 1.08, 4.30). All significant differences in AE rates after start of medication were higher for placebo than varenicline. CONCLUSION A randomized trial in smokers with major depressive disorder found that varenicline improved smoking abstinence versus placebo at 27 weeks without elevating rates of adverse events. Behavioral activation for smoking cessation did not outperform standard behavioral treatment, with or without adjunctive varenicline therapy.
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Affiliation(s)
- Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States
| | - George D Papandonatos
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island, United States
| | - Jacqueline K Gollan
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States
- Asher Center for the Study and Treatment of Depressive Disorders, Chicago, Illinois, United States
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States
- Cardiovascular Program, The George Institute for Global Health, University of South Wales, Newtown, New South Wales, Australia
| | - Raymond Niaura
- Department of Epidemiology, School of Global Public Health, New York University, New York, New York, United States
| | - David C Mohr
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, United States
| | - Anna K Veluz-Wilkins
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Su Fen Lubitz
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Anita Hole
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Frank T Leone
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, United States
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Erica N Fox
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Anna-Marika Bauer
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - E Paul Wileyto
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Joseph Bastian
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Robert A Schnoll
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
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Baliunas D, Gartner C, Hollingworth SA, Sullivan C, Comans T, Pole JD. Publicly subsidised smoking cessation medicines in times of COVID-19 in Australia: An interrupted time series analysis. Drug Alcohol Rev 2023; 42:225-232. [PMID: 36173196 PMCID: PMC10087959 DOI: 10.1111/dar.13557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 08/31/2022] [Accepted: 09/12/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION In Australia, the available published literature demonstrated a spike in dispensed prescription medicines after the onset of the COVID-19 pandemic that subsequently returned to expected levels. Smoking cessation medicines may not follow this pattern because quit attempts are influenced by a range of factors. Knowledge of whether dispensing of these medicines has changed since the pandemic is lacking. We explored the change in dispensing of publicly subsidised smoking cessation medicines since the pandemic. METHODS Australia's universal health-care system provides access to government-subsidised medicines via the Pharmaceutical Benefits Scheme and records of dispensed medicines are publicly available on a nationally aggregated level. We retrieved Pharmaceutical Benefits Scheme data from January 2016 to January 2021. We used interrupted time series modelling to quantify the impact of COVID-19 on dispensing of nicotine replacement therapy (NRT) patches, varenicline and all smoking cessation treatments combined separately. RESULTS After an initial spike in medicines at the onset of the pandemic, the monthly rate of prescriptions dispensed for varenicline was predominantly within predicted ranges, while that of NRT patches was predominantly below predicted ranges. DISCUSSION AND CONCLUSIONS There has been a differential change in the number of subsidised smoking cessation medicines supplied in Australia since the COVID-19 pandemic, with varenicline prescriptions largely within, and NRT patches largely lower than, expected ranges. The reasons for the apparent change in dispensing of subsidised smoking cessation medicines are unclear.
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Affiliation(s)
- Dolly Baliunas
- School of Public Health, The University of Queensland, Brisbane, Australia.,Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - Coral Gartner
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Clair Sullivan
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.,Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Jason D Pole
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada.,Centre for Health Services Research, The University of Queensland, Brisbane, Australia
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Fan T, Yingst JM, Bascom R, Tuanquin L, Veldheer S, Branstetter S, Foulds J, Muscat JE. Feasibility of Patient Navigation-Based Smoking Cessation Program in Cancer Patients. Int J Environ Res Public Health 2022; 19:4034. [PMID: 35409717 DOI: 10.3390/ijerph19074034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/26/2022] [Indexed: 12/04/2022]
Abstract
Continued smoking after a cancer diagnosis is causally associated with increased risks of all-cause and cancer-specific mortality, and of smoking-related second primary cancers. Patient navigation provides individualized assistance to address barriers to smoking cessation treatment and represents a promising bridge to smoking cessation in persons with cancer who smoke cigarettes. We conducted a single-arm interventional cohort study of current smokers identified through prospective health record screening and recruited from Penn State Cancer Institute outpatient clinics. Consented participants received two telephone intervention sessions and gain-framed messaging-based smoking cessation educational materials designed for persons with cancer. The primary study outcome was the feasibility of the patient navigation-based intervention; the secondary outcome was the engagement in smoking cessation treatment at the two-month follow-up. Of 1168 unique screened Cancer Institute patients, 134 (11.5%) were identified as current cigarette smokers. Among 67 patients approached at outpatient clinics, 24 (35.8%) were interested in participating, 12 (17.9%) were enrolled, eight (11.9%) completed the intervention sessions and study assessments, and six engaged in smoking cessation treatment. The participants expressed satisfaction with the intervention sessions (median = 8.5, scale 0–10). The low recruitment rates preclude patient navigation as a feasible method for connecting cancer patients to smoking cessation treatment resources.
