Randomized Trial of a Smoking Cessation Program for Persons with SMI

描述(由申请人提供)： 摘要70%以上的严重和持续性精神疾病患者吸烟。我们发现，按照退伍军人管理局的要求，向SPMI患者提供戒烟5AS(询问、建议、评估、协助、安排)，可以适度减少吸烟，增加一些戒烟辅助工具的使用，但不会增加戒烟率。SPMI现有的戒烟“最佳实践”产生了较低的短期戒烟率，而且几乎没有持续戒烟。需要一种新的方法，这种方法是为SPMI患者设计的，并利用所有可用的策略进行成瘾治疗。我们开发了一种名为“SPMI戒烟行为治疗”(BTSCS)的干预措施，这是一项创新的计划，通过应急管理补充药物治疗和教育，以及解决SPMI患者特有的认知、动机和社会支持问题的多方面行为团体治疗。我们建议对BTSCS和反映当前最佳实践的手动标准戒烟方案(StSST)进行随机试验。BTSCS是仿照研究小组为患有双重障碍的人设计的一个成功的项目(SPMI中物质滥用的行为治疗)而建立的。假设：我们假设，根据自我报告和过期的CO水平，BTSCS在产生和维持戒断方面将比STSST更有效。受试人群：我们将招募210名SPMI患者，他们每天至少从退伍军人管理局马里兰州医疗保健系统中抽10支烟。我们预计随机抽取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)、3个月和6个月的随访时完成。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高医疗、经济和社会成本，并指示确保向退伍军人提供戒烟计划。测试针对SPMI患者的创新戒烟疗法对退伍军人具有非常重要的意义，因为：(1)退伍军人的吸烟率高于普通人群；(2)SPMI患者的吸烟率更高；(3)几乎没有针对SPMI退伍军人的有效戒烟治疗方法。 公共卫生相关性： 项目简介尽管人们普遍认识到吸烟对健康的破坏性影响，以及SMI人群中吸烟率极高，但SMI中的吸烟并没有得到应有的充分和紧迫的关注。鉴于SMI患者吸烟率的上升，我们努力测试一种创新的、基础广泛的戒烟计划，该计划是为满足这一多残疾人群的需求而量身定做的，具有显著的成本、健康和护理质量影响。将戒烟与心理健康治疗结合起来，也将为解决尼古丁成瘾问题提供一个新的背景，进一步加强这项研究的公共卫生意义。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Project Narrative Despite widespread recognition of the devastating health effects of smoking and the extraordinarily high rates of smoking in people SMI, smoking in SMI has not received the full and urgent attention that it deserves. Given the elevated rates of smoking among patients with SMI, our efforts to test an innovative, broad-based smoking cessation program that is tailored to the needs of this multi-handicapped population carry significant cost, health, and quality of care implications. Integration of smoking cessation within the context of mental health treatment will also provide a new context for addressing nicotine addiction, further enhancing the public health significance of the research.