Multimodal treatment for smoking cessation with varenicline in alcoholic, methadone-maintained, and psychotic patients: A one-year follow-up

Abstract

INTRODUCTION Numerous studies have evaluated the efficacy and safety of varenicline for smoking cessation in smokers in the general population and, to a lesser extent, among the psychiatric population. However, few studies have evaluated varenicline in patients with other addictions. The present study was conducted to assess outcomes of a multimodal treatment for smoking cessation intervention with varenicline in a sample of alcohol and substance use disorders and patients with psychotic disorders. METHODS This was a prospective, multicenter study. The patient sample comprised alcoholics in remission, methadone-maintained patients, and patients with psychotic disorders, all of whom wanted to stop smoking. All participants received multimodal treatment for smoking cessation therapy (psychological therapy plus varenicline). Smoking abstinence and changes in the psychopathological state of patients were assessed at predefined time points during a 12-month follow-up. The probability of tobacco abstinence after one year of treatment was computed using Kaplan-Meier life tables. RESULTS The probability of abstinence at one year was 0.225 (95% CI: 0.1430-0.319). By group, the probabilities were as follows: patients with psychotic disorders 0.254 (95% CI: 0.118-0.415); alcoholics 0.237 (95% CI: 0.098-0.409); and methadone-maintained patients 0.177 (95% CI: 0.065-0.335). Patients with previous quit attempts had a higher probability of achieving abstinence at one year (p<0.01). CONCLUSIONS The results of this study support the use of multimodal treatment with varenicline in patients with alcohol addiction in remission, patients on methadone maintenance, and patients with stable psychotic disorders. Previous smoking cessation attempts were predictive of smoking cessation success in these patients.

Effectiveness of multimodal interventions focused on smoking cessation in patients with schizophrenia: A systematic review

“…In fact, all studies reported higher biochemically validated smoking reduction rates after treatment, and this effect was maintained at follow-ups in most of them. This conclusion is supported by other studies that also reported the effectiveness of multimodal smoking cessation treatments among patients with stable psychotic disorders (Raich et al, 2018;Stubbs et al, 2015). However, multimodal interventions were not as effective in helping individuals to achieve smoking abstinence and to maintain it over time.…”

Factors affecting success and abstinence within a smoking cessation clinic: A one-year follow-up study in Turkey

“…Also, in relapses, no significant difference was found between the two drugs. There are studies showing the superiority of varenicline to bupropion, nicotine replacement therapy and placebo in smoking cessation 8,[27][28][29][30][31][32][33][34][35][36][37] . There are also studies showing that there is no difference in the success of smoking cessation among medical treatments 14 .…”

Impact of the Ottawa model on opiate screening and smoking cessation in methadone-treated patients with opioid use disorder: A retrospective cohort analysis

“…This finding underscores the potential advantage of directly observed therapy in improving medication adherence, particularly in the initial six weeks of treatment. The findings from Raich et al 19 highlight the necessity for multimodal approaches in treating nicotine dependence in patients with concurrent disorders. The varied patient profiles in this study reinforce the need for personalized treatment plans, considering the unique challenges these individuals face.…”