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Li M, Okamoto R. Gender differences and smoking cessation in the Japanese smoking cessation treatment program. Tob Induc Dis 2020; 18:95. [PMID: 33223985 PMCID: PMC7676305 DOI: 10.18332/tid/128497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/14/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Meng Li
- Division of Health Sciences, Graduate School of Medicine, Japan
| | - Reiko Okamoto
- Division of Health Sciences, Graduate School of Medicine, Japan
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Ramsey AT, Baker TB, Pham G, Stoneking F, Smock N, Colditz GA, James AS, Liu J, Bierut LJ, Chen LS. Low Burden Strategies Are Needed to Reduce Smoking in Rural Healthcare Settings: A Lesson from Cancer Clinics. Int J Environ Res Public Health 2020; 17:E1728. [PMID: 32155775 PMCID: PMC7084618 DOI: 10.3390/ijerph17051728] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/26/2022]
Abstract
Rural populations face significant smoking-related health disparities, such as a higher prevalence of lung cancer and cancer mortality, higher prevalence of smoking, and lower likelihood of receiving cessation treatment than urban counterparts. A significant proportion of health disparities in rural populations could be eliminated with low-barrier, easy-access treatment delivery methods for smoking cessation. In this study, we assessed treatment engagement among patients in rural and urban settings. Then, we examined the effect of an electronic health record-based smoking cessation module on patient receipt of evidence-based cessation care. As part of a quality improvement project, we retrospectively observed 479,798 unique patients accounting for 1,426,089 outpatient clinical encounters from June 2018-March 2019 across 766 clinics in the greater St. Louis, southern Illinois, and mid-Missouri regions. Smoking prevalence was higher in rural versus urban clinics (20.7% vs. 13.9%, 6.7% [6.3, 7.1], odds ratio = 1.6 [1.6, 1.6], p < 0.0001), and yet rural smokers were nearly three times less likely than their urban counterparts to receive any smoking cessation treatment after adjusting for patients clustering within clinics (9.6% vs. 25.8%, -16.2% [-16.9, -15.5], odds ratio = 0.304 [0.28, 0.33], p < 0.0001). Although not yet scaled up in the rural setting, we examined the effects of a low-burden, point-of-care smoking module currently implemented in cancer clinics. After adjusting for patient clustering within clinics, patients were more likely to receive smoking treatment in clinics that implemented the module versus clinics that did not implement the module (31.2% vs. 17.5%, 13.7% [10.8, 16.6], odds ratio = 2.1 [1.8, 2.6], p < 0.0001). The point-of-care treatment approach offers a promising solution for rural settings, both in and outside the context of cancer care.
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Affiliation(s)
- Alex T. Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
| | - Timothy B. Baker
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA;
| | - Giang Pham
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
| | - Faith Stoneking
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
| | - Nina Smock
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
| | - Graham A. Colditz
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Aimee S. James
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jingxia Liu
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Laura J. Bierut
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
| | - Li-Shiun Chen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.P.); (F.S.); (N.S.); (L.J.B.); (L.-S.C.)
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA; (G.A.C.); (A.S.J.); (J.L.)
