Integrating Tobacco Cessation Treatment into Mental Health Care for Patients with Posttraumatic Stress Disorder

Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, Seattle, Washington, United States
American Journal on Addictions (Impact Factor: 1.74). 09/2006; 15(5):336-44. DOI: 10.1080/10550490600859892
Source: PubMed


The integration of tobacco cessation treatment into mental health care for posttraumatic stress disorder (PTSD), known as Integrated Care (IC), was evaluated in an uncontrolled feasibility and effectiveness study. Veterans (N = 107) in PTSD treatment at two outpatient clinics received IC delivered by mental health practitioners. Outcomes were seven-day point prevalence abstinence measured at two, four, six, and nine months post-enrollment and repeated seven-day point prevalence abstinence (RPPA) obtained across three consecutive assessment intervals (four, six, and nine months). Abstinence rates at the four assessment intervals were 28%, 23%, 25%, and 18%, respectively, and RPPA was 15%. The number of IC sessions and a previous quit history greater than six months predicted RPPA. Stopping smoking was not associated with worsening PTSD or depression.

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    • "Several studies also have demonstrated the feasibility and effectiveness of treating tobacco dependence among samples of adult smokers with mental health issues without harm to their mental health recovery (Hall and Prochaska, 2009; Hall et al., 2006; McFall et al., 2006; Prochaska et al., 2008). Similar tobacco treatment outcome research with adolescent and young adult samples is needed. "
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    ABSTRACT: Young people with mental health concerns are at high-risk for initiation and continuation of tobacco use. To inform treatment needs, the current study sought to describe tobacco dependence, motivations to quit and associated sociodemographic factors among young people seen in mental health settings. Sixty adolescent and young adult smokers (age mean=19.5 years, range 13-25) receiving outpatient mental health treatment completed measures of tobacco dependence, motivation to quit smoking, mental health, and social environmental factors. Participants averaged 8.0 cigarettes per day (SD=6.6) and moderate nicotine dependence (mFTQ M=4.8, SD=1.6). Participants' mean rating (10-point scales) of perceived difficulty with avoiding relapse during a quit attempt was significantly higher (M=6.7, SD=2.6), than ratings of desire (M=5.1, SD=2.6) and perceived success (M=4.6, SD=2.6) with quitting. Over half (52%) did not intend to quit smoking in the next 6 months, and few (11%) were prepared to quit in the next 30 days. Mental health treatment and symptomatology measures were unrelated to level of dependence or motivation to quit. Among the social environmental factors, having close friends who smoke was associated with greater perceived difficulty with avoiding relapse during a quit attempt (r=0.25, p<0.01). In this sample of adolescent and young adult smokers in mental health treatment, moderate levels of tobacco dependence and motivation to quit were observed and found to be unrelated to mental health measures. Over half of the sample was not intending to quit smoking in the near future, supporting the need for treatment strategies aimed at increasing motivation.
    Drug and alcohol dependence 05/2012; 125(1-2):127-31. DOI:10.1016/j.drugalcdep.2012.04.005 · 3.42 Impact Factor
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    • "Addiction treatment settings are gaining success with banning smoking and effectively treating all substances of abuse, which includes tobacco (Bauman, 2008). People with mental illness can quit smoking and without detriment to their mental health recovery (Hall et al., 2006; McFall et al., 2006; Prochaska et al., 2008b). Failure to treat tobacco dependence in mental health and addiction treatment settings ignores clinical practice treatment guidelines and brings real liability risks (Torrijos and Glantz, 2006). "
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    ABSTRACT: In mental health and addiction treatment settings, failure to treat tobacco dependence has been rationalized by some as a clinical approach to harm reduction. That is, tobacco use is viewed as a less harmful alternative to alcohol or illicit drug use and/or other self-harm behaviors. This paper examines the impact of providers' failure to treat tobacco use on patients' alcohol and illicit drug use and associated high-risk behaviors. The weight of the evidence in the literature indicates: (1) tobacco use is a leading cause of death in patients with psychiatric illness or addictive disorders; (2) tobacco use is associated with worsened substance abuse treatment outcomes, whereas treatment of tobacco dependence supports long-term sobriety; (3) tobacco use is associated with increased (not decreased) depressive symptoms and suicidal risk behavior; (4) tobacco use adversely impacts psychiatric treatment; (5) tobacco use is a lethal and ineffective long-term coping strategy for managing stress, and (6) treatment of tobacco use does not harm mental health recovery. Failure to treat tobacco dependence in mental health and addiction treatment settings is not consistent with a harm reduction model. In contrast, emerging evidence indicates treatment of tobacco dependence may even improve addiction treatment and mental health outcomes. Providers in mental health and addiction treatment settings have an ethical duty to intervene on patients' tobacco use and provide available evidence-based treatments.
    Drug and alcohol dependence 04/2010; 110(3):177-82. DOI:10.1016/j.drugalcdep.2010.03.002 · 3.42 Impact Factor
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    • "Follow-up analyses of 10 psychiatric indicators, including depression symptoms, suicidality, psychiatric hospitalization, and use of alcohol and illicit drugs, found no detriment to mental health recovery among individuals who quit smoking as compared to continued smokers (Prochaska et al., 2008). In a trial with smokers in treatment for posttraumatic stress disorder (PTSD), participants assigned to integrated care were five times more likely than participants undergoing usual care to be abstinent from smoking at 9 months followup (McFall et al., 2006). Critically, treatment for tobacco dependence was not associated with worsening PTSD symptoms. "

    Journal of the American Psychiatric Nurses Association 12/2009; 15(6):404-9. DOI:10.1177/1078390309355318 · 0.98 Impact Factor
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