with alcohol dependence (Fiore et al., 2008). Although quit rates and relapse rates are higher in populations with psychiatric disorders, long-term abstinence can be achieved. In treating psychiatric patients for tobacco use, it must be remembered that traditional tobacco-cessation therapies may need modification to address issues specific to a psychiatric population such as self-medication, the particular psychiatric diagnoses, medications that the patients are already taking for their psychiatric symptoms, and the need for modified psychotherapy. Furthermore, in treating nicotine addiction, as in treating such other addictions as heroin addiction, it may be necessary to provide treatment for longer periods than the typical 12 weeks (Schroeder, 2009). The committee notes that treatment of tobacco dependence in people who have psychiatric disorders requires a tailored approach to meet individual needs, treatment can be enhanced through a combination of medication and psychosocial therapy, and tobacco use can alter the effectiveness of a variety of medications.

Behavioral Interventions

Behavioral interventions have been applied for tobacco users with several mental-health disorders, including schizophrenia (McChargue et al., 2002; Ziedonis, 2004; Ziedonis et al., 2007), depression (Brown et al., 2001; Hitsman et al., 2003), and substance-use disorders (Gulliver et al., 2006; Kodl et al., 2006). The 2008 PHS guideline (Fiore et al., 2008) indicates that current evidence is insufficient to determine whether smokers with mental-health disorders are more likely to quit if they receive interventions tailored to their disorders or symptoms or whether standard treatments are equally effective. Ziedonis (2004) found that cessation interventions for psychiatric patients may include telephone-based counseling, Internet-based approaches, and face-to-face counseling, but more research is needed. They caution, however, that the interventions may be most effective in those with less severe mental illnesses, including addictions, because the interventions tend to be brief or time-limited and are not tailored to a particular mental illness.

Tobacco-Cessation Medications

In general, the FDA-approved tobacco-cessation medications that have been shown to be effective for the general population—NRTs (gum, patch, spray, lozenge, and inhaler), bupropion, and varenicline—have also been shown to be effective in people with psychiatric disorders (Fiore et al., 2008; Stapleton et al., 2008). However, as with patients with any comorbidity, treating tobacco dependence in psychiatric patients



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