New Approach to Smoking Cessation Boosts Quit Rates
for Veterans with PTSD
WASHINGTON -- Smoking cessation treatment that is made part of mental
health care for Veterans with Post Traumatic Stress Disorder (PTSD)
improves quit rates, according to a Department of Veterans Affairs (VA)
study published in the Dec. 8 Journal of the American Medical
Association.
"The smoking cessation techniques used in this new approach will give
Veterans an important step towards a better quality of life," said VA
Under Secretary for Health Dr. Robert Petzel. "Veterans will be at a
lower risk for cardiovascular or lung disease if they do not smoke."
On measures of smoking abstinence for shorter periods of time,
researchers found that quit rates were as high as 18 percent for the
integrated care group, versus 11 percent for those receiving usual care.
When compared to usual care-referral to a standard smoking cessation
clinic-the new, integrated approach nearly doubled the rate at which
study volunteers stayed smoke-free for a year or longer, from 4.5
percent to almost 9 percent.
Importantly, Veterans in the study who quit smoking showed no worsening
of symptoms of PTSD or depression. In fact, study participants averaged
a 10-percent reduction in PTSD symptoms, regardless of which treatment
they received or whether they quit smoking or not. The findings help
dispel concerns that combining care for PTSD and smoking cessation
detracts from PTSD treatment or makes it less effective.
Study leaders Miles McFall, Ph.D., and Andrew Saxon, M.D., say the
results validate a promising new VA model of care that can make safe,
effective smoking cessation treatment accessible to far more Veterans
with PTSD. The new approach may also be effective for smokers receiving
mental health care for other psychiatric illnesses, they add.
Says McFall, "One of the most important things mental health providers
can do to improve the quality and length of their patients' lives is to
help them stop smoking by using proven, evidence-based practices."
McFall is director of PTSD Programs and Saxon is director of the
Addictions Treatment Center at the VA Puget Sound Health Care System.
Both are professors in the department of psychiatry and behavioral
sciences at the University of Washington.
VA smoking cessation care generally involves a mix of group and
individual counseling, typically in combination with nicotine
replacement therapy or other medication prescribed by a VA health care
provider. In VA's study, Veterans in the integrated-care group worked
with the same therapist on PTSD and smoking issues. Medication for
smoking cessation, if used, was prescribed on an individual basis by the
same medical provider managing pharmacologic treatment of the Veteran's
PTSD symptoms.
The study followed 943 Veterans at 10 VA medical centers nationwide.
Prolonged abstinence from tobacco, as reported by participants, was
confirmed using breath and urine tests to detect evidence of smoking.
Using such "bio-verification" measures in combination with self-reports
is considered the "gold standard" in smoking cessation research, says
McFall.
Of some 400,000 Veterans being treated for PTSD in the VA health care
system, roughly 30 to 50 percent are smokers, compared to a smoking rate
of about 20 percent among VA enrollees and U.S. adults in general.
Research shows, also, that those with PTSD smoke more heavily than
smokers without PTSD and have an especially hard time quitting.
"We've come a long way in understanding that nicotine dependence for
many Veterans with PTSD is a chronic, relapsing condition that responds
best to intensive treatment extended over time," McFall says. "These
study findings will help us empower more Veterans with the resources
they need to quit smoking. Single-shot, brief episodic care for nicotine
addiction is no match for what is a chronic, relapsing disorder for many
of our Veterans."
Based on the findings and evidence from prior research, VA has begun
piloting the integrated smoking cessation approach as a standard of
practice at six VA medical centers. The researchers say they hope to see
the new approach further expanded over time.
McFall notes that while most of the participants in the study were
Vietnam-era Veterans, integrated smoking cessation care may be
especially beneficial for younger Veterans with PTSD, such as many of
those returning from Iraq or Afghanistan, who stand to benefit greatly
from quitting smoking relatively early in life.
Says McFall, "Ideally, we can help Veterans quit smoking before it
becomes a chronic or intractable condition and causes irreversible
health problems such as cardiovascular or lung disease."
The study was conducted by VA's Cooperative Studies Program. For more
information on CSP, visit www.csp.research.va.gov.
Wednesday, December 8, 2010
New Approach to Smoking Cessation Boosts Quit Rates
