Deconstructing myths, building alliances: a networking model to enhance tobacco control in hospital mental health settings

AbstractLife expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals —the early adopters— based on Rogers’ theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals’ awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings

Deconstructing myths, building alliances: a networking model to enhance tobacco control in hospital mental health settings

Life expectancy for people with severe mental disorders is up to 25 years less in comparison to the general population, mainly due to diseases caused or worsened by smoking. However, smoking is usually a neglected issue in mental healthcare settings. The aim of this article is to describe a strategy to improve tobacco control in the hospital mental healthcare services of Catalonia (Spain). To bridge this gap, the Catalan Network of Smoke-free Hospitals launched a nationwide bottom-up strategy in Catalonia in 2007. The strategy relied on the creation of a working group of key professionals from various hospitals the - early adopters - based on Rogers' theory of the Diffusion of Innovations. In 2016, the working group is composed of professionals from 17 hospitals (70.8% of all hospitals in the region with mental health inpatient units). Since 2007, tobacco control has improved in different areas such as increasing mental health professionals' awareness of smoking, training professionals on smoking cessation interventions and achieving good compliance with the national smoking ban. The working group has produced and disseminated various materials, including clinical practice and best practice guidelines, implemented smoking cessation programmes and organised seminars and training sessions on smoking cessation measures in patients with mental illnesses. The next challenge is to ensure effective follow-up for smoking cessation after discharge. While some areas of tobacco control within these services still require significant improvement, the aforementioned initiative promotes successful tobacco control in these settings. (C) 2016 SESPAS. Published by Elsevier Espana, S.L.U

Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial

Mental disorders; Smoking cessation; TelephoneMalalties mentals; Deixar de fumar; TelèfonEnfermedades mentales; Dejar de fumar; TeléfonoBACKGROUND: Up to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards. METHODS: A pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, β = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups. DISCUSSION: This trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System

Vareniclina en el tratamiento del tabaquismo: efi cacia y seguridad en población general, psiquiátrica y drogodependiente

Desde el año 2006 la vareniclina se está utilizando como tratamiento de primera elección para dejar de fumar. La mayoría de estudios publicados sobre efi cacia y seguridad de este producto se han hecho sobre muestras de fumadores sanos. El presente trabajo es una revisión de estudios publicados que aportan datos sobre efi cacia y seguridad de vareniclina en tres tipos de población: población general, psiquiátrica y drogodependiente. En población general se presentan los resultados sobre efi cacia en comparación a placebo, Terapia Sustitutiva de Nicotina y Bupropion. Se valoran los estudios relacionados con la seguridad que tratan sobre los efectos adversos psiquiátricos de la medicación. En población psiquiátrica y población drogodependiente se valoran las conclusiones de los pocos estudios relacionados con el tema. Se concluye que la efi cacia y la seguridad de vareniclina en población general están confi rmadas. Destaca la escasez de estudios controlados realizados con población psiquiátrica y drogodependiente. Se recomienda monitorizar bien los pacientes psiquiátricos y drogodependientes que tomen este fármaco.Varenicline has been used as a fi rst-line treatment for smoking cessation since 2006, but most studies to date on its effi cacy and safety have been conducted in samples of healthy smokers. This paper reviews published studies about the effi cacy and safety of varenicline in three types of population: the general population, psychiatric patients and drug addicts. In the general population we present the results of effi cacy of varenicline compared to placebo, nicotine replacement therapy and bupropion. Results about neuropsychiatric adverse events are also presented. In psychiatric patients and drug-dependent population we present the conclusions of the few studies on the topic. Our fi ndings confi rmed the effi cacy of varenicline in the general population and emphasize the paucity of controlled studies in psychiatric and drug addict populations. We thus recommend that treatment should be monitored in these latter populations

Characteristics of resident physicians accessing a specialised mental health service: a retrospective study

