Smoking and mental health - NCSCT

Smoking and mental health
1.41–1.92) for telephone support. 4 There is as yet insufficient information to
determine which elements of behavioural support are effective, or whether one
approach, such as motivational interviewing or cognitive–behavioural therapy, is
more effective than another. However it appears that group support is generally
more effective than one-to-one support, and that support should involve
multiple sessions. 28
In people with SMI, a study comparing a specialist quit smoking programme
with standard smoking cessation group therapy, both delivered together with
NRT, 29 found no difference in point prevalence abstinence at the primary trial
endpoint of 3 months (relative risk (RR) of smoking = 1.01, 95% CI 0.45–2.28),
although there was a non-significant reduction in smoking risk at the last time
point of the study (8.5 months; RR = 0.61, 95% CI 0.14–2.67). Baker et al 30
compared the effectiveness of individual therapy (cognitive–behavioural therapy
and motivational enhancement) plus NRT with usual care (booklets and access
to primary care) without NRT among participants with SMI, predominantly
schizophrenia. At 4 months (the trial endpoint), the intervention group were
significantly more likely to abstain from smoking (RR = 2.74, 95% CI 1.10–6.81),
although this effect was not sustained in later comparisons and the effect
attributable to the behavioural intervention (as opposed to the NRT) is unclear.
Thus, there is evidence that behavioural support delivered with NRT is effective
in SMI, but no strong evidence that tailored behavioural interventions are more
effective than standard group therapy.
5.2.2 Nicotine replacement therapy
A meta-analysis of more than 100 randomised controlled trials in general
populations 9 has demonstrated that all forms of NRT (including transdermal
patches, gum, inhalator, nasal spray, lozenges and others) are similarly effective in
aiding long-term cessation (overall OR 1.77, 95% CI 1.66–1.88), and that
combinations of slower (transdermal patches) and faster-acting NRT
formulations (oral or nasal delivery products) are more effective than either
formulation alone.
Use of NRT in people with SMI has not been subject to large-scale clinical
trials, although there are no grounds to suspect that NRT is likely to be
ineffective in this population. However, smokers with SMI tend to smoke more
cigarettes, 31,32 and to smoke each cigarette more intensely and hence extract
more nicotine from each cigarette, 33 so the severity of nicotine withdrawal
symptoms is likely to be particularly intense in this group. As in the general
population of more dependent smokers, it is therefore probably especially
important to use combination NRT, 9 supplementing a transdermal patch with a
faster-acting product (of which the nasal spray may be particularly effective 34 ), in
people with SMI. It is also probably important to continue NRT for longer than
the typically recommended 8–12 weeks, and indeed to consider long-term
86 © Royal College of Physicians 2013