How to treat nicotine dependence in smokers with schizophrenia
Improve patients’ health, help them kick addiction with this practical approach.
9 Discuss rewards patients can give themselves instead of cigarettes. This concept will be new to many but is important to help patients depend less on cigarettes for gratification.
10 Call patients on their quit date or the day after to make sure they are on track.
Table 3
CBT tools to help schizophrenia patients quit smoking
| Create ‘reasons to quit’ card |
| Provide ‘4Ds’ card of ‘coping skills when I crave a cigarette’ (deep breathe, drink fluids, delay (smoking), do something else) |
| Evaluate and practice problem-solving skills around ‘triggers and risky situations’ |
| Encourage patient to develop a ‘5 things I will do when I feel like smoking’ card |
| Develop a detailed ‘quit day’ plan |
| Role-play cigarette refusal skills |
| Prepare a smoking cessation ‘survival kit’ |
6-step problem-solving skills to help prevent smoking relapse
| Step (with sample therapist question) | Sample patient response |
|---|---|
| 1. Identify the problem (What is the situation that is making it difficult for you to stay quit?) | I am tempted to buy cigarettes every time I walk by the convenience store in my neighborhood |
| 2. Brainstorm solutions (What are some possible solutions?) | 1. Walk a different way to the bus so I don’t pass the convenience store 2. Tell the people at the convenience store that I quit smoking 3. Don’t carry extra money so I can’t buy cigarettes |
| 3. Evaluate pros and cons (What are the good things and the not-so-good things about each possible solution?) | Walking a different route to the bus: Pros: less temptation, more exercise Cons: longer trip, different routine Don’t carry money: Pros: can’t buy cigarettes Cons: can’t buy other things; might need money in an emergency |
| 4. Pick a solution (Which solution or combination of solutions looks the best?) | Walk a different way to the bus so I don’t pass the store |
| 5. Make a plan (What do you need to do to try it out?) | I need to test out other routes to the bus, set alarm earlier so have enough time for longer route |
| 6. Rate the solution (How well did it work? Do you need to try something else?) | Since I planned my route in advance, I don’t feel nervous about it. I think about cigarettes less in the morning now |
CASE CONTINUED: An improving picture
With CBT, Mr. V grasped that he had to make important changes to quit smoking and reduce his risk of relapse. He embraced the “4 Ds” and successfully adhered to the plan for his quit date. He maintained abstinence through the 12-month relapse prevention treatment period with the same bupropion and NRT dosage he had used to quit smoking (and tapered CBT sessions).
Mr. V realized early in treatment that if he quit smoking he could save $1,000 per year in the price of cigarettes. The camera he bought with the money he saved served as a motivator and helped alleviate the boredom that had kept him smoking.
Related resources
- U.S. Public Health Service. Clinical practice guideline. Treating tobacco use and dependence. www.surgeongeneral.gov/tobacco/tobaqrg.htm.
- Agency for Healthcare Research and Quality. Treating tobacco use and dependence: clinician’s packet. A how-to guide for implementing the Public Health Service Clinical Practice Guideline. www.ahcpr.gov/clinic/tobacco.
- Massachusetts Department of Public Health. www.trytostop.org.
- Centers for Disease Control and Prevention. Tobacco Information and Prevention Source (TIPS). www.cdc.gov/obacco.
- Benztropine mesylate • Cogentin
- Bupropion SR • Zyban
- Clozapine • Clozaril
- Lorazepam • Ativan
- Nicotine/transdermal • Nicotrol, Prostep
- Nicotine/nasal spray • Nicotrol NS
- Nicotine/polacrilex • Nicorette
- Perphenazine • various
- Varenicline • Chantix
- Ziprasidone • Geodon
- Zonisamide • Zonegram
Dr. Gottlieb reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
Dr. Evins receives research support from Janssen Pharmaceutica.
