Clinical Management of Tobacco Dependence in Inpatient Psychiatry: Provider Practices and Patient Utilization

Abstract

Objective This investigation examined predictors of utilization of nicotine replacement therapy (NRT) during a smoke-free psychiatric hospitalization. Methods Smokers (N=324) were recruited from smoke-free adult inpatient psychiatric units. Exploratory analyses examined correlates of NRT provision and utilization. Results The prevalence of NRT use was 51% overall and was greater among patients offered NRT on admission (58%) versus later (34%), among patients with more severe depression and nicotine withdrawal, and among those who reported perceptions that NRT decreases nicotine withdrawal, provides a nicotine substitute, and helps with quitting smoking (p<.05, all comparisons). Although the ratio of nicotine patch dose to usual cigarettes per day was 1.2±.7, the ratio was negatively correlated with time to first cigarette (Spearman’s ρ=−.30, p<.01), suggesting potential underdosing of more dependent smokers. Conclusions During smoke-free psychiatric hospitalizations, clinical management of nicotine withdrawal may be enhanced by offering patients NRT directly on admission, educating patients on the benefits of NRT, and increasing the dosage for more dependent smokers.

Effect of implementation of a smoke-free policy on physical violence in a psychiatric inpatient setting: an interrupted time series analysis

“…Over the study period, 747,338 occupied bed days of care were delivered to patients. The characteristics of patients were: 57% (n=10,269) male; 60% (n=10,813) under 45 years of age; 40% (n=7180) had a primary diagnosis of schizophrenia or related disorder (ICD-10, F20-29), 20% (n=3,598) a mood disorder (F. [30][31][32][33][34][35][36][37][38][39] and the remainder other diagnoses e.g. dementia, addiction disorder; 44% (n=8,007) were formally detained under mental health legislation.…”

“…Supporting patients to temporarily abstain from smoking without the discomfort of nicotine withdrawal or encouraging a quit attempt can be achieved by promptly offering inpatient smokers NRT on admission, increasing the dose for heavily dependent smokers and education on the benefits of NRT compared to smoking tobacco. 31 Concerns about violence are impeding the introduction of smoke-free policies worldwide and such concerns may not be substantiated. Instead, adequately resourced smoke-free policies could be part of broader violence reduction strategies in psychiatric settings.…”

Smokers with serious mental illness and requests for nicotine replacement therapy post-hospitalisation

“…24 Predictors of NRT use posthospitalisation have not been examined. While our earlier research has demonstrated efficacy of initiating tobacco treatment during psychiatric hospitalisation, 25 the study protocol restricted NRT availability to participants intending to quit and, as a result, NRT was used by only 49% of intervention participants.…”

Does menthol cigarette use moderate the effect of nicotine metabolism on short-term smoking cessation?

“…Therefore, while existing studies indicate that menthol cigarette use is associated with increased nicotine dependence and poor smoking cessation outcomes, our findings question this pattern by raising the question of whether menthol cigarette use should remain as a commonly viewed risk factor in smoking persistence. Third, we also examined response after a standard 8 week regiment of a consistently high dose of 21 mg of the nicotine patch, which is both effective and highly utilized by treatment providers (Leyro et al, 2013; Tonnesen et al, 1999). In a large scale, time-limited nicotine replacement therapy giveaway program, menthol cigarette smokers reported greater use of any nicotine replacement therapy, but had lower quit rates (Thihalolipavan, Jung, Jasek, & Chamany, 2014).…”