Adult psychiatry; Medical education & training; Mental healthPsiquiatria d'adults; Educació i formació mèdica; Salut mentalPsiquiatría de adultos; Educación y formación médica; Salud mentalObjectives Little is known about resident physicians being treated at physician health programmes around the world despite the fact that it is a highly demanding training period. This study aims to describe the profiles of resident physicians accessing a specialised mental health service in Spain over a 20-year period and to compare them to consultant-grade physicians. Design Retrospective observational study. Setting Medical records of the Galatea Care Programme for Sick Physicians. Participants 1846 physicians registered at the Barcelona Medical Council-Association and admitted to the programme from January 1998 to December 2018. Primary and secondary outcome measures Number of admissions, sociodemographic and clinical variables, including medical specialty, main diagnosis and need of hospitalisation. Results Residents accounted for 18.1% (n=335) of the sample and admissions increased over the years. Most residents (n=311; 94.5%) and consultant-grade physicians (n=1391; 92.8%) were self-referred. The most common specialty among residents was family medicine (n=107; 31.9%), followed by internal medicine (n=18; 5.4%), paediatrics (n=14; 4.2%), psychiatry (n=13; 3.9%) and anaesthesiology (n=13; 3.9%). Residents, regardless of year of training, mainly asked for help because of adjustment (n=131; 39.1%), affective (n=77; 23%), anxiety disorders (n=40; 18.8%) and addictions (n=19; 5.7%). There were no significant differences between groups in the main diagnosis and in the variables related to need of hospitalisation. The percentage of residents accessing the programme was higher than in the reference population registered at the Barcelona Medical Council-Association (18.1% vs 7.6%; z=7.2, p<0.001) as was the percentage of family medicine residents (31.9% vs 19.6%; z=5.7, p<0.001). Conclusions Residents are more likely than consultant-grade physicians to seek help when suffering from mental disorders. Local primary prevention actions since the beginning of their training period and having access to a well-known highly reliable programme may partly explain these findings

Impact of a training in brief intervention: differences in the hospital approach of tobacco and alcohol consumption

Atención de enfermería; Consumo de bebidas alcohólicas; TabaquismoNursing care; Consumption of alcoholic beverages; SmokingAtenció d'infermeria; Consum de begudes alcohòliques; TabaquismeObjetivo: Evaluar el impacto de una intervención formativa para profesionales sanitarios sobre consumo de alcohol y tabaco en pacientes hospitalizados y comparar la intervención hospitalaria de dichas sustancias. Métodos: A través de dos estudios paralelos se compara, mediante cuestionarios autoadministrados, la conducta clínica declarada de 66 profesionales sanitarios frente al consumo de tabaco de sus pacientes y la intervención recibida de 169 pacientes por parte de estos profesionales, con la conducta clínica de otros 38 profesionales frente al consumo de alcohol de sus pacientes y otros 118 pacientes de diferentes unidades de hospitalización antes y después de una formación en intervención breve en tabaquismo y consumo de riesgo de alcohol respectivamente. Resultados: Se observan pocas diferencias en la conducta de los profesionales ante las dos sustancias. Los profesionales dicen prestar más ayuda en el caso del alcohol (36,4% vs 10,9% [p<.0001]) si bien, según la intervención recibida declarada por los pacientes, no se observan estas diferencias aunque sí se les ha preguntado más por el consumo de alcohol (43,6% vs 30,8% [p<.05]). Después de la formación no se observan cambios significativos. Discusión: En estos dos estudios, la frecuencia de intervención de los profesionales sanitarios sobre el consumo de tabaco y alcohol es baja, tanto previa como posteriormente a la formación recibida, aunque se observa una mayor detección y ayuda en el caso del alcohol. Es necesario analizar otras barreras que frenan la aplicación de los conocimientos adquiridos.Objective: To evaluate th e impact of a training intervention for health care professionals on inpatients’ smoking and alcohol consumption and to compare the hospital intervention for the two substances. Methods: Through two parallel studies, we compared, using auto-administered questionnaires, the referred clinical behaviour on smoking of 66 health care professionals and the intervention received by 169 patients, with the clinical behaviour on hazardous drinking of other 38 professionals and other 118 patients from different hospital wards before and after attending a training in brief intervention on smoking cessation and hazardous alcohol drinking respectively. Results: We only found slight differences between alcohol and tobacco concerning professionals’ behaviour. Professionals declared to assist more often patients with alcohol risk consumption than smoking (36,4% vs 10,9% [p<.0001]) although with patients those differences haven’t been confirmed. They just told to have been asked more often about alcohol consumption than about smoking (43,6% vs 30,8% [p<.05]). There were no differences after the training sessions. Discussion: Before and after training, health professionals hardly intervene in patients with alcohol or tobacco consumption even we observed higher detection and assist for alcohol risk consumption. It is necessary to examine other barriers to the application of the knowledge gained.Este estudio ha sido realizado y financiado parcialmente en el marco del convenio de colaboración entre el Instituto Catalán de Oncología (ICO) y la DG de Salut Pública del Departament de Salut para el desarrollo de la Red de Hospitales Sin Humo de Cataluña y a través de la Subdirección General de Drogodependencias de la DG de Salut Pública en el marco del programa “Beveu Menys”

Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders : Study protocol for a randomized controlled trial

Background: Up to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards. Methods: A pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, β = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups. Discussion: This trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System. Trial registration: ClinicalTrials.gov, NCT03230955. Registered on 24 July 2017

Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial

Background: up to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards. Methods: a pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, β = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups. Discussion: this trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System

Tractament del tabaquisme: psicopatologia i personalitat

El consum de tabac és entre dos i quatre vegades més freqüent en pacients amb patologia psiquiàtrica. A més, els pacients amb comorbiditat psiquiàtrica fumen més quantitat de tabac i tenen més dependència a la nicotina que la població general. Aquest fet es tradueix amb un major cost per la salut i major cost econòmic. Tot i que en els darrers anys s’ha reduït la prevalença de fumadors en els països més desenvolupats, no s’ha observat aquesta reducció en la població psiquiàtrica. Un dels factors clau pot ser l’ajornament sine die de l’abordatge del tabaquisme dels pacients amb psicopatologia per por a descompensacions psiquiàtriques o a recaigudes en consum d’ altres tòxics, encara que vulguin deixar de fumar. Aquest és un fet freqüent en pacients amb dependència de l’alcohol. D’altra banda, tot i que els pacients amb psicopatologia poden deixar de fumar, sovint l’èxit dels tractaments és menor. Així, no queda clar quin és el paper que juguen els antecedents de depressió major i la simptomatologia depressiva present a l’ inici del tractament per abandonar el tabac. Tampoc es coneix si hi ha trets de la personalitat, segons el model de personalitat de Zuckerman, que dificultin l’abstinència. Els objectius són: 1. Analitzar quin és el millor moment per a iniciar un tractament del tabaquisme en pacients amb dependència de l’alcohol; el mateix moment que inicien tractament per a l’alcohol o sis mesos després. 2. Avaluar l’ impacte dels antecedents de depressió major i de la simptomatologia depressiva, en l’abstinència tabàquica. 3. Mesurar quins trets de personalitat, segons el model de Zuckerman, s’associen a major risc de dependència nicotínica, major consum i risc de recaiguda. Les dades d’aquesta tesi vénen de dos estudis diferents: el primer amb població amb dependència de l’alcohol i el segon amb població general. En el primer estudi, un grup de pacients rep tractament estàndard per l’alcohol i per deixar de fumar simultàniament o en diferit, primer per l’alcohol i sis mesos més tard pel tabac. En el segon estudi, s’ avalua l’ impacte dels antecedents de depressió major, simptomatologia depressiva i trets de personalitat en els resultats d’una intervenció en tabaquisme. En tots els casos, la intervenció per deixar de fumar combina tractament cognitiu-conductual i farmacoteràpia. Els resultats indiquen que els pacients amb dependència de l’alcohol poden deixar de fumar i beure a la vegada sense que augmenti el risc de recaiguda en l’ alcohol, tampoc afecta a l’ adherència, ni hi ha diferències en la taxa d’ abstinència del consum de tabac, comparat amb fer tractament per l’alcohol i després pel tabac. D’altra banda, els antecedents de depressió major no disminueixen la probabilitat d’abstinència de consum tabac. En canvi, la simptomatologia depressiva a l’ inici del tractament per deixar de fumar, sí minva la probabilitat d’abstinència. Per últim, s’evidencia l’existència de trets de personalitat diferencials segons el sexe, que impliquen major risc de dependència i recaiguda. En homes, un baix nivell de sociabilitat