Concurrent varenicline and prolonged exposure for patients with nicotine dependence and PTSD: A randomized controlled trial.

Abstract

Background Prevalence of smoking among individuals with post-traumatic stress disorder (PTSD) is disproportionately high, and PTSD is associated with especially poor response to smoking cessation treatment. Objective The current study examined whether integrating treatments for smoking cessation (varenicline plus smoking cessation counseling; VARCC) and PTSD (prolonged exposure therapy; PE) enhances smoking outcomes among smokers diagnosed with PTSD. Method 142 adults with nicotine dependence and PTSD were randomized to a treatment program consisting of varenicline, smoking cessation counseling, and PE (VARCC+PE) or to VARCC only. Seven-day point prevalence abstinence (PPA) at post-treatment (3-months post-quit day) and follow-up (6-months post-quit day), verified by serum cotinine levels and exhaled carbon monoxide, was our primary smoking outcome. Psychological outcomes were PTSD and depression severity. Mixed effects models included baseline PTSD severity as a moderator of treatment condition effects. Results Overall, VARCC+PE participants did not show greater PPA than VARCC participants. However, treatment effects were moderated by baseline PTSD severity. For participants with moderate and high PTSD severity, VARCC+PE led to significantly higher PPA than VARCC alone (ps<.05). No differences between treatment conditions emerged for participants with low baseline PTSD severity. Participants who received PE showed significantly greater reduction of PTSD and depression symptoms than those who did not receive PE. Conclusions Integrating psychological treatment for PTSD and smoking cessation treatment enhances smoking cessation for participants with moderate or severe PTSD symptom severity, but does not enhance smoking cessation for participants with low baseline PTSD severity.

Efficacy and safety of pharmacotherapies for smoking cessation in anxiety disorders: Subgroup analysis of the randomized, active‐ and placebo‐controlled EAGLES trial

“…However, larger head‐to‐head studies are needed to test those hypotheses because some studies have found beneficial effects for bupropion in smokers with PTSD (Hertzberg, Moore, Feldman, & Beckham, ; McFall et al, ). Our finding is consistent with a retrospective, open‐label trial of varenicline (Okoli, Wiggins, Fallin‐Bennett, & Rayens, ), and a concurrent varenicline and prolonged‐exposure therapy trial in smokers with PTSD (Foa et al, ), both of which showed beneficial effects of varenicline in smokers with PTSD. They are also consistent with nonplacebo‐controlled trials of NRT (Hertzberg et al, ; Kelly et al, a; Kelly et al, b; McFall et al, ) showing beneficial effects in smokers with PTSD.…”

Posttraumatic stress disorder and cigarette smoking: A systematic review

“…Trade Center survivors (Gonzalez et al, 2016), and one among a general clinical sample (Foa et al, 2017 (Beckham et al, 1997).…”

“…These include preliminary treatment studies (e.g., STOP IT; Dedert et al, 2016;Feldner et al, 2013) and RCTs in both veteran (Battaglia et al, 2013;McFall et al, 2010) and general clinical samples (Foa et al, 2017;Gonzalez et al, 2016). These include preliminary treatment studies (e.g., STOP IT; Dedert et al, 2016;Feldner et al, 2013) and RCTs in both veteran (Battaglia et al, 2013;McFall et al, 2010) and general clinical samples (Foa et al, 2017;Gonzalez et al, 2016).…”

“…These studies have provided new information in those areas of need, including: (a) updated epidemiological surveys of PTSD-smoking comorbidity from nationally representative samples (Cougle, Zvolensky, Fitch, & Sachs-Ericsson, 2010;Forbes et al, 2015) and contextually distinct, trauma-exposed populations (e.g., veterans, World Trade Center survivors; Cook, Jakupcak, Rosenheck, Fontana, & McFall, 2009;Welch, Jasek, Caramanica, Chiles, & Johns, 2015); (b) research examining etiological risk factors (e.g., psychiatric history; Wilson et al, 2014) and moderators (e.g., smoking outcome expectancies; Langdon & Leventhal, 2014) that may advance the understanding of PTSD-smoking comorbidity; (c) research comparatively evaluating PTSD-smoking lapse and cessation with other comorbid conditions (e.g., panic; Marshall et al, 2008); (d) short-term, prospective, and longitudinal work targetting quit success among individuals with PTSD (Beckham, Calhoun, Dennis, Wilson, & Dedert, 2013;Zvolensky et al, 2008); and (e) several innovative pilot treatment studies (e.g., mobile contingency management [mCM]; Hertzberg et al, 2013) and four RCTs of specialized, integrated treatments for PTSD-smoking (e.g., Battaglia et al, 2016;Foa et al, 2017). These studies have provided new information in those areas of need, including: (a) updated epidemiological surveys of PTSD-smoking comorbidity from nationally representative samples (Cougle, Zvolensky, Fitch, & Sachs-Ericsson, 2010;Forbes et al, 2015) and contextually distinct, trauma-exposed populations (e.g., veterans, World Trade Center survivors; Cook, Jakupcak, Rosenheck, Fontana, & McFall, 2009;Welch, Jasek, Caramanica, Chiles, & Johns, 2015); (b) research examining etiological risk factors (e.g., psychiatric history; Wilson et al, 2014) and moderators (e.g., smoking outcome expectancies; Langdon & Leventhal, 2014) that may advance the understanding of PTSD-smoking comorbidity; (c) research comparatively evaluating PTSD-smoking lapse and cessation with other comorbid conditions (e.g., panic; Marshall et al, 2008); (d) short-term, prospective, and longitudinal work targetting quit success among individuals with PTSD (Beckham, Calhoun, Dennis, Wilson, & Dedert, 2013;Zv...…”

“…Facilitated by calls for research from government agencies and grant funding from the National Institute on Drug Abuse and National Cancer Institute (NCI), an extensive body of work conducted since the initial 2007 reviews has targeted these areas of need. These studies have provided new information in those areas of need, including: (a) updated epidemiological surveys of PTSD-smoking comorbidity from nationally representative samples (Cougle, Zvolensky, Fitch, & Sachs-Ericsson, 2010;Forbes et al, 2015) and contextually distinct, trauma-exposed populations (e.g., veterans, World Trade Center survivors; Cook, Jakupcak, Rosenheck, Fontana, & McFall, 2009;Welch, Jasek, Caramanica, Chiles, & Johns, 2015); (b) research examining etiological risk factors (e.g., psychiatric history; Wilson et al, 2014) and moderators (e.g., smoking outcome expectancies; Langdon & Leventhal, 2014) that may advance the understanding of PTSD-smoking comorbidity; (c) research comparatively evaluating PTSD-smoking lapse and cessation with other comorbid conditions (e.g., panic; Marshall et al, 2008); (d) short-term, prospective, and longitudinal work targetting quit success among individuals with PTSD (Beckham, Calhoun, Dennis, Wilson, & Dedert, 2013;Zvolensky et al, 2008); and (e) several innovative pilot treatment studies (e.g., mobile contingency management [mCM]; Hertzberg et al, 2013) and four RCTs of specialized, integrated treatments for PTSD-smoking (e.g., Battaglia et al, 2016;Foa et al, 2017).…”