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Combining Smoking Cessation with PTSD Therapy Boosts Quit Rates

by U.S. Medicine

January 22, 2011

WASHINGTON, DC—Smoking cessation treatment that is made part of mental healthcare for veterans with PTSD improves quit rates, according to a VA study published in the December 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 Robert Petzel, MD. “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% for the integrated care group, versus 11% 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% to almost 9%.

Also, veterans in the study who quit smoking showed no worsening of symptoms of PTSD or depression. In fact, study participants averaged a 10% reduction in PTSD symptoms, regardless of which treatment they received or whether they quit smoking or not. According to the researchers, the findings help dispel concerns that combining care for PTSD and smoking cessation detracts from PTSD treatment or makes it less effective.

The results validate a promising new VA model of care that can make safe, effective smoking cessation treatment available to more veterans with PTSD, study leaders Miles McFall, PhD, and Andrew Saxon, MD, said. The new approach may also be effective for smokers receiving mental healthcare for other psychiatric illnesses. 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 healthcare 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.

Of some 400,000 veterans being treated for PTSD in the VA healthcare system, roughly 30 to 50% are smokers, compared to a smoking rate of 19.5% among VA enrollees and 21% among US adults nationwide. Research shows that those with PTSD smoke more heavily than smokers without PTSD and have an especially hard time quitting.

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 noted 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, who stand to benefit greatly from quitting smoking relatively early in life.

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