Okoli Chizimuzo T C, Anand Vivek, Khara Milan
a University of Kentucky College of Nursing , Lexington , Kentucky , USA.
b East Carolina University, Brody School of Medicine , Greenville , North Carolina , USA.
J Dual Diagn. 2017 Jan-Mar;13(1):21-28. doi: 10.1080/15504263.2017.1290860. Epub 2017 Feb 6.
It is common practice to individualize smoking cessation pharmacotherapy based on clinical judgment and patient response. However, little has been documented about the use and outcomes of smoking cessation pharmacotherapy in real-world settings. This study examines factors associated with using smoking cessation pharmacotherapy and related outcomes among smokers with psychiatric and/or substance use disorders who completed an intensive tobacco treatment program within mental health and addiction services settings in Vancouver, Canada.
A retrospective analysis was used to examine combined program participation data (N = 889) from two tobacco treatment programs (i.e., the Tobacco Dependence Clinic and the Butt Out group) between September 2007 and July 2013. Changes in smoking cessation pharmacotherapy from the initial to final treatment and seven-day point prevalence of smoking abstinence (verified by expired carbon monoxide) were assessed at the end of treatment.
During treatment, 60% of participants remained on the initial pharmacotherapy plan, 30% received adjunctive treatment, and 10% had treatment plans that were switched. Those whose pharmacotherapy was switched had higher cigarette consumption and nicotine dependence at baseline and were less likely to have a psychiatric disorder history. When comparing between pharmacotherapy groups, individuals who switched medications were less likely to achieve abstinence at the end of treatment as compared to those whose medication treatment plans remained the same or who received adjunctive treatment (unchanged = 36.8%, adjunctive = 38.1% vs. switched = 20.9%, χ = 9.59, df = 2, p = .008). In multivariate regression analysis, switching pharmacotherapy was associated with lower smoking cessation (OR = .33, 95% CI [.17, .63]) and significantly mediated the effectiveness of pharmacotherapy. As there were differences in medication switching rates at the clinical level, there were limitations in assessing the impact of mental illness or substance use disorder variables.
At least 40% of individuals may have their smoking cessation pharmacotherapy plan changed during treatment. Switching pharmacotherapy may indicate a subgroup of smokers characterized by greater challenges in smoking cessation. Our findings may enhance algorithms for using smoking cessation pharmacotherapy in clinical practice and provide directions for future research in treating tobacco use disorder among individuals with mental health and substance use disorders.
根据临床判断和患者反应来个体化戒烟药物治疗是常见做法。然而，关于现实环境中戒烟药物治疗的使用情况和结果，鲜有文献记载。本研究探讨了加拿大温哥华心理健康和成瘾服务机构中，完成强化烟草治疗项目的患有精神疾病和/或物质使用障碍的吸烟者使用戒烟药物治疗的相关因素及相关结果。
采用回顾性分析，研究2007年9月至2013年7月期间两个烟草治疗项目（即烟草依赖诊所和戒烟小组）的联合项目参与数据（N = 889）。在治疗结束时，评估从初始治疗到最终治疗期间戒烟药物治疗的变化以及七天时点戒烟率（通过呼出一氧化碳验证）。
治疗期间，60%的参与者维持初始药物治疗方案，30%接受辅助治疗，10%的治疗方案发生了改变。药物治疗方案发生改变的参与者在基线时吸烟量和尼古丁依赖程度较高，且有精神疾病病史的可能性较小。在比较药物治疗组时，与药物治疗方案保持不变或接受辅助治疗的参与者相比，改变药物治疗的参与者在治疗结束时戒烟的可能性较小（不变 = 36.8%，辅助 = 38.1% vs. 改变 = 20.9%，χ = 9.59，自由度 = 2，p = .008）。在多变量回归分析中，改变药物治疗与较低的戒烟率相关（OR = .33，95% CI [.17, .63]），并显著介导了药物治疗的有效性。由于临床层面药物改变率存在差异，在评估精神疾病或物质使用障碍变量的影响方面存在局限性。
至少40%的个体在治疗期间可能会改变其戒烟药物治疗方案。改变药物治疗可能表明存在一个在戒烟方面面临更大挑战的吸烟者亚组。我们的研究结果可能会改进临床实践中使用戒烟药物治疗的算法，并为未来治疗患有精神健康和物质使用障碍的个体的烟草使用障碍研究提供方向。
