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Short-Term Naturalistic Treatment Outcomes in Cigarette Smokers With Substance Abuse and/or Mental Illness.[CME]

J Clin Psychiatry 2007;68(6):892-898

Objective: The majority of cigarette smokers have a lifetime diagnosis of substance abuse and/or mental illness, and treatment outcomes for smokers with these comorbidities are generally reported to be worse than for smokers without comorbidities. We sought to examine the effect of specific substance abuse/mental illness diagnoses compared to one another on treatment outcomes.

Method: A retrospective chart review of naturalistic treatment for nicotine dependence was performed on male smokers (N = 231) who enrolled in the Greater Los Angeles Veterans Affairs Mental Health Clinic Smoking Cessation Program (Los Angeles, Calif.) over a 1.5-year period (January 2004 to June 2005). Subjects in this program, who were diagnosed with nicotine dependence on the basis of a DSM-IV-based interview and a Fagerström Test for Nicotine Dependence score of >= 3, underwent comprehensive treatment for nicotine dependence (including, but not limited to, group psychotherapy, nicotine replacement therapy, and bupropion hydrochloride). Quitting smoking was defined as a report of at least 1 week of abstinence and an exhaled carbon monoxide less than or equal to 8 parts per million at the final clinic visit.

Results: Of the total group, 36.4% (84/231) quit smoking at the end of treatment. Quit rates were affected by the presence of specific diagnoses, with smokers with a history of alcohol abuse/dependence or schizophrenia/schizoaffective disorder having poorer response rates than smokers without such diagnoses. Other substance abuse and mental illness diagnoses did not affect quit rates.

Conclusion: Lower quit rates among patients with alcohol abuse/dependence or schizophrenia/schizoaffective disorder may be due to the severity of these conditions and suggest that specialized treatment is needed for these populations of smokers. Smokers with most comorbid diagnoses are successfully treated with standard treatment methods.