Randomized Trial of a Smoking Cessation Program for Persons with SMI

摘要 超过70%的严重和持续性精神疾病患者吸烟 香烟。我们发现，提供戒烟的5个AS(询问、建议、 对SPMI患者进行评估、协助、安排)，这是退伍军人管理局要求的做法，产生 吸烟的适度减少和一些戒烟辅助工具的使用增加，但 不会增加禁欲。SPMI中现有的戒烟“最佳实践” 产生较低的短期禁酒率，几乎没有持续的禁欲。一种新的 需要为SPMI患者设计的方法，并利用所有可用的 成瘾治疗的策略。我们开发了一种名为“行为干预”的干预方法 SPMI戒烟治疗“(BTSCS)，这是一项创新计划， 通过应急管理补充药物治疗和教育 多方面的行为团体治疗，解决认知、动机和 SPMI患者特有的社会支持问题。我们建议进行一项 BTSCS的随机试验与手动标准戒烟方案的比较 (STSST)，这反映了当前的最佳做法。BTSCS是在一次成功的 由研究小组创建的计划(SPMI中药物滥用的行为治疗) 这是为患有双重障碍的人设计的。 假设：我们假设BTSCS将比STSST更有效地生产 和 通过自我报告和过期的CO水平来衡量持续戒断。 受试人群：我们将招募210名吸烟至少10人的SPMI患者 每天从退伍军人事务部马里兰州医疗保健系统获得的香烟。我们希望随机化 178人。 程序：两种情况下的参与者都将接受短暂的外展。研究 评估将在基线、3个月(治疗结束)和3-和6- 一个月的随访。 对退伍军人医疗保健的潜在影响：退伍军人管理局已经认识到， 吸烟的经济和社会成本，以及确保向退伍军人提供 戒烟计划。为患有以下疾病的人测试一种创新的戒烟疗法 SPMI对退伍军人非常重要，因为：(1)退伍军人的吸烟率 高于普通人群；(2)SPMI患者的吸烟率为 更高，以及；(3)实际上没有针对患有以下疾病的退伍军人的戒烟治疗 在产生禁欲方面有效的SPMI。

Abstract Over 70% of people with serious and persistent mental illnesses (SPMI) smoke cigarettes. We have found that delivery of the 5 As of smoking cessation (Ask, Advise, Assess, Assist, Arrange) to persons with SPMI, a practice required by the VA, produces modest reductions in smoking and some increased use of smoking cessation aids, but does not increase abstinence. Existing "best practices" for smoking cessation in SPMI produce low short-term abstinence rates and almost no sustained abstinence. A new approach is needed that is designed for persons with SPMI and utilizes all available strategies for addiction treatment. We have developed an intervention called "Behavioral Treatment of Smoking Cessation in SPMI" (BTSCS), an innovative program that supplements pharmacotherapy and education with contingency management and a multifaceted behavioral group treatment that addresses the cognitive, motivational, and social support problems characteristic of people with SPMI. We propose to conduct a randomized trial of BTSCS compared to a manualized standard cessation program (StSST) that reflects current best practices. BTSCS was modeled after a successful program (Behavioral Treatment of Substance Abuse in SPMI) created by the study team that was designed for people with dual disorders. Hypotheses: We hypothesize that BTSCS will be more effective than StSST in producing and sustaining abstinence as measured by self report and expired CO levels. Subject Population: We will recruit 210 people with SPMI who smoke at least 10 cigarettes per day from the VA Maryland Healthcare System. We expect to randomize 178 people. Procedures: Participants in both conditions will receive brief outreach. Research assessments will be completed at baseline, 3 months (end of treatment), and 3- and 6- month follow ups. Potential Impact on Veterans' Health Care: The VA has recognized the high medical, economic, and social costs of smoking with directives to ensure that veterans are offered cessation programs. Testing an innovative smoking cessation treatment for persons with SPMI is highly significant for the VA because: (1) the rates of smoking among veterans are higher that the general population; (2) smoking rates among persons with SPMI are higher still, and; (3) there are virtually no smoking cessation treatments for veterans with SPMI that are effective in producing abstinence.