Depressed smokers can be helped to kick the habit

Staged smoking cessation interventions can help smokers who are receiving outpatient psychiatric treatment for depression quit smoking, a study shows.

"The mental health system has been reluctant to identify and treat tobacco dependence despite exhortations to diagnose and treat this often fatal disorder," Dr. Sharon M. Hall, of the University of California, San Francisco, and colleagues write in the American Journal of Public Health.

"This phenomenon," they continue, "can be linked to the belief on the part of mental health professionals that they do not have the skills to provide smoking treatment, the failure to understand that mental health patients can succeed in quitting smoking, reimbursement concerns, and fear of exacerbation of symptoms during nicotine withdrawal."

Hall's team examined the efficacy of a staged care intervention to reduce cigarette smoking among 322 patients receiving psychiatric treatment for depression and who smoked at least one cigarette per day.

Patients randomized to the staged care intervention group received computerized motivational feedback at entry and 3, 6, and 12 months. These patients were also offered a 6-session psychological counseling and drug cessation treatment program. Subjects in the control group received a self-help guide and a referral list of local smoking cessation programs.

Compared to control subjects, those in the staged care intervention group had higher abstinence rates at 12 and 18 months. The abstinence rate at 18 months was roughly 25 percent in the intervention group, and 19 percent in the control group.

Staged care intervention subjects were also significantly more likely to report a quit attempt and to have more stringent smoking cessation goals.

"The staged care intervention appears to have increased the probability that heavier, but not lighter, smokers would attempt to quit," Hall and colleagues report.

SOURCE: American Journal of Public Health, October 2006.