Intervention Helps Smokers With Psychotic Disorders


AUSTIN, TEX. – Despite a generally low rate of participation in smoking-cessation programs among persons with psychotic disorders, cessation intervention is effective in this population, at least in the short term, Amanda Baker, Ph.D., said at the annual meeting of the Society for Research on Nicotine and Tobacco.

For the randomized, double-blind trial, Dr. Baker of the University of Newcastle (Australia) and colleagues enrolled 298 regular smokers with a nonacute psychotic disorder (including but not limited to schizophrenia) who lived in the community.

Participants were assigned to routine care (151 persons) or usual treatment plus a smoking cessation intervention (147 persons). There were eight sessions in the intervention, and they included nicotine replacement therapy, motivational interviewing, and cognitive-behavioral therapy. There were six weekly 1-hour sessions and two more biweekly sessions. The investigators observed a statistically significant dose-response relationship between treatment session attendance and smoking cessation at 1 year but not at 3 years. At 12 months, 18% of control participants had quit smoking, vs. 31% of treatment participants (11% for fewer than five sessions, 21% for five to seven sessions, and 47% for all eight sessions).

At 3 years, 19% of controls and 19% of all treatment participants had achieved cessation (6% of those attending fewer than five sessions, 12% who attended five to seven sessions, and 30% who participated in all eight sessions). The 3-year results did not reach statistical significance, however, and Dr. Baker noted that the investigators were able to contact only slightly more than half the participants at 3 years' follow-up. The portion of each group completing all intervention sessions was similar between the two arms: 56% of the intervention group and 54% of the control group.

The investigators noted that 12-month smoking reduction by at least 50% was significantly predictive of abstinence at 3 years. Point-prevalence abstinence at 36 months was 34% among those who had reduced their smoking by half at 12 months, vs. 11% for those who had not, Dr. Baker reported. There was no worsening of psychotic symptoms among any of those patients.

The 3-year results mean that “maintenance of treatment gains… really remains a major challenge” in patients with psychotic disorder, she said. A forthcoming study will modify the intervention to include longer sessions and address overall lifestyle of the smokers.

Participants were a mean of 37 years old, and 56% were male. Most were receiving disability benefits, and 72% were single. At baseline, they smoked a mean of 30 cigarettes per day and reported two previous quit attempts. They were residents of the greater Sydney area or of the Newcastle area, 2 hours north of Sydney.

Most of the participants cited going “cold turkey” as their most effective prior method of smoking cessation. Their main self-reported reasons for smoking were “craving” or “addiction,” Dr. Baker said.

The nicotine replacement patches used in the study were provided by GlaxoSmithKline Inc.

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