Integrating Tobacco Cessation Into Mental Health Care for Posttraumatic Stress Disorder: A Randomized Controlled Trial

CONTEXT Most smokers with mental illness do not receive tobacco cessation treatment. OBJECTIVE To determine whether integrating smoking cessation treatment into mental health care for veterans with posttraumatic stress disorder (PTSD) improves long-term smoking abstinence rates. DESIGN, SETTING, AND...

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Published in:	JAMA : the journal of the American Medical Association Vol. 304; no. 22; pp. 2485 - 2493
Main Authors:	McFall, Miles, Saxon, Andrew J, Malte, Carol A, Chow, Bruce, Bailey, Sara, Baker, Dewleen G, Beckham, Jean C, Boardman, Kathy D, Carmody, Timothy P, Joseph, Anne M, Smith, Mark W, Shih, Mei-Chiung, Lu, JJJ, Holodniy, Mark, Lavori, Philip W, CSP 519 Study Team, for the
Format:	Journal Article
Language:	English
Published:	Chicago, IL American Medical Association 08-12-2010
Subjects:	Addictive behaviors Adult and adolescent clinical studies Biological and medical sciences Check lists Clinical trials Counseling Depression Depression - complications Depression - therapy Drug addiction Female General aspects Humans Inventories Male Medical sciences Mental disorders Mental health care Mental Health Services - organization & administration Middle Aged Post traumatic stress disorder Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Smoking Smoking - therapy Smoking Cessation Stress Disorders, Post-Traumatic - complications Stress Disorders, Post-Traumatic - therapy Substance-Related Disorders - therapy Tobacco Tobacco smoking Tobacco, tobacco smoking Toxicology Treatment Outcome Veterans Anxiety disorder Mental health Tobacco smoking Posttraumatic stress disorder Randomized controlled trial Care Stress Medicine Randomization Tobacco Shutdown Clinical trial Public health
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Summary:	CONTEXT Most smokers with mental illness do not receive tobacco cessation treatment. OBJECTIVE To determine whether integrating smoking cessation treatment into mental health care for veterans with posttraumatic stress disorder (PTSD) improves long-term smoking abstinence rates. DESIGN, SETTING, AND PATIENTS A randomized controlled trial of 943 smokers with military-related PTSD who were recruited from outpatient PTSD clinics at 10 Veterans Affairs medical centers and followed up for 18 to 48 months between November 2004 and July 2009. INTERVENTION Smoking cessation treatment integrated within mental health care for PTSD delivered by mental health clinicians (integrated care [IC]) vs referral to Veterans Affairs smoking cessation clinics (SCC). Patients received smoking cessation treatment within 3 months of study enrollment. MAIN OUTCOME MEASURES Smoking outcomes included 12-month bioverified prolonged abstinence (primary outcome) and 7- and 30-day point prevalence abstinence assessed at 3-month intervals. Amount of smoking cessation medications and counseling sessions delivered were tested as mediators of outcome. Posttraumatic stress disorder and depression were repeatedly assessed using the PTSD Checklist and Patient Health Questionnaire 9, respectively, to determine if IC participation or quitting smoking worsened psychiatric status. RESULTS Integrated care was better than SCC on prolonged abstinence (8.9% vs 4.5%; adjusted odds ratio, 2.26; 95% confidence interval [CI], 1.30-3.91; P = .004). Differences between IC vs SCC were largest at 6 months for 7-day point prevalence abstinence (78/472 [16.5%] vs 34/471 [7.2%], P < .001) and remained significant at 18 months (86/472 [18.2%] vs 51/471 [10.8%], P < .001). Number of counseling sessions received and days of cessation medication used explained 39.1% of the treatment effect. Between baseline and 18 months, psychiatric status did not differ between treatment conditions. Posttraumatic stress disorder symptoms for quitters and nonquitters improved. Nonquitters worsened slightly on the Patient Health Questionnaire 9 relative to quitters (differences ranged between 0.4 and 2.1, P = .03), whose scores did not change over time. CONCLUSION Among smokers with military-related PTSD, integrating smoking cessation treatment into mental health care compared with referral to specialized cessation treatment resulted in greater prolonged abstinence. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00118534
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0098-7484 1538-3598
DOI:	10.1001/jama.2010.1769