Staying Smoke-Free

Smoking cessation treatment program effective and lowered rates of psychiatric readmissions

(RxWiki News) Low-cost treatment and support programs can help people quit smoking. Such programs may even help psychiatric patients quit long-term and avoid returning to the hospital.

A recent clinical trial tested a smoking cessation treatment program on a group of patients in an in-patient psychiatric hospital.

The results of this trial showed that patients in the treatment program were more likely to quit smoking for up to 18 months after discharge and less likely to return to the hospital for psychiatric illness compared to patients who were not in the treatment program.

"Reach out for help with quitting smoking."

In this clinical trial led by Judith Prochaska, PhD, MPH, an associate professor of medicine at Stanford University, researchers investigated a smoking cessation treatment program offered to psychiatric patients during their hospitalization.

According to the authors, tobacco use is roughly two to four times higher among people with a mental illness compared to those in the general population. In previous research, very few psychiatric patients have said they were encouraged to quit smoking by healthcare providers. Some even reported that they were actively discouraged to quit smoking.

The study authors noted that psychiatrists have suggested that quitting smoking may aggravate mental health symptoms, and continued smoking may help facilitate mental health recovery.

"Even among hospitals that ban tobacco use, cessation advice and treatment are rare. Without intervention, almost all patients return to smoking after a smoke-free hospitalization, most within minutes of hospital discharge, " the authors wrote. 

The researchers recruited 224 people from an in-patient psychiatry unit for this tobacco cessation trial. The patients were split into a treatment group and a control (comparison) group.

The majority of the patients (47 percent) were diagnosed with depression, 25 percent were diagnosed with bipolar depression and 15 percent were diagnosed with schizophrenia.

The hospital had a strict no-smoking policy. Patients were given nicotine replacement therapy (NRT), such as nicotine patches and/or prescription medications during their stay.

Upon discharge, the hospital did not provide any NRT or referrals for treatment or support.

The smoking cessation treatment during hospitalization was meant to help the patients avoid smoking after discharge.

Before entering hospital care, the patients averaged 19 cigarettes per day. Only 16 percent said they had intentions to quit smoking in the following 30 days.

The smoking cessation treatment program consisted of the following:

  • 15 to 30 minute smoking cessation counseling sessions
  • A letter to the patient’s regular healthcare provider alerting them of the patient’s need for smoking cessation support after discharge
  • Written materials to promote smoking cessation
  • Post-hospitalization contact at three and six months
  • Post-hospitalization support via computer-generated interventions based on survey responses
  • Nicotine patches for at least 10 weeks and up to six months

Three months after discharge, 13.9 percent of patients in the smoking cessation treatment group reported that they were still not smoking. Only 3.2 percent of patients in the control group remained quit after three months.

After six months, 14.4 percent of patients in the treatment group were still not smoking, compared to 6.5 percent of those in the control group. At 12 months, 19.4 percent of the treatment participants were still not smoking, compared to 10.9 percent of the untreated group members.

Finally, after 18 months, 20 percent of those who received smoking cessation treatment were still not smoking, compared to 7.7 percent of the untreated group.

Patients who said they wanted to quit smoking after discharge had better rates of success with quitting. Patients in the control group were nearly twice as likely to check back into the psychiatric hospital compared to the patients in the smoking cessation treatment group.

The study authors concluded that the smoking cessation treatment program increased the odds of a psychiatric patient remaining smoke-free after hospital discharge by more than threefold.

“This is a very low-cost, brief intervention that helped patients quit smoking and offers evidence that it may have helped their mental health recovery,” Dr. Prochaska said in a press release.

This study was published in August in the American Journal of Public Health.

The National Institute on Drug Abuse supported funding for this project. The study authors declared no conflicts of interest.

Review Date: 
August 16, 2013