es relaciona amb major nivells de dependència, mentre que no es troben trets relacionats amb major dependència en dones. Majors nivells d’impulsivitat i sociabilitat es relacionen amb major risc de recaiguda en homes i dones, respectivament. Aquesta tesi aporta dades a favor de la rellevància d’identificar aspectes psicopatològics i de personalitat en pacients que inicien tractament per a la deshabituació tabàquica. La identificació de variables associades amb la recaiguda en el consum de tabac hauria de permetre orientar esforços a minimitzar el seu efecte i millorar els resultats de les intervencions en tabaquisme.The prevalence of smoking in patients with mental disorders is two- to fourfold higher than in the general population. In addition, patients with co-morbid psychiatric illnesses are more likely to be heavily addicted to cigarettes. Tobacco smoking is more hazardous to the health of people with mental disorders than to the general population and the costs related to smoking are also higher. Although prevalence of smoking in most developed countries has fallen, this is unfortunately not the case in psychiatric patients. The idea that smoking cessation in psychiatric patients might increase acute psychiatric symptoms or increase relapse rates in other drugs has led to postponing help with quitting smoking sine die, even when the patient wants to quit. This happens often in patients with alcohol dependence. On the other hand, although patients with mental illness are able to quit smoking, their success rates are often lower than the general population. Thus, it is not clear the role played by major depression history and depressive symptoms when starting a smoking cessation treatment. We know neither if there are personality traits, according to Zuckerman’s model of personality, that complicate quitting. The three aims are: 1. Explore the issue of when tobacco treatment should be offered to outpatients seeking to change their drinking behavior, either concurrently or six months later. 2. Assess if major depression history and/or depressive symptoms when starting treatment reduce odds of quitting smoking. 3. Evaluate which personality traits, according to Zuckerman’s model of personality, are related to higher nicotine dependence, higher smoking and relapse rates. These thesis’ data come from two studies: the first one with alcohol-dependent patients and the second one with general population. The first study delivered a standard alcohol treatment and a smoking cessation treatment, either simultaneously or delayed, that is first for alcohol and six months later for smoking. In the second study, we assessed if major depression history, depressive symptoms and personality increase relapse rates when receiving treatment to quit smoking with a twelve month follow-up. In all cases smoking cessation treatment consisted in cognitive-behavioral therapy in combination with pharmacotherapy. Simultaneous treatment did not lead to impaired outcome for alcohol dependence. Drop-out rates were similar in both groups. Smoking cessation outcomes were not different between groups, either. On the other hand, a positive major depression history did not influence outcomes, but higher depressive symptoms when starting treatment were associated with lower abstinence rates. Finally, we found gender to play a decisive role in the association between personality and nicotine dependence and cessation. In men, low scores on sociability predicted higher nicotine dependence, whereas no personality traits were associated with dependence in women. High levels on impulsivity predicted relapse in males, but high levels on sociability predicted relapse in women. This thesis suggests the relevance of assessing psychopathology and personality in patients undergoing smoking cessation treatment. Identification of factors associated with smoking relapse should allow minimizing their effects on outcomes

