Combining PTSD, Stop-Smoking Therapies Works
Study: More Quit Smoking When Treatments Are Combined
By Bill Hendrick
WebMD Health News
Reviewed by Laura J. Martin, MD
crushed cigarette and ashes

Dec. 7, 2010 -- People with military-related posttraumatic stress disorder have a better chance of quitting smoking if their PTSD therapy is combined with clinical treatment for fighting their nicotine habit, new research indicates.

Miles McFall, PhD, of the Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues found in a study that combining smoking cessation therapy with mental health treatment of PTSD helped veterans improve their tobacco abstinence rates, compared with those who received mental health care and smoking cessation treatment separately.

The study involved 943 military-related PTSD patients who were followed for 18 to 48 months between November 2004 and July 2009.

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Nicotine Addiction and Mental Illness

Nicotine dependence is more common among people with mental illness. And PTSD, which is considered a mental disorder, is highly associated with smoking and unsuccessful attempts to quit. Indeed, 45% of PTSD patients are smokers or use tobacco in some form.

According to the Department of Veterans Affairs, about 400,000 veterans are being treated for PTSD.
PTSD Therapy and Quitting Smoking

The PTSD patients in the study who received smoking cessation treatment integrated with mental health care were twice as likely to quit as those who received mental health care and smoking cessation treatment separately. They also were more likely to use smoking cessation medications than those enrolled only in programs designed to help them quit smoking, the researchers say.

“Number of counseling sessions received and days of cessation medication used explained 39.1% of the treatment effect,” the study authors write.

In addition, the authors say, “post-traumatic stress disorder symptoms for quitters and non-quitters improved” among both groups. “Delivering cessation assistance as part of primary mental health treatment was both more effective than referral and led to greater intensity of treatment utilization, a major factor in treatment effectiveness,” the authors write. “Integrated care could be applied to the sizable proportion of smokers among the approximately 400,000 veterans enrolled in VA care for PTSD.”

The study is published in the Dec. 8 issue of the Journal of the American Medical Association.
Advance in Treating Tobacco Dependence

Judith J. Prochaska, PhD, MPH, of the University of California-San Francisco, writes in an accompanying editorial that the study findings show a significant treatment effect in a diverse group of patients with PTSD. She says the study “represents a significant advance in the evidence base on the effectiveness of treating tobacco dependence in smokers with mental disorders and integration of tobacco treatment services into mental health care settings.

She says the study “represents a major step forward on the path to abating the previously overlooked epidemic of tobacco dependence that has plagued persons with mental illness.”