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Owens MM, MacKillop J, Gray JC, Beach SR, Stein MD, Niaura RS, Sweet LH. Neural correlates of tobacco cue reactivity predict duration to lapse and continuous abstinence in smoking cessation treatment. Addict Biol 2018; 23:1189-1199. [PMID: 28877410 DOI: 10.1111/adb.12549] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/15/2017] [Accepted: 07/25/2017] [Indexed: 11/30/2022]
Abstract
It has been hypothesized that neural reactivity to drug cues in certain limbic/paralimbic regions of the brain is an indicator of addiction severity and a marker for likelihood of success in treatment. To address this question, in the current study, 32 participants (44 percent female) completed a functional magnetic resonance imaging cigarette cue exposure paradigm 2 hours after smoking, and then enrolled in a 9-week smoking cessation treatment program. Neural activation to smoking cues was measured in five a priori defined limbic/paralimbic regions previously implicated with cue reactivity across substances. These included regions of the ventral striatum, anterior cingulate cortex and amygdala. Cox proportional hazard modeling was conducted to predict the number of days to first smoking lapse by using neural activation in these regions. Greater neural activation during pre-treatment exposure to smoking cues in the right ventral striatum, the left amygdala, and the anterior cingulate was associated with longer periods of abstinence following cessation. A similar pattern was present for continuous abstinence for the full duration of treatment. While baseline levels of nicotine dependence were strongly associated with treatment outcome, activation in the right ventral striatum predicted duration of abstinence beyond level of nicotine dependence. These results suggest that pre-treatment reactivity to smoking cues in areas associated with cue reactivity may be associated with successfully maintaining abstinence during treatment. This is consistent with models that propose that as addiction becomes more severe, motivational processing shifts from regions that subserve reward salience and learning to regions responsible motor behavior and habit learning.
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Affiliation(s)
| | - James MacKillop
- The University of Georgia; Athens GA USA
- Peter Boris Centre for Addictions Research; McMaster University/St Joseph's Healthcare Hamilton; Hamilton ON Canada
- Brown University; Providence RI USA
| | - Joshua C. Gray
- The University of Georgia; Athens GA USA
- Brown University; Providence RI USA
| | | | | | | | - Lawrence H. Sweet
- The University of Georgia; Athens GA USA
- Brown University; Providence RI USA
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Nordin ASA, Kadir RA, Yahya NA, Zakaria H, Rashid RA, Habil MH. Empowering Malaysian dentists to tobacco dependence treatment conduct. Int Dent J 2014; 64:206-12. [PMID: 24835463 DOI: 10.1111/idj.12110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
As a signatory to the World Health Organisation 2003 Framework Convention on Tobacco Control, Malaysia has policies in place and funded 300 public Quit clinics. Unfortunately, government dentists are not included to run tobacco dependence treatment. A cross-sectional exploratory survey was carried out to seek Malaysian dentists' opinion on their knowledge, perception and willingness to conduct tobacco dependence treatment. Participation was voluntary from those who attended a specially designed one-day, four-module workshop on tobacco cessation intervention. Data were collected using the Audience-Response-System equipment which tracked immediate responses covering four domains namely: smoking as a public health problem, smoking as an addiction, the role of dentists in the programme and confidence in conducting smoking cessation in the clinic. Sample comprised more female dentists (73.5%), mean age 33.6 (SD 8.99) years and with more than 3 years working experience. Findings indicated that the majority agreed Malaysia has a rising problem in the prevalence of smoking (71.6%) and predicted that it will affect mostly the young (81.9%). Only half of the dentists surveyed (58.9%) routinely recorded their patients' smoking habits. The majority (71.6%) believed that dentists are effective in helping their patient to stop smoking and 76.3% agreed that dentists should discuss the smoking habit with their patients; however, 60% agreed that doing so is too time consuming. In addition, only 24.7% knew of more ways to treat a smoking habit. The majority felt comfortable giving advice to patients about changing their habits (76.5%) or discussing treatment options (60.5%): 75% would opt for a combined programme of counselling and use of medication if they have to do, 15% would choose to go on counselling only, while 8% did not want to treat. In conclusion, the findings suggest that dentists have a strong potential to contribute significantly to providing smoking cessation treatment if adequately trained.
