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Treating PTSD and Smoking Together Best Way to Help Vets Kick Cigarettes
Date:12/7/2010

By Jenifer Goodwin
HealthDay Reporter

TUESDAY, Dec. 7 (HealthDay News) -- Combining post-traumatic stress disorder treatment with smoking cessation is the best way to help such veterans stop smoking, a new study reports.

In the study, Veterans Affairs (VA) researchers randomly assigned 943 smokers with PTSD from their wartime service into two groups: One group got mental health care and its participants were referred to a VA smoking cessation clinic. The other group received integrated care, in which VA mental health counselors provided smoking cessation treatment along with PTSD treatment.

Vets in the integrated care group were twice as likely to quit smoking for a prolonged period as the group referred to cessation clinics, the study reported. Both groups were recruited from outpatient PTSD clinics at 10 VA medical centers.

Researchers verified who had quit by using a test for exhaled carbon monoxide as well as a urine test that checked for cotinine, a byproduct of nicotine. Over a follow-up period of up to 48 months between 2004 and 2009, they found that forty-two patients, or nearly 9 percent, in the integrated care group quit smoking for at least a year, compared to 21 patients, or 4.5 percent, in the group referred to smoking cessation clinics.

"Veterans with PTSD can be helped for their nicotine addiction," said lead study author Miles McFall, director of post-traumatic stress disorder treatment programs at the VA Puget Sound Health Care System in Seattle. "We do have effective treatments to help them, and they should not be afraid to ask their health care provider, including mental health providers, for assistance in stopping smoking."

The study appears in the Dec. 8 issue of the Journal of the American Medical Association.

The study is "a major step forward on the road to abating the previously overlooked epidemic of tobacco dependence" plaguing people with mental illness, according to Judith Prochaska, an associate professor in the department of psychiatry at University of California, San Francisco, who wrote an accompanying editorial.

People with mental health problems or addictions such as alcoholism or substance abuse tend to smoke more than those in the general population, she said. For example, about 41 percent of the 10 million people in the United States who receive mental health treatment annually are smokers, according to background information in the article.

And, Prochaska added, of the 440,000 people who died each year of smoking-related illnesses in the United States, about 180,000 of them had a mental health or substance abuse problem.

Despite the toll of cigarettes, efforts to help people with mental health and substance abuse issues have been limited because of the mistaken assumption that smoking is a needed coping mechanism and that encouraging people to quit smoking is a lost cause, or will worsen their mental health condition or will make it harder to stay off drugs or alcohol, according to Prochaska.

"It's been in the culture of mental health and substance abuse counseling for so long," she said. "Tobacco has always been there. Treatment providers even smoke with patients; it's that ingrained."

Few researchers have studied smoking cessation and the mental health population, she added. Of about 8,700 trials on smoking cessation, fewer than two dozen have focused on smokers with addictive and mental health disorder because the problems of those patients are seen as too complicated, Prochaska said.

"There has been a longstanding concern that maybe you shouldn't treat tobacco [in patients with mental health problems]," Prochaska said. "But the data coming out now is not supporting that. There is data now that shows smokers with mental concerns are just as ready to quit smoking as smokers in the general population."

In the study, the integrated care was more effective in part because those veterans attended more smoking cessation counseling sessions and were more likely to use smoking cessations medications such as the nicotine patch, researchers noted.

In both groups, however, PTSD symptoms improved by 10 percent over the course of the follow-up period, while symptoms of depression did not worsen.

About 400,000 veterans go to VA clinics for PTSD treatment. Integrated treatment for war trauma and smoking could be especially effective in preventing tobacco-related health problems down the road among younger vets from Iraq and Afghanistan with PTSD, the researchers noted.

"Mental health providers who care for vets with PTSD can be effective change agents," McFall said. "They can deliver tobacco cessation care that is effective and safe."

More information

The National Institute of Mental Health has more on PTSD.

SOURCES: Miles McFall, Ph.D., director, post-traumatic stress disorder treatment programs and psychology service, Veterans Affairs Puget Sound Health Care System, and professor, University of Washington School of Medicine, Seattle; Judith Prochaska, Ph.D., M.P.H., associate professor, psychiatry, University of California, San Francisco; Dec. 8, 2010, Journal of the American Medical Association


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