Extended Nicotine Patch Treatment among Smokers With and Without Comorbid Psychopathology.

Introduction: Individuals with psychiatric conditions smoke at higher rates than the general population and may need more intensive treatment to quit. We examined whether or not extended treatment with nicotine patch, combined with behavior counseling, would disproportionally benefit smokers with versus without a lifetime psychiatric condition.

Methods: We conducted secondary data analysis of data from an effectiveness trial of treatment with 12 counseling sessions (48 weeks) and 21-mg nicotine patch (8, 24, or 52 weeks) among 525 adult daily smokers (Schnoll et al 2015 JAMA Intern Med). A structured clinical interview assessed past and current DSM-IV psychiatric disorders (major depression, generalized anxiety disorder, alcohol abuse/dependence, and substance abuse/dependence). Abstinence was bioverified at Week 52. Logistic regression evaluated the effect of the psychiatric status by treatment duration interaction on abstinence at Week 52, covarying for sociodemographics, baseline psychological symptoms, and treatment adherence.

Results: At baseline, 115 (21.9%) participants were diagnosed with one or more psychiatric conditions. The psychiatric status by treatment duration interaction was significant for Week 52 abstinence (p=.027). Abstinence rates between smokers with versus without a psychiatric condition in the 24-week treatment arm (9.3% vs. 31.5% abstinent) significantly differed from the 8-week treatment arm (18.8% vs. 22.3%), p=.017. Abstinence rates for smokers with (22.5%) versus without a psychiatric condition (19.7%) in the 52-week treatment arm did not differ from the 8-week arm.

Conclusions: Targeted smoking cessation treatment, rather than extending treatment duration, may be especially warranted to optimize treatment for smokers with comorbid mood, anxiety, and substance use disorders.