group and 3% in the standard smoking-cessation group (difference not significant) (McFall et al., 2005, 2006). The sample was small, but, given the effect size, the committee considers that this intervention merits further study.

Collie et al. (2006) reported that cue-reactivity and coping-skills training may be beneficial in cessation efforts in smokers who have PTSD, extrapolating from the literature on preventing alcohol abuse. Other approaches that have been found effective in increasing tobacco-cessation rates in people with PTSD include supportive counseling and mood management, particularly before the quit attempt begins. Unaided quit attempts result in higher relapse rates in the first week after quitting in smokers with PTSD than in smokers without a mental disorder (Zvolensky et al., 2008).

One small trial of bupropion SR in PTSD patients found it to be effective compared with placebo (Hertzberg et al., 2001).

Depression

Research indicates that smokers with depression can be motivated to attempt to quit smoking and, with formal assistance, accept and use tobacco-cessation treatment (Acton et al., 2001; Haug et al., 2005; Prochaska et al., 2004a). Acceptance was not correlated with chronicity of depression history, severity of current depressive symptoms, severity of nicotine dependence, sex, age, or education (Haug et al., 2005). Recent research has shown that people in treatment for chronic depression can be treated for tobacco dependence with no adverse effects on their mental-health functioning or compensation with other substance use (Prochaska et al., 2008).

Meta-analyses of smoking-cessation trials published in 1988–2000 found that smokers with a history of depression were as likely as those without such a history to achieve short-term (up to 3 months) or long-term abstinence (at least 6 months) (Covey et al., 2006; Hitsman et al., 2003). Three randomized, controlled trials indicate that smokers with MDD are capable of achieving abstinence rates comparable with those of nondepressed smokers after similar interventions (Hall et al., 2006; Muñoz et al., 1997; Thorsteinsson et al., 2001). Several studies have compared standard smoking-cessation treatment (ST) with the combination of ST and cognitive-behavioral therapy for depression (CBT-D) in smokers with past MDD and recurrent MDD (Brown et al., 2001; Haas et al., 2004; Hall et al., 1994, 1996, 1998). Contrary to expectation, CBT-D with ST did not produce significantly higher abstinence rates than ST alone in smokers with past MDD, perhaps because these smokers already fared well in nonpharmacologic standard



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