Treating Tobacco Dependence in Inpatient Psychiatry

描述（由申请人提供）： 尼古丁依赖是精神病患者中最普遍的物质滥用障碍，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措施对住院医疗患者的有效性，但精神病住院患者在很大程度上被排除在外。该提案的目的是支持候选人发展技能，以便在新环境中对合并症吸烟者进行烟草依赖治疗领域以患者为导向的研究。职业计划包括临床试验，成本效益和精神药理学方面的培训。UCSF精神病学系和NIDA资助的P50 San弗朗西斯科治疗中心为开发研究人员提供了一个特殊的环境。主要导师Sharon Hall博士是治疗尼古丁依赖和其他滥用药物的领先专家。她广泛的研究背景包括在精神病环境中治疗共病吸烟者。研究计划的主要具体目的是在一项随机临床试验（N=300）中测试一系列关于扩展专家系统干预加尼古丁替代疗法（NRT）治疗无烟精神科住院患者烟草依赖的有效性的假设。据推测，在3个月、6个月、12个月和18个月的随访中，干预将比增强的标准护理控制条件（带自助手册的单元NRT）更有效地产生经生化验证的戒烟。此外，干预参与者将表现出更大的阶段进展，承诺戒烟，并延迟出院后的吸烟复发，这些因素预测未来戒烟成功。戒烟治疗已被证明是非常具有成本效益的一般人群的吸烟者，成本很可能是一个考虑因素，努力将额外的服务纳入住院精神病设置。因此，第二个具体目标是模拟戒烟干预的成本效益。干预效果将在一所大学的精神科住院部进行检查。一项规模较小的试点研究（N=48）将检查干预措施的翻译，以县医院服务于更多样化的患者人群。结果将用于提交R01申请，以进行多中心随机试验。

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.