Mortality following inpatient addictions treatment. Role of tobacco use in a community-based cohort

Hurt, R. Douglas; Offord, Kenneth P.; Croghan, Ivana T.; Gomez-Dahl, Leigh C.; Kottke, Thomas E.; Morse, R.; Melton, L. Joseph

doi:10.1001/jama.275.14.1097

Cited by 426 publications

(299 citation statements)

References 36 publications

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“…Interestingly, the previous study of bupropion for MA dependence failed to find an effect for bupropion on cigarette smoking relative to placebo (Elkashef et al, 2007), and the reason for this discrepancy between the two studies is not clear. Considering that the prevalence of cigarette smoking among illicit drug users, including MA users, is as high as 70%-90% (Budney et al, 1993;Grant et al, 2004;Kalman et al, 2005;Richter et al, 2002) and that cigarette smoking is associated with poor health outcomes among illicit drug users, above and beyond those found in nonsmoking drug users (Hser et al, 1994;Hurt et al, 1996), the identification of smoking cessation treatments effective in MA users is an important public health priority. Our results provide preliminary support for bupropion as a smoking cessation medication among MA users and provide evidence for continued evaluation of bupropion as a medication for comorbid stimulant abusers who smoke cigarettes.…”

Section: Discussionmentioning

confidence: 99%

Randomized, placebo-controlled trial of bupropion for the treatment of methamphetamine dependence

Shoptaw

Heinzerling

Rotheram-Fuller

et al. 2008

Drug and Alcohol Dependence

131

129

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Objective-To compare bupropion to placebo for reducing methamphetamine (MA) use, increasing retention, and reducing the severity of depressive symptoms and MA cravings. A secondary objective compared bupropion to placebo for reducing cigarette smoking among MA dependent participants.Methods-Following a 2-week, non-medication baseline screening period, 73 treatment-seeking MA dependent participants were randomly assigned to bupropion sustained release (150 mg twice daily; N=36) or placebo (twice daily; N=37) for 12-weeks under double blind conditions. Participants attended clinic thrice weekly to provide urine samples analyzed for MA-metabolite, to complete research measures and assessments, and to receive contingency management and weekly cognitive behavioral therapy sessions.Results-There were no statistically significant effects for bupropion relative to placebo on MA use verified by urine drug screens, for reducing the severity of depressive symptoms or MA cravings, or on study retention. In a post hoc analysis, there was a statistically significant effect of bupropion treatment on MA use among participants with lighter (0-2 MA-positive urines), but not heavier (3-6 MA-positive urines) MA use during baseline (OR=2.81, 95% CI=1.61-4.93, p<0.001 for MA-free week with bupropion among light users). Bupropion treatment was also associated with significantly reduced cigarette smoking, by almost 5 cigarettes per day (p=0.0002).Conclusion-Bupropion was no more effective than placebo in reducing MA use in planned analyses, though bupropion did reduce cigarette smoking. Post hoc findings of an effect for bupropion among baseline light, but not heavy, MA users suggests further evaluation of bupropion for light MA users is warranted.

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Section: Discussionmentioning

confidence: 99%

Randomized, placebo-controlled trial of bupropion for the treatment of methamphetamine dependence

Shoptaw

Heinzerling

Rotheram-Fuller

et al. 2008

Drug and Alcohol Dependence

131

129

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“…1 Although tobacco use is clearly a substantial contributor to long-term mortality, 52 in this population of postdetoxification individuals with substance dependence (most of whom smoked cigarettes), relatively short-term mortality is so substantial that it merits consideration for intervention. At least some causes of death in these individuals may be preventable.…”

Section: Discussionmentioning

confidence: 99%

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

Saitz

Gaeta²,

Cheng³

et al. 2007

J Urban Health

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The objective of this analysis was to assess the mortality rate and risk factors in adults, with substance dependence, who are not receiving primary medical care (PC). Date and cause of death were identified using the National Death Index data and death certificates for 470 adults without PC over a period of almost 4 years after detailed clinical assessment after detoxification. Factors associated with risk of mortality were determined using stepwise Cox proportional hazards models. Subjects were 76% male, 47% homeless, and 47% with chronic medical illness; 40% reported alcohol, 27% heroin, and 33% cocaine as substance of choice. Median age was 35. During a period of up to 4 years, 27 (6%) subjects died. Median age at death was 39. Causes included: poisoning by any substance (40.9% of deaths), trauma (13%), cardiovascular disease (13.6%), and exposure to cold (9.1%). The age adjusted mortality rate was 4.4 times that of the general population in the same city. Among these individuals without PC in a detoxification unit, risk factors associated with death were the following: drug of choice [heroin: hazard ratio (HR) 6.9 (95% confidence interval (CI) 1.6-31.1]; alcohol: HR 3.7 (95% CI 0.79-16.9) compared to cocaine); past suicide attempt (HR 2.1, 95% CI 0.96-4.5); persistent homelessness (HR 2.4, 95% CI 1.1-5.3); and history of any chronic medical illness (HR 2.1, 95% CI 0.93-4.7). Receipt of primary care was not significantly associated with death (HR 0.85, 95% CI 0.34-2.1). Risk of mortality is high in patients with addictions and risk factors identifiable when these patients seek help from the health care system (i.e., for detoxification) may help identify those at highest risk for whom interventions could be targeted.

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“…In particular, rates of tobacco use are high, and tobacco is a primary cause of death among individuals treated for substance abuse (Hser, et al, 1994, Hurt, et al, 1996. Concerns about potential compromised sobriety, however, have limited access to tobacco cessation treatments in practice.…”

Section: Or Diabetes (Diabetes Prevention Programmentioning

confidence: 99%

Multiple health behavior change research: An introduction and overview

Prochaska

Spring²,

Nigg

2008

Preventive Medicine

504

399

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In 2002, the Society of Behavioral Medicine's special interest group on Multiple Health Behavior Change was formed. The group focuses on the interrelationships among health behaviors and interventions designed to promote change in more than one health behavior at a time. Growing evidence suggests the potential for multiple-behavior interventions to have a greater impact on public health than single-behavior interventions. However, there exists surprisingly little understanding of some very basic principles concerning multiple health behavior change (MHBC) research. This paper presents the rationale and need for MHBC research and interventions, briefly reviews the research base, and identifies core conceptual and methodological issues unique to this growing area. The prospects of MHBC for the health of individuals and populations are considerable.Keywords multiple health behavior change; methodology; interventions; review OverviewIn 2002, the Society of Behavioral Medicine formed a special interest group (SIG) to contribute to the development of a science of multiple health behavior change (MHBC) for health promotion and disease management. This multidisciplinary group of researchers and practitioners focuses on the interrelationships among health behaviors and interventions designed to promote change in more than one health behavior at a time. Recognizing that intervention on multiple behaviors presents a unique set of challenges, the group addresses theoretical, methodologic, intervention, statistical, and funding issues and fosters networking, mentorship, career development, and scientific discussion among its members. PrécisThis paper presents the rationale and need for multiple health behavior change research, briefly reviews the research base, and identifies core conceptual and methodological issues unique to this growing area.

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Mortality following inpatient addictions treatment. Role of tobacco use in a community-based cohort

Cited by 426 publications

References 36 publications

Randomized, placebo-controlled trial of bupropion for the treatment of methamphetamine dependence

Randomized, placebo-controlled trial of bupropion for the treatment of methamphetamine dependence

Risk of Mortality during Four Years after Substance Detoxification in Urban Adults

Multiple health behavior change research: An introduction and overview

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