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Tobacco Dependence

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In this chapter, the most recent literature on cognitive behavioral therapy interventions for the treatment of tobacco dependence is reviewed. Evidence was compiled primarily from meta-analyses, Cochrane Reviews, and recent qualitative review papers focused on the efficacy of various cognitive behavioral therapy approaches for achieving tobacco abstinence. Emphasis is given to the literature pertaining to general cognitive behavioral therapy approaches for smoking cessation as well as newer extensions of cognitive behavioral therapy including mindfulness-based approaches and relapse prevention. The evidence in this review indicates that cognitive behavioral therapy-based interventions are effective at increasing rates of tobacco abstinence in the general population, in special populations, and in individuals with comorbid psychological disorders such as depression. Recent studies examining extensions of cognitive behavioral therapy such as mindfulness-based urge surfing interventions and relapse prevention models suggest that these techniques may also hold promise for increasing the likelihood of a successful quit attempt. Finally, a growing body of evidence indicates that pairing certain types of pharmacotherapy for smoking cessation with cognitive behavioral therapy may be more efficacious than pharmacotherapy alone. Overall, the clinical literature on smoking cessation indicates that cognitive behavioral therapy-based interventions are an effective therapeutic option in the treatment of tobacco dependence.
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This review summarizes the current meta-analysis literature on treatment outcomes of CBT for a wide range of psychiatric disorders. A search of the literature resulted in a total of 16 methodologically rigorous meta-analyses. Our review focuses on effect sizes that contrast outcomes for CBT with outcomes for various control groups for each disorder, which provides an overview of the effectiveness of cognitive therapy as quantified by meta-analysis. Large effect sizes were found for CBT for unipolar depression, generalized anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders. Effect sizes for CBT of marital distress, anger, childhood somatic disorders, and chronic pain were in the moderate range. CBT was somewhat superior to antidepressants in the treatment of adult depression. CBT was equally effective as behavior therapy in the treatment of adult depression and obsessive-compulsive disorder. Large uncontrolled effect sizes were found for bulimia nervosa and schizophrenia. The 16 meta-analyses we reviewed support the efficacy of CBT for many disorders. While limitations of the meta-analytic approach need to be considered in interpreting the results of this review, our findings are consistent with other review methodologies that also provide support for the efficacy CBT.
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There is no doubt that smoking is damaging global health on an unprecedented scale. However, there is continuing debate on the economics of tobacco control, including the costs and consequences of tobacco control policies. This book aims to fill the analytic gap around this debate This book brings together a set of critical reviews of the current status of knowledge on tobacco control. While the focus is on the needs of low-income and middle- income countries, the analyses are relevant globally. The book examines tobacco use and its consequences including new analyses of welfare issues in tobacco consumption, poverty and tobacco, and the rationale for government involvement. It provides an evidence-based review of policies to reduce demand including taxation, information, and regulation. It critically reviews supply-side issues such as trade and industry and farming issues, including new analyses on smuggling. It also discusses the impact of tobacco control programs on economies, including issues such as employment, tax revenue and welfare losses. It provides new evidence on the effectiveness and cost-effectiveness of control interventions. Finally, it outlines broad areas for national and international action, including future research directions. A statistical annex will contain information on where the reader can find data on tobacco consumption, prices, trade, employment and other items. The book is directed at academic economists and epidemiologists as well as technical staff within governments and international agencies. Students of economics, epidemiology and public policy will find this an excellent comprehensive introduction to economics of tobacco control.