A Comparison of Smoking Cessation Treatments for Persons with Schizophrenia and Other Serious Mental Illnesses

Abstract

Adults with any DSM-IV diagnosed mental illness smoke nearly half of the cigarettes consumed in the U.S. (Lasser et al. 2000). This study compared two smoking cessation interventions for persons with schizophrenia or other serious mental illness because national data suggests that: (1) they smoke at two to three times the rate of the general population; (2) cessation interventions for this population are understudied; (3) most cessation studies exclude persons with serious mental illness; and (4) cessation results in public health care savings and disposable income savings for clients. This study included a large number of persons with serious mental illness (N=181) who were randomly assigned to one of three groups: contingent reinforcement (CR), CR plus nicotine patch (21 mg, CR+NRT) for 16 weeks, and a minimal intervention, self-quit control group. These participants were followed for 36 weeks. CR was accomplished with escalating financial compensation for achieving and maintaining abstinence as verified by expired carbon monoxide (CO). Quit rates, as measured by expired CO, were higher and discordant with saliva cotinine quit rates. Cotinine showed lower quit rates and small differences between intervention and control participants at weeks 20 and 36. There was, however, evidence of reduced smoking and importantly, no evidence of psychiatric exacerbation.

Factors Affecting Smoking Cessation Efforts of People With Severe Mental Illness: A Qualitative Study

“…As found in the present study, previous research indicates that people with a high degree of perceived life stress have less successful smoking cessation outcomes (Gallager, Penn, Schindler, & Layne, 2007). People who smoke may value assistance in learning alternative, enjoyable methods for coping with stressful situations.…”

A review of research on smoking cessation interventions for adults with schizophrenia spectrum disorders

“…The nature of these two studies precludes any conclusions. The different cultural context and the unusual follow-up rate in the Chou et al (2004) study suggest caution, and the effect sizes in Table 2 from the Gallagher et al (2007) study based on CO exhalation were inconsistent with the cotinine results showing much lower abstinence rates.…”

“…Using a three-group randomized design, Gallagher et al (2007) compared transdermal nicotine patch with contingency management, contingency management alone, and 3 weeks of a self-quit group for 180 individuals with severe mental illness. As measured by CO, the abstinence rates for nicotine patch plus contingency management, contingency management alone, and self-quit treatment groups were 42% (25/60), 38% (23/60), and 5% (3/60), respectively, at week 20.…”

“…In the Chou et al (2004) study, the comparison was between NRT and placebo, which resulted in an effect size of 1.0 at follow-up (see Table 2). In contrast, Gallagher et al (2007) compared contingency management with and without NRT. The comparison of NRT plus contingency management versus contingency management alone resulted in an effect size of 0.08 during treatment and 0.12 after treatment.…”

“…In the Gallagher et al (2007) study described above, contingency management (CM) alone was compared with self-quit in individuals with severe mental illness. Contingency management is a method of reinforcing abstinence from smoking with monetary reward.…”