Identification and Treatment of Patients with Nicotine Problems in Routine Clinical Psychiatry Practice

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
American Journal on Addictions (Impact Factor: 1.74). 02/2010; 14(5):441-54. DOI: 10.1080/10550490500247123
Source: PubMed


The aim of this study is to assess the rates of nicotine problems diagnosed by psychiatrists, the characteristics of psychiatric patients who smoke, and the services provided to them in routine psychiatric practice. Data were obtained by asking psychiatrists participating in the American Psychiatric Institute for Psychiatric Research and Education's Practice Research Network to complete a self-administered questionnaire to provide detailed sociodemographic, clinical, and health plan information on three of their patients seen during routine clinical practice. A total of 615 psychiatrists provided information on 1,843 patients, of which 280 (16.6%) were reported to have a current nicotine problem. Of these, 9.1% were reported to receive treatment for nicotine dependence. Patients with nicotine problems were significantly more likely to be males, divorced or separated, disabled, and uninsured, and have fewer years of education. They also had significantly more co-morbid psychiatric disorders, particularly schizophrenia or alcohol/substance use disorders; a lower Global Assessment Functioning score; and poorer treatment compliance than their counterparts. The results suggest a very low rate of identification and treatment of nicotine problems among patients treated by psychiatrists, even though psychiatric patients who smoke seem to have more clinical and psychosocial stressors and more severe psychiatric problems than those who do not smoke. Programs should be developed to raise the awareness and ability of psychiatrists to diagnose and treat patients with nicotine problems, with a particular emphasis on the increased medical and psychosocial needs of psychiatric patients who smoke.

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    • "Moreover, compared to other physicians, psychiatrists were among the least familiar with state funded tobacco treatment resources, thus leading to reduced utilization among mentally ill smokers (Steinberg et al. 2006). Despite over 10 year old recommendations for psychiatrists to treat tobacco in all their patients (APA 1996), most still do not (Peterson et al. 2003; Montoya et al. 2005; Himelhoch and Daumit 2003). Training the next generation of providers, and those professionals currently in practice is needed. "
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    ABSTRACT: Despite the high prevalence of tobacco use, disproportionate tobacco consumption, and excess morbidity and mortality, smokers with mental illness have reduced access to tobacco dependence treatment across the health care spectrum. We have developed a comprehensive model for Mental Health Tobacco Recovery in New Jersey (MHTR-NJ) that has the overarching goal of improving tobacco cessation for smokers with serious mental illness. Important steps involve engaging patients, professionals and the community to increase understanding that addressing tobacco use is important. In addition to increasing demand for tobacco treatment services, we must educate mental health professionals in evidence-based treatments so that patients can seek help in their usual behavioral health care setting. Peer services that offer hope and support to smokers are essential. Each of the policy or cessation initiatives described address the two core goals of this model: to increase demand for tobacco cessation services for mentally ill smokers and to help more smokers with mental illness to quit. Each has been pilot tested for feasibility and/or effectiveness and revised with feedback from stakeholders. In this way this implementation model has brought together academics, clinicians, administrators and mental health consumers to develop tobacco programming and policy that has been tested in a real world environment and serves as a model for other states.
    Administration and Policy in Mental Health and Mental Health Services Research 11/2010; 38(5):368-83. DOI:10.1007/s10488-010-0324-x · 3.44 Impact Factor
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    • "In inpatient psychiatry, cigarettes were provided to patients, considered among the most effective forms of reinforcement, with some patients first starting to smoke while hospitalized (Hayworth, 1996; Holtzman, 1975; Robertson, 2000). Still to this day, most mental health training programs lack adequate instruction in treating tobacco dependence (American Psychiatric Nurses Association, 2008; Prochaska et al., 2006), and, likely related, psychiatric patients' tobacco dependence is rarely addressed in clinical practice (Himelhoch et al., 2004; Montoya et al., 2005; Phillips and Brandon, 2004; Prochaska et al., 2005). In a recent national survey, psychiatrists were the least likely to address tobacco use with their patients relative to other medical specialties (Association of American Medical Colleges, 2007). "
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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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    • "Furthermore, tobacco dependence treatment in such populations has not been addressed in labeling of currently approved pharmacotherapeutics (e.g., Asher et al., 2003; Ziedonis, 2007). Nonetheless, progress has been made in advancing treatment of tobacco dependence and withdrawal in psychiatric populations (e.g., American Psychiatric Association, 1994; Ziedonis et al., 1994; Ziedonis & Williams, 2003; Lemon et al., 2003; Williams & Ziedonis, 2004; Montoya et al., 2005; Hughes & Kalman, 2006). One possible impediment to the use of some medications in psychiatric populations are early indications that two medications, varenicline and bupropion, may themselves promote the psychiatric symptoms of suicidal ideation (Food and Drug Administration, 2009). "
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    ABSTRACT: Several pharmacotherapies for tobacco dependence and withdrawal have been approved by the Food and Drug Administration to aid smoking cessation. These medicines double to triple the odds of cessation compared to placebo, with the diversity in chemical entity (e.g., nicotine, varenicline, bupropion) and route (e.g., nicotine gum and transdermal patch) providing options for people who find a given medication unacceptable or ineffective. Treatments in development include vaccines, combinations of existing products, and new indications, such as reduced tobacco use and exposure. These therapies have been developed on the foundation of research on the neuropharmacology of tobacco dependence and withdrawal. Ongoing research is expected to contribute to more efficacious use of existing therapies and the development of new approaches. This article addresses these developments as well as the challenges to medication development. Challenges include understanding the population-based and individual differences in the vulnerability to dependence and responsiveness to various treatment options, which could contribute to effective treatment to patient matching. Research on the CNS effects of administration and withdrawal of nicotine and other tobacco product constituents is expanding, providing the basis for more effective therapeutic approaches and new medications development. Additionally, whereas medications are approved on the basis of standardized assessments of efficacy and safety in clinical trials, the public health impact of medications depends also on their appeal to smokers and their effectiveness in actual use settings. Research on more effective medication use along with policies that support improved access and utilization are vital to conquering the tobacco epidemic.
    Pharmacology [?] Therapeutics 05/2009; 123(1):1-16. DOI:10.1016/j.pharmthera.2009.03.011 · 9.72 Impact Factor
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