This meta-analysis examined outcomes of smoking cessation interventions evaluated in 19 randomized controlled trials with individuals in current addictions treatment or recovery. Smoking and substance use outcomes at posttreatment and long-term follow-up (> or = 6 months) were summarized with random effects models. Intervention effects for smoking cessation were significant at posttreatment and comparable for participants in addictions treatment and recovery; however, intervention effects for smoking cessation were nonsignificant at long-term follow-up. Smoking cessation interventions provided during addictions treatment were associated with a 25% increased likelihood of long-term abstinence from alcohol and illicit drugs. Short-term smoking cessation effects look promising, but innovative strategies are needed for long-term cessation. Contrary to previous concerns, smoking cessation interventions during addictions treatment appeared to enhance rather than compromise long-term sobriety.

Nortriptyline is a promising adjunct for smoking cessation. Smokers with a history of depression are aided by more intensive psychosocial treatments. Mood and diagnosis interact to predict relapse. Increases in negative affect after quitting smoking are attenuated by nortriptyline.

This article describes the test of the hypothesis that a cognitive-behavioral mood management intervention would be effective for smokers with a history of major depressive disorder (MDD). The method was randomized trial; the assessments occurred at Weeks 0, 8, 12, 26, and 52. Ss were 149 smokers; 31% had a history of MDD. All received 2 mg of nicotine gum. Mood management was provided in 10 group sessions over 8 weeks. Standard treatment was provided in 5 group sessions over 8 weeks. Outcome was continuous abstinence. History-positive Ss were more likely to be abstinent when treated with mood management. Treatment condition differences were not significant for history-negative Ss. For history-positive Ss, less anger at baseline predicted abstinence. For history-negative Ss, more years smoked and higher baseline carbon monoxide (CO) predicted abstinence. Cognitive-behavioral therapy did not affect mood after quitting. Abstinence predictors differed as a function of baseline diagnosis.

The effects of commitment to abstinence and acute stress on return to drug use were examined in a study of treated alcoholics, opiate users, and cigarette smokers (N = 221). Subjects were followed for 12 weeks or until they used their problem drug for 7 consecutive days. Commitment to absolute abstinence at end of treatment was related to a lower risk of returning to use and longer time between the first use and relapse. Withdrawal symptoms and negative and positive moods predicted first drug use, but only when assessed retrospectively. Prospective analyses failed to reveal a link between these variables and return to use. These findings suggest a reevaluation of current models of relapse. Acute stress may be less important in precipitating return to drug use than previously believed.

The findings support initiation of motivationally tailored tobacco cessation treatment during acute psychiatric hospitalization. Psychiatric severity did not moderate treatment efficacy, and cessation treatment appeared to decrease rehospitalization risk, perhaps by providing broader therapeutic benefit.

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This article reviews the research on the treatment of cigarette smoking in individuals who have comorbid mental illnesses or non-nicotinic addictions. The prevalence of smoking in mentally ill and substance-abusing populations is presented, as well as reasons for this high prevalence. The historical role of cigarettes and tobacco in mental illness and addiction is reviewed to help the reader better understand the pervasiveness of smoking in these disorders and the relative absence of intervention efforts in mental heath and addiction treatment settings. The article then discusses the several reasons for integrating smoking treatment into mental health and addiction settings. The outcome research for adult and adolescent comorbid smokers is reviewed, and barriers to treatment are discussed. The review closes with a brief discussion of models of integration and thoughts about prevention. Keywordstobacco; mental illness; substance abuse; intervention; health services OVERVIEWThe purpose of this review is to discuss the comorbidity between nicotine dependence and other mental health disorders, including non-nicotinic addictions and mental illnesses, in order to better understand the state of the art of the treatment of nicotine dependence in these smokers. We focus on strategies to improve the treatment of cigarette smoking in smokers with mental health and substance abuse disorders and in mental health treatment settings.The use of tobacco products other than cigarettes (for example, smokeless tobacco and cigars) has not been studied in individuals with mental health disorders and with addictions to nonnicotinic drugs. In this review, we limit our discussion to cigarette smoking treatment.

The data suggest that individuals in psychiatric treatment for depression can be aided in quitting smoking through use of staged care interventions and that smoking cessation interventions used in the general population can be implemented in psychiatric outpatient settings.