A retrospective analysis of the comparative effectiveness of smoking cessation medication among individuals with mental illness in community‐based mental health and addictions treatment settings

Abstract

Introduction Individuals with mental illnesses (MI) have diagnosis-specific reasons for smoking and achieve low smoking cessation when using cessation medications. Aim To assess differences in smoking cessation outcomes by MI diagnosis and cessation medications in outpatient mental health and addictions treatment settings in Vancouver, Canada. Method This is a retrospective analysis of tobacco treatment outcomes from 539 participants. The programme consists of cessation pharmacotherapy with 8 to 12 weeks of behavioural counselling and 12 weeks of support group. Smoking cessation was verified by expired carbon monoxide levels. Generalized estimating equations models assessed differences in cessation by type of medication in both total and stratified samples. Results There were no significant differences in cessation by pharmacotherapy in the total sample. Individuals with a mood disorder were two times more likely to achieve cessation as compared to those with an anxiety disorder. Among individuals with mood disorders, receiving varenicline alone resulted in three times the likelihood of cessation as compared to receiving single NRT. Discussion The differences in outcomes by MI diagnosis suggest the need for more diagnosis-specific approaches to optimize cessation. Implications for Practice Compared with other diagnoses, persons with anxiety disorders may have a greater challenge quitting and those with a psychotic disorder may require longer treatment durations.

Efficacy and safety of pharmacotherapies for smoking cessation in anxiety disorders: Subgroup analysis of the randomized, active‐ and placebo‐controlled EAGLES trial

“…However, larger head‐to‐head studies are needed to test those hypotheses because some studies have found beneficial effects for bupropion in smokers with PTSD (Hertzberg, Moore, Feldman, & Beckham, ; McFall et al, ). Our finding is consistent with a retrospective, open‐label trial of varenicline (Okoli, Wiggins, Fallin‐Bennett, & Rayens, ), and a concurrent varenicline and prolonged‐exposure therapy trial in smokers with PTSD (Foa et al, ), both of which showed beneficial effects of varenicline in smokers with PTSD. They are also consistent with nonplacebo‐controlled trials of NRT (Hertzberg et al, ; Kelly et al, a; Kelly et al, b; McFall et al, ) showing beneficial effects in smokers with PTSD.…”

Psychiatric Disorders and Smoking Behavior: A Comprehensive Examination of Interventions by Psychiatric Nurses

“…These intervention programs include telephonebased, web-based, or combined telephone and web-based counseling. In the study by Ocoli et al, it was stated that these intervention programs were as effective as medical treatment (C. Okoli, Wiggins, Fallin-Bennett, & Rayens, 2017).…”

Healthcare Costs of Smokers Using Varenicline Versus Nicotine-Replacement Therapy Patch in the United States: Evidence from Real-World Practice

“…Thus, combination therapy of VAR and OTC NRT cannot be identified. Clinical trials have shown better efficacy of VAR in combination with NRT than VAR alone [45]; however, an analysis of patients who attended tobacco treatment programs in Canada showed a similar abstinence rate among dual VAR and NRT users, dual NRT users, and single NRT users [23]. With mixed results in the literature and unknown patterns of prescription and OTC NRT, the expected real-world impact of the unbalanced missing information is uncertain.…”