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Treatment of Tobacco Dependence in Mental Health and Addictive Disorders (PDF) 

Conclusions and Recommendations

Our review highlights the advances during the last decade in the treatment of TD in people with MHA disorders. Much progress has been achieved. Treatment combining intensive CBT and multiple pharmacotherapy has shown the greatest efficacy. Among the many studies measuring changes in psy- chiatric symptoms during smoking treatment, most show improvements. Increasing the efficacy of these interventions may be achieved through extending the duration of treat- ment, providing them in the context of mental health care,60 and promoting reduction as an acceptable initial treatment goal. MET and CM as adjunctive interventions to increase readiness to quit, treatment usage, and smoking abstinence (or reduction) should also be evaluated in future studies, and CBT should be used as a part of relapse-prevention therapy. Experimental therapies, such as selegiline and nicotine vac- cine, among others, have yet to be tested in MHA smokers.95 An evidence-based algorithm for the general approach to smoking cessation in people with MHA disorders is displayed in Figure 1.

Additional recommendations include creating and establishing programs to raise the awareness and ability of mental health care professionals to identify and treat people with TD. . . .

With the exception of obsessive–compulsive disorder, all of the major MHA disorders are associated with a significantly higher prevalence of smoking than that found among the gen- eral US population.9 To date, there has been only one treat- ment study of smokers with BD, and none have targeted smokers with panic disorder. The evidence suggests that many of the patients with these disorders may be able to reduce their smoking or achieve abstinence if provided with treatment. Future research is needed for these MHA subgroups.

Lastly, there is a critical need for research aimed at identify- ing smoker characteristics that predict positive smoking ces- sation treatment outcomes (usage, reduction, and [or] abstinence) among smokers with MHA. For example, some studies have found that atypical antipsychotic medication is associated with short-term abstinence in treatment combin- ing MET and NRT or bupropion.6,49 To the extent that people with schizophrenia smoke to help alleviate pathophysiologic aspects of their condition, such as prefrontal cortical and information processing deficits, pharmacological treatments targeting these processes may lead to improved cessation out- comes.9,31 A similar approach is needed in treatment studies of smokers with other MHA diagnoses.

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