Dedert Eric A, Dennis Paul A, Calhoun Patrick S, Dennis Michelle F, Beckham Jean C
a Department of Veterans Affairs, Durham Veterans Affairs Health Care System , Durham , North Carolina , USA.
b Department of Psychiatry and Behavioral Sciences , Duke University Medical Center , Durham , North Carolina , USA.
J Dual Diagn. 2018 Jul-Sep;14(3):148-157. doi: 10.1080/15504263.2018.1468947. Epub 2018 Oct 10.
The aim of this research was to determine whether augmenting standard smoking cessation treatment by wearing an active nicotine patch before the smoking quit date improves rates of smoking cessation in individuals with posttraumatic stress disorder (PTSD) and to explore mechanisms of treatment response such as decreased cigarette craving and symptom relief from smoking.
This was a double-blind parallel randomized controlled trial in 81 people with PTSD who smoked cigarettes. Participants were recruited from Veterans Affairs outpatient clinics and flyers in the community. Participants provided ecological momentary assessments (EMAs) of PTSD symptoms, smoking withdrawal symptoms, and cravings before and after smoking a cigarette during one week of ad lib smoking and then three weeks of either a nicotine patch (n = 37) or placebo patch (n = 44) preceding the quit date. All participants received standard pharmacotherapy and behavioral treatment for smoking cessation after the quit date. To test the efficacy of nicotine patch preloading for engaging proposed treatment targets during the pre-quit phases, we used multilevel models to compare post-smoking changes in symptoms and cravings during the preloading phases to post-smoking changes reported during the ad lib smoking phase.
There was no significant difference in quit rates across the two conditions on the primary outcome of seven-day point prevalence smoking abstinence bioverified with breath carbon monoxide at six weeks post-quit date. In a multivariable multilevel model pre- to post-cigarette changes in PTSD symptom clusters, smoking withdrawal symptoms, and cravings, there was a significant interaction between treatment phase and condition. Relative to participants in the placebo condition, participants in the nicotine patch condition experienced diminished relief from PTSD reexperiencing symptoms, smoking withdrawal symptoms, and cigarette craving after smoking a cigarette.
Relative to placebo patch preloading, nicotine patch preloading diminished the reinforcing effects of smoking cigarettes. However, the low quit rates in both conditions suggest that nicotine patch preloading is not a sufficiently intensive treatment for achieving smoking cessation in people with PTSD.
clinicaltrials.gov: NCT00625131.
本研究旨在确定在戒烟日期前佩戴活性尼古丁贴片强化标准戒烟治疗是否能提高创伤后应激障碍（PTSD）患者的戒烟率，并探索治疗反应机制，如减少对香烟的渴望和吸烟症状缓解。
这是一项针对81名吸烟的PTSD患者的双盲平行随机对照试验。参与者从退伍军人事务门诊诊所和社区传单中招募。参与者在一周自由吸烟期间以及戒烟日期前三周使用尼古丁贴片（n = 37）或安慰剂贴片（n = 44）期间，提供创伤后应激障碍症状、戒烟症状和吸烟前后渴望的生态瞬时评估（EMA）。所有参与者在戒烟日期后接受标准药物治疗和行为戒烟治疗。为了测试尼古丁贴片预加载在戒烟前阶段实现拟议治疗目标的疗效，我们使用多层次模型将预加载阶段吸烟后症状和渴望的变化与自由吸烟阶段报告的吸烟后变化进行比较。
在戒烟日期后六周通过呼出一氧化碳生物验证的七天点患病率戒烟这一主要结果上，两种情况的戒烟率没有显著差异。在创伤后应激障碍症状群、戒烟症状和渴望的香烟前后多变量多层次模型中，治疗阶段和情况之间存在显著交互作用。相对于安慰剂组的参与者，尼古丁贴片组的参与者在吸烟后创伤后应激障碍重现症状、戒烟症状和对香烟的渴望缓解程度较低。
相对于安慰剂贴片预加载，尼古丁贴片预加载降低了吸烟的强化作用。然而，两种情况的低戒烟率表明，尼古丁贴片预加载对于实现创伤后应激障碍患者的戒烟不是一种足够强化的治疗方法。
clinicaltrials.gov：NCT00625131。
