Premium
Extended treatment of older cigarette smokers
Author(s) -
Hall Sharon M.,
Humfleet Gary L.,
Muñoz Ricardo F.,
Reus Victor I.,
Robbins Julie A.,
Prochaska Judith J.
Publication year - 2009
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/j.1360-0443.2009.02548.x
Subject(s) - abstinence , medicine , nicotine replacement therapy , randomized controlled trial , nicotine , cognitive behavioral therapy , nicotine gum , smoking cessation , clinical trial , bupropion , psychological intervention , nicotine withdrawal , physical therapy , psychiatry , placebo , alternative medicine , pathology
Aims Tobacco dependence treatments achieve abstinence rates of 25–30% at 1 year. Low rates may reflect failure to conceptualize tobacco dependence as a chronic disorder. The aims of the present study were to determine the efficacy of extended cognitive behavioral and pharmacological interventions in smokers ≥ 50 years of age, and to determine if gender differences in efficacy existed. Design Open randomized clinical trial. Setting A free‐standing, smoking treatment research clinic. Participants A total of 402 smokers of ≥ 10 cigarettes per day, all 50 years of age or older. Intervention Participants completed a 12‐week treatment that included group counseling, nicotine replacement therapy (NRT) and bupropion. Participants, independent of smoking status, were then assigned randomly to follow‐up conditions: (i) standard treatment (ST; no further treatment); (ii) extended NRT (E‐NRT; 40 weeks of nicotine gum availability); (iii) extended cognitive behavioral therapy (E‐CBT; 11 cognitive behavioral sessions over a 40‐week period); or (iv) E‐CBT plus E‐NRT (E‐combined; 11 cognitive behavioral sessions plus 40 weeks nicotine gum availability). Measurements Primary outcome variable was 7‐day point prevalence cigarette abstinence verified biochemically at weeks 24, 52, 64 and 104. Findings The most clinically important findings were significant main effects for treatment condition, time and the treatment × time interaction. The E‐CBT condition produced high cigarette abstinence rates that were maintained throughout the 2‐year study period [(week 24 (58%), 52 (55%), 64 (55%) and 104 (55%)], and was significantly more effective than E‐NRT and ST across that period. No other treatment condition was significantly different to ST. No effects for gender were found. Conclusions Extended cognitive behavioral treatments can produce high and stable cigarette abstinence rates for both men and women. NRT does not add to the efficacy of extended CBT, and may hamper its efficacy. Research is needed to determine if these results can be replicated in a sample with a greater range of ages, and improved upon with the addition of medications other than NRT.