Would smokers with schizophrenia benefit from a more flexible approach to smoking treatment?

Abstract

We evaluated literature that addresses the notion that flexible smoking treatment approaches are warranted for smokers with a diagnosis of schizophrenia. Understanding the biological and psychological mechanisms that increase the likelihood of smoking and decrease the motivation to quit for these individuals is addressed within the framework of a neurobiological model. We provide a brief overview of the limited smoking cessation treatment literature for patients with schizophrenia and compare abstinence‐focused versus reduction‐focused treatment modalities. The potential utility of the reduction‐focused approach to tobacco treatment for these smokers is evaluated. Suggestions for future research to address the utility and efficacy of reduction‐focused interventions for smokers with schizophrenia are put forth. We conclude with a consideration of the implications for the current understanding of smoking treatment among patients with co‐morbid psychiatric diagnoses.

The Etiology and Treatment of Nicotine Dependence: A Biopsychosocial Perspective

“…For example, patients with major depression may smoke to improve depressed mood states (Hall et al, 1993). Similarly, patients with schizophrenia may find that smoking helps to reduce negative symptoms such as anhedonia, apathy, blunted affect, and emotional withdrawal (McChargue et al, 2002a(McChargue et al, , 2002b. Finally, patients with posttraumatic stress disorder and other anxiety disorders may smoke to cope with emotional and physiological distress (Beckham et al, 1997).…”

“…Comorbid psychopathology represents an important issue to address in nicotine dependence research because these individuals report excessive dependence levels and have extreme difficulty in quitting McChargue, Gulliver, & Hitsman, 2002a, 2002b. Moreover, psychiatric smokers are at a heightened risk of smoking and psychiatric-related health problems as compared with nonsmoking psychiatric patients and nonpsychiatric smokers (Jeste, Gladsjo, Lindamer, & Lacro, 1996;Linkins & Cornstock, 1990).…”

“…As such, the goal of complete abstinence might not be initially possible for some psychiatric subgroups (e.g., individuals diagnosed with schizophrenia). These individuals may require a stepped care approach that focuses on reducing exposure to tobacco toxins until the individuals are able to stabilize lower rates of tobacco use and learn adequate coping skills (McChargue et al, 2002a(McChargue et al, , 2002b.…”

“…If all else fails, the clinician is advised to lower tobacco use behavior when abstinence appears to be initially unattainable (McChargue et al, 2002a(McChargue et al, , 2002b and/or pharmacological therapies are not suitable (Ockene et al, 1999). Reducing tobacco use may be accomplished via nicotine fading.…”

A brief motivational intervention based on positive experience and temporary smoking abstinence: Feasibility in a psychiatric hospital

“…Several types of cessation programs have shown to be effective, for smokers with or without psychiatric disorders [5][6][7] . Tobacco addiction is a chronic disorder 8 and treatment implies multiple quit attempts and relapses, with single interventions showing low success rates 9,10 .…”