Purpose: To examine the program completion and smoking cessation outcomes of a tobacco dependence treatment program for individuals with a history of substance use (SUD) and/or psychiatric disorders (PD). Despite the steady decline in the overall smoking prevalence in North America during the last decade some subsets of the population continue to smoke at high rates, particularly individuals with a SUD and/or PD. Among clinical samples, an estimated 75% of individuals with SUD and up to 90% of individuals with PD concurrently smoke. Such findings have prompted the need for tailored tobacco dependence treatment approaches in this population.
Methods: The program is implemented by a multidisciplinary team of physicians, nurses, and addictions counselors. Participants engage in an initial, 8-week ‘structured’ group therapy program, and are then offered an additional 18 weeks of therapy following a ‘support group’ model. Adhering to evidence-based recommendations, participants are further provided with pharmacotherapy for smoking cessation for the duration of treatment (up to 6 months). The outcome analyses for this study are based on a retrospective chart review of data from 540 participants enrolled in the program between September 2007 and May 2011. The main outcome measures were program completion at 8-weeks and smoking cessation at the end-of-treatment [validated by expired carbon monoxide (CO) levels]. Multivariate logistic analyses models were used to determine predictors of successful program completion and smoking cessation at end-of-treatment.
Results: For individuals who completed the program (n = 406), the abstinence rate was 41%. There were no significant differences in smoking cessation by diagnostic categories (smoking cessation rates ranged from 31.4% among individuals with a history of heroin misuse to 50% among those with a history of schizophrenia). Significant predictors of treatment completion were: a) being female and b) older age. Among program completers (n = 406), significant predictors of successful smoking abstinence at the end-of-treatment were: a) having a lower expired CO level at baseline, and b) staying in treatment for a greater number of weeks.
Conclusions and Implications for Practice: Tobacco dependence treatment is an important approach to reducing the disproportionate prevalence and mortality associated with tobacco use in these often marginalized populations. Specialized treatment programs in mental health and addictions settings are well received by clients who are motivated to quit smoking. Evidence-based recommendations require that nurses in psychiatric and mental health settings engage clients in discussions regarding their smoking behavior. Nurses should provide brief intervention for smoking cessation to all clients at every clinic visit and refer them to specialized tobacco dependence treatment as appropriate