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Affiliation(s)
- Amer Siddiq Amer Nordin
- University Malaya Centre of Addiction Sciences (UMCAS), Kuala Lumpur, Malaysia; National Addiction Centre, University of Otago Christchurch, Christchurch, New Zealand
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Metrik J, Spillane NS, Leventhal AM, Kahler CW. Marijuana use and tobacco smoking cessation among heavy alcohol drinkers. Drug Alcohol Depend 2011; 119:194-200. [PMID: 21724341 DOI: 10.1016/j.drugalcdep.2011.06.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2011] [Revised: 06/03/2011] [Accepted: 06/07/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Whereas problem drinking impedes smoking cessation, less is known whether marijuana use affects smoking cessation outcomes and whether smoking cessation treatment leads to changes in marijuana smoking. METHODS In a randomized clinical trial that recruited 236 heavy drinkers seeking smoking cessation treatment, we examined whether current marijuana smokers (n=57) differed from the rest of the sample in tobacco smoking and alcohol use outcomes and whether the patterns of marijuana use changed during treatment. RESULTS Half of the marijuana users reported smoking marijuana at least weekly (an average of 42% of possible smoking days), the other half used infrequently, an average of 5% of possible days. There were no significant differences between the marijuana use groups and non-users on smoking outcomes and marijuana use did not predict smoking lapses. All participants made large reductions in weekly alcohol consumption during the trial, with weekly marijuana users reducing their drinking by 47% and at a faster rate than non-marijuana users after the 8-week follow-up. Weekly marijuana smokers also steadily decreased their marijuana use over the course of the study (at 8-, 16-, and 26-week follow-ups) by more than 24%. CONCLUSIONS These data suggest that frequent marijuana smokers may benefit from smoking cessation interventions, even when marijuana use is not explicitly discussed. These individuals do not show any more difficulty than other cigarette smokers in making efforts to reduce tobacco smoking and in fact, make meaningful changes in marijuana use and heavy drinking. Future clinical trials should examine whether smoking cessation treatment that addresses both marijuana and tobacco smoking leads to substantial reductions in marijuana use.
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Ait-Daoud N, Lynch WJ, Penberthy JK, Breland AB, Marzani-Nissen GR, Johnson BA. Treating smoking dependence in depressed alcoholics. Alcohol Res Health 2006; 29:213-20. [PMID: 17373412 PMCID: PMC6527046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Alcoholism and nicotine dependence share many neurobiological underpinnings; the presence of one drug can cause a person to crave the other. Depressive illness can complicate comorbid alcohol and nicotine dependence by exacerbating the negative affect encountered during attempts to abstain from one or both drugs. Given the morbidity and mortality associated with cigarette smoking, it is imperative to identify treatments to promote smoking cessation and address comorbid psychiatric conditions contemporaneously. Pharmacotherapeutic options demonstrating varying degrees of efficacy and promise in preclinical and clinical studies include nicotine replacement therapy (NRT), selective serotonin reuptake inhibitors (SSRIs), bupropion, varenicline, tricyclic antidepressants, and bupropion plus NRT. Topiramate has shown potential for promoting smoking cessation in alcoholics, although its safety in depressed patients has not been fully explored. The efficacy of medications for treating nicotine dependence is generally enhanced by the inclusion of behavioral interventions such as cognitive behavioral therapy. When group cohesion and social support are stressed, success rates increase among depressed smokers undergoing smoking cessation treatment. Additional treatment strategies targeting dually dependent individuals with comorbid psychiatric disorders, including special populations such as women and adolescents, await further investigation.
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Affiliation(s)
- Nassima Ait-Daoud
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
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Kodl M, Fu SS, Joseph AM. Tobacco cessation treatment for alcohol-dependent smokers: when is the best time? Alcohol Res Health 2006; 29:203-7. [PMID: 17373410 PMCID: PMC6527038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cigarette smoking is highly prevalent among people with alcohol use disorders. Although several studies have demonstrated the feasibility of treating nicotine dependence in people with substance use disorders, researchers and clinicians continue to debate whether nicotine dependence treatment should be delivered simultaneously with or subsequent to alcohol treatment. Evidence suggests that alcohol-dependent individuals prefer sequential treatment and that simultaneous treatment can negatively impact alcohol use outcomes, although the literature is not conclusive. This review includes recommendations of considerations for treatment timing decisions and future research directions.
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Affiliation(s)
- Molly Kodl
- The Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minnesota, USA
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Myers MG, Kelly JF. Cigarette smoking among adolescents with alcohol and other drug use problems. Alcohol Res Health 2006; 29:221-7. [PMID: 17373413 PMCID: PMC1931414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cigarette and alcohol use often develop concurrently, and smoking is especially common among youth treated for alcohol and other drug (AOD) use disorders. Special considerations for adolescent smoking cessation treatment include peer influences, motivation, and nicotine dependence. Little research has addressed smoking cessation treatment for youth with AOD use disorders, but the few available studies suggest that tobacco cessation efforts are feasible and potentially effective for this population. Findings to date suggest that adolescents with AOD use disorders may benefit more from relatively intensive multicomponent programs rather than brief treatment for smoking cessation. Additional research is needed to further address the inclusion of tobacco-specific interventions for adolescents in AOD use disorder treatment programs.
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Affiliation(s)
- Mark G Myers
- University of California, San Diego, California, USA
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