Specific programs should be developed and evaluated to ensure the availability of effective tools to address tobacco cessation in military personnel with PTSD. It should be noted that one of the most promising new medications for tobacco cessation, varenicline, was given a safety alert by FDA in 2008. In June 2008, the following DoD medication safety notice was issued (http://www.health.mil/Press/Release.aspx?ID=244):

“In light of recent reports linking varenicline (Chantix) to hallucinations and even suicide, the [MHS] would like to re-issue our Medication Safety Notice concerning the use of varenicline (Chantix), a prescription drug used across the country in smoking-cessation programs. While the drug is not on the TRICARE formulary, many MHS patients have prescriptions for it. It is highly recommended that a doctor be consulted immediately in rare cases of psychiatric side effects including nightmares, paranoia, or feelings of suicide. In response to the recent FDA warnings, the [MHS] is analyzing all available information in a continuing effort to maintain the highest levels of safety and security for our beneficiaries.”

Finding: Military service, particularly deployment, increases the likelihood of tobacco use as a result of stress and boredom (see Chapter 3). Deployed military personnel have higher rates of mental-health disorders than nondeployed personnel. Evidence suggests that people with mental-health disorders are willing and able to participate in tobacco-cessation treatments.


Recommendation: Military health-care providers should continue to ask patients who have mental-health disorders about their interest in tobacco cessation and should provide cessation treatments to patients willing to make an attempt to quit.

Smokeless Tobacco and Dual Use

One of the groups at highest risk for adoption and use of smokeless tobacco is the US military (Peterson et al., 2007). Recent data (DoD, 2006) indicate that 14.5% of all military personnel regularly use



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