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

Abstract

Background: Recent studies show that 75-85% of people with schizophrenia spectrum disorders in the United States smoke cigarettes, compared with 23% of the general population. Moreover, people with these illnesses on average have life expectancies 25 years lower than the general population, and smoking is a contributor. Aims: To review intervention research and evaluate the methods and clinical findings associated with attempts to eliminate, or reduce, smoking in people with schizophrenia spectrum disorders. Methods: PubMed and PsychInfo were searched from early 1990 through 2007 with select keywords. Thirteen treatment studies addressing smoking cessation interventions in people with schizophrenia spectrum disorders or severe mental illness were identified. Results: Nicotine replacement therapy, psychosocial interventions, and bupropion have been studied. Overall, treatment compliance was moderate, quit rates were low, and relapse to smoking was high. Modest evidence supports the efficacy of bupropion and/or nicotine replacement combined with psychosocial interventions, and of specific psychosocial interventions combined with nicotine replacement. Conclusion: Preliminary data show modest efficacy of nicotine replacement therapy, psychosocial interventions, and bupropion. Future studies should address motivation, effectiveness, new interventions, long-term interventions, and methods.

Expanding Cessation Pharmacotherapy Via Videoconference Educational Outreach to Prescribers

“…This is key, because pharmacotherapy is an important component of evidence-based cessation treatment for this population. 38 To our knowledge, this is the first randomized trial comparing videoconference to in-person educational outreach with audit and feedback aimed at improving prescribing practices in a state mental health system serving people with severe mental illnesses. Similar to at least one previous feasibility report, 34 clinicians were satisfied with the technology-delivered educational intervention.…”

Social predictors of cessation treatment use among smokers with serious mental illness

“…Smoking is the leading cause of preventable mortality in the United States (CDC, 2014) and implicated in the 25-30-year reduced life expectancy of individuals with serious mental illness (Colton & Manderscheid, 2006). Behavioral treatment combined with nicotine replacement therapy or other FDA approved cessation medications dramatically improves outcomes for smokers with serious mental illness (Evins et al, 2014;Ferron, Alterman, McHugo, Brunette, & Drake, 2009) and many of these individuals want to quit (Baker et al, 2007;Lucksted, McGuire, Postrado, Kreyenbuhl, & Dixon, 2004), yet the prevalence of quitting in this population is low (McClave et al, 2010). More effective strategies are needed to engage individuals with serious mental illness in evidence based smoking cessation treatment.…”

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

“…Results indicate that the combination of pharmaceutical and behavioral interventions effective within the general population is also helpful for people with severe mental illness who smoke (Banham & Gilbody, 2010;Morrison & Naegle, 2010;Schreoder & Morris, 2010). Interventions that are intensive, featuring high doses of nicotine replacement therapy, multiple treatment modalities used in combination (e.g., telephonic quitline, group counseling, and nicotine replacement therapy), and longer durations of treatment (e.g., three to six months, as opposed to the typical 4 to 12 weeks) have been shown to be particularly effective (Chou, Chen, Lee, Ku, and Lu, 2004;Ferron, Alterman, McHugo, Brunette, & Drake, 2009;Morris & Neagle, 2010). Yet even in the most successful interventions, the majority of people living with severe mental illness do not quit smoking, and those who do tend to eventually relapse (Chou et al, 2004;Currie et al, 2008;Ferron et al, 2009;Griffiths, Kidd, Pike, & Chan, 2010).…”