Treating Tobacco Dependence in Inpatient Psychiatry

描述(由申请人提供)： 尼古丁依赖是精神疾病患者中最常见的物质滥用障碍，这一群体占美国烟草市场的44%。虽然许多试验已经确定了戒烟干预对住院内科患者的有效性，但精神科住院患者基本上被排除在外。这项提议的目的是支持候选人发展技能，以便在新的环境中与患有共病的吸烟者进行烟草依赖治疗领域的以患者为导向的研究。职业生涯计划包括临床试验、成本效益和精神药理学方面的培训。加州大学旧金山分校精神病学系和NIDA资助的P50旧金山治疗中心为培养研究人员提供了一个特殊的环境。主要导师莎伦·霍尔博士是治疗尼古丁依赖和其他药物滥用的领先专家。她广泛的研究背景包括在精神科环境中治疗共病吸烟者。该研究计划的主要具体目标是在一项随机临床试验(N=300)中测试一系列假说，这些假说涉及延长专家系统干预加尼古丁替代疗法(NRT)在治疗在无烟精神病室住院的患者中对烟草依赖的疗效。据推测，在3个月、6个月、12个月和18个月的随访中，干预措施将比增强型标准护理控制条件(带自助手册的单位内NRT)更有效地产生经生物化学证实的戒烟。此外，干预参与者将表现出更大的阶段性进展，对戒烟的承诺，以及出院后再次吸烟的延迟，这些因素预示着未来戒烟的成功。戒烟治疗已被证明在普通吸烟者中具有很高的成本效益，在努力将更多的服务纳入住院精神环境时，成本可能是一个考虑因素。因此，第二个具体目标是建立戒烟干预措施的成本效益模型。干预效果将在以大学为基础的精神科住院病房进行检查。一项规模较小的试点研究(N=48)将检查将干预措施转化为一家为更多样化的患者群体提供服务的县医院。研究结果将被用于提交R01申请，以进行一项多点随机试验。

DESCRIPTION (provided by applicant): Nicotine dependence is the most prevalent substance abuse disorder among psychiatric patients, a group that accounts for 44% of the U.S. tobacco market. While numerous trials have established the effectiveness of smoking cessation interventions for hospitalized medical patients, psychiatric inpatients have largely been excluded. The objective of this proposal is to support the candidate's development of skills to perform patient-oriented research in the area of tobacco dependence treatment with comorbid smokers in new settings. The career plan includes training in clinical trials, cost-effectiveness, and psychopharmacology. The UCSF Department of Psychiatry and the NIDA-funded P50 San Francisco Treatment Center provide an exceptional environment for developing research investigators. The primary mentor, Dr. Sharon Hall, is a leading expert in the treatment of nicotine dependence and other drugs of abuse. Her extensive research background includes treatment of comorbid smokers in psychiatric settings. The primary specific aim of the research plan is to test in a randomized clinical trial (N=300) a series of hypotheses concerning the efficacy of an extended expert-system intervention plus nicotine replacement therapy (NRT) for treating tobacco dependence among patients hospitalized on a smoke-free psychiatric unit. It is hypothesized that the intervention will be more effective than the enhanced standard care control condition (on-unit NRT with self-help brochure) in producing biochemically verified abstinence from cigarettes at 3-, 6-, 12-, and 18-months follow up. Additionally, intervention participants will exhibit greater stage progression, commitment to abstinence, and delay in relapse to smoking following hospital discharge, factors predictive of future success with quitting smoking. Smoking cessation treatments have been shown to be highly cost-effective with the general population of smokers, and cost is likely to be a consideration in efforts to incorporate additional services into an inpatient psychiatric setting. Therefore, a secondary specific aim is to model the cost-effectiveness of the smoking cessation intervention. Intervention efficacy will be examined in a university-based psychiatric inpatient unit. A smaller pilot study (N=48) will examine translation of the intervention to a county hospital serving a more diversified patient population. Findings will be used in submission of an R01 application to conduct a multisite randomized trial.