Tractament del tabaquisme: psicopatologia i personalitat

El consum de tabac és entre dos i quatre vegades més freqüent en pacients amb patologia psiquiàtrica. A més, els pacients amb comorbiditat psiquiàtrica fumen més quantitat de tabac i tenen més dependència a la nicotina que la població general. Aquest fet es tradueix amb un major cost per la salut i major cost econòmic. Tot i que en els darrers anys s'ha reduït la prevalença de fumadors en els països més desenvolupats, no s'ha observat aquesta reducció en la població psiquiàtrica. Un dels factors clau pot ser l'ajornament sine die de l'abordatge del tabaquisme dels pacients amb psicopatologia per por a descompensacions psiquiàtriques o a recaigudes en consum d' altres tòxics, encara que vulguin deixar de fumar. Aquest és un fet freqüent en pacients amb dependència de l'alcohol. D'altra banda, tot i que els pacients amb psicopatologia poden deixar de fumar, sovint l'èxit dels tractaments és menor. Així, no queda clar quin és el paper que juguen els antecedents de depressió major i la simptomatologia depressiva present a l' inici del tractament per abandonar el tabac. Tampoc es coneix si hi ha trets de la personalitat, segons el model de personalitat de Zuckerman, que dificultin l'abstinència. Els objectius són: 1. Analitzar quin és el millor moment per a iniciar un tractament del tabaquisme en pacients amb dependència de l'alcohol; el mateix moment que inicien tractament per a l'alcohol o sis mesos després. 2. Avaluar l' impacte dels antecedents de depressió major i de la simptomatologia depressiva, en l'abstinència tabàquica. 3. Mesurar quins trets de personalitat, segons el model de Zuckerman, s'associen a major risc de dependència nicotínica, major consum i risc de recaiguda. Les dades d'aquesta tesi vénen de dos estudis diferents: el primer amb població amb dependència de l'alcohol i el segon amb població general. En el primer estudi, un grup de pacients rep tractament estàndard per l'alcohol i per deixar de fumar simultàniament o en diferit, primer per l'alcohol i sis mesos més tard pel tabac. En el segon estudi, s' avalua l' impacte dels antecedents de depressió major, simptomatologia depressiva i trets de personalitat en els resultats d'una intervenció en tabaquisme. En tots els casos, la intervenció per deixar de fumar combina tractament cognitiu-conductual i farmacoteràpia. Els resultats indiquen que els pacients amb dependència de l'alcohol poden deixar de fumar i beure a la vegada sense que augmenti el risc de recaiguda en l' alcohol, tampoc afecta a l' adherència, ni hi ha diferències en la taxa d' abstinència del consum de tabac, comparat amb fer tractament per l'alcohol i després pel tabac. D'altra banda, els antecedents de depressió major no disminueixen la probabilitat d'abstinència de consum tabac. En canvi, la simptomatologia depressiva a l' inici del tractament per deixar de fumar, sí minva la probabilitat d'abstinència. Per últim, s'evidencia l'existència de trets de personalitat diferencials segons el sexe, que impliquen major risc de dependència i recaiguda. En homes, un baix nivell de sociabilitat es relaciona amb major nivells de dependència, mentre que no es troben trets relacionats amb major dependència en dones. Majors nivells d'impulsivitat i sociabilitat es relacionen amb major risc de recaiguda en homes i dones, respectivament. Aquesta tesi aporta dades a favor de la rellevància d'identificar aspectes psicopatològics i de personalitat en pacients que inicien tractament per a la deshabituació tabàquica. La identificació de variables associades amb la recaiguda en el consum de tabac hauria de permetre orientar esforços a minimitzar el seu efecte i millorar els resultats de les intervencions en tabaquisme.The prevalence of smoking in patients with mental disorders is two- to fourfold higher than in the general population. In addition, patients with co-morbid psychiatric illnesses are more likely to be heavily addicted to cigarettes. Tobacco smoking is more hazardous to the health of people with mental disorders than to the general population and the costs related to smoking are also higher. Although prevalence of smoking in most developed countries has fallen, this is unfortunately not the case in psychiatric patients. The idea that smoking cessation in psychiatric patients might increase acute psychiatric symptoms or increase relapse rates in other drugs has led to postponing help with quitting smoking sine die, even when the patient wants to quit. This happens often in patients with alcohol dependence. On the other hand, although patients with mental illness are able to quit smoking, their success rates are often lower than the general population. Thus, it is not clear the role played by major depression history and depressive symptoms when starting a smoking cessation treatment. We know neither if there are personality traits, according to Zuckerman's model of personality, that complicate quitting. The three aims are: 1. Explore the issue of when tobacco treatment should be offered to outpatients seeking to change their drinking behavior, either concurrently or six months later. 2. Assess if major depression history and/or depressive symptoms when starting treatment reduce odds of quitting smoking. 3. Evaluate which personality traits, according to Zuckerman's model of personality, are related to higher nicotine dependence, higher smoking and relapse rates. These thesis' data come from two studies: the first one with alcohol-dependent patients and the second one with general population. The first study delivered a standard alcohol treatment and a smoking cessation treatment, either simultaneously or delayed, that is first for alcohol and six months later for smoking. In the second study, we assessed if major depression history, depressive symptoms and personality increase relapse rates when receiving treatment to quit smoking with a twelve month follow-up. In all cases smoking cessation treatment consisted in cognitive-behavioral therapy in combination with pharmacotherapy. Simultaneous treatment did not lead to impaired outcome for alcohol dependence. Drop-out rates were similar in both groups. Smoking cessation outcomes were not different between groups, either. On the other hand, a positive major depression history did not influence outcomes, but higher depressive symptoms when starting treatment were associated with lower abstinence rates. Finally, we found gender to play a decisive role in the association between personality and nicotine dependence and cessation. In men, low scores on sociability predicted higher nicotine dependence, whereas no personality traits were associated with dependence in women. High levels on impulsivity predicted relapse in males, but high levels on sociability predicted relapse in women. This thesis suggests the relevance of assessing psychopathology and personality in patients undergoing smoking cessation treatment. Identification of factors associated with smoking relapse should allow minimizing their effects on outcomes