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. 2020 Feb 1:207:107796.
doi: 10.1016/j.drugalcdep.2019.107796. Epub 2019 Dec 12.

Psychiatric comorbidities in a comparative effectiveness smoking cessation trial: Relations with cessation success, treatment response, and relapse risk factors

Adrienne L Johnson  1 , Jesse Kaye  1 , Timothy B Baker  2 , Michael C Fiore  2 , Jessica W Cook  1 , Megan E Piper  3
Affiliations

Psychiatric comorbidities in a comparative effectiveness smoking cessation trial: Relations with cessation success, treatment response, and relapse risk factors

Adrienne L Johnson et al. Drug Alcohol Depend. .

Abstract

Background: Comorbid psychiatric diagnoses have been shown to predict cessation failure. The relative impact of various diagnoses on cessation and other cessation processes is rarely studied, particularly among a general population. The impact of psychiatric history among primary care patients seeking cessation services on nicotine dependence, cessation outcomes, treatment effects and adherence, and withdrawal symptoms was examined.

Methods: Secondary data analysis of a multi-site comparative effectiveness smoking cessation trial was conducted. Adult smokers (n = 1051; 52.5 % Female, 68.1 % white) completed a structured clinical interview at baseline to assess psychiatric diagnostic history (past-year and lifetime). Nicotine dependence was assessed via self-report measures at baseline. Point-prevalence abstinence was assessed at 8 weeks and 6 months post-quit. Withdrawal symptoms were assessed for one week pre- and post-quit using ecological momentary assessment. Treatment adherence was self-reported at 1, 4, 8, and 12 weeks post-quit.

Results: Past-year substance use disorder, lifetime mood disorder, and > one lifetime diagnosis, were related to lower rates of short-term, but not long-term, cessation. Lifetime psychiatric diagnosis was related to elevated nicotine dependence, particularly to secondary dependence motives associated with instrumental tobacco use. History of psychiatric diagnosis was associated with increased withdrawal-related craving. There was little evidence that psychiatric diagnostic status moderated the effects of the tested pharmacotherapies on long-term abstinence.

Conclusions: Psychiatric diagnoses affect risk factors that exert their effects early in the post-quit process and highlight the potential utility of examining transdiagnostic risk factors to better understand the relations between psychiatric vulnerabilities and the smoking cessation process.

Keywords: Cessation; Cigarette; Nicotine dependence; Psychiatric comorbidity; Smoking.

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Conflict of interest statement

Conflict of Interest: No conflict declared.

Figures

Figure 1.
Figure 1.
Past-year psychiatric diagnosis distribution and 8-week and 6-month abstinence rates. aNumbers do not add up to total because participants could have more than one specific diagnosis (e.g., a diagnosis of both Generalized Anxiety Disorder and Panic Disorder in the past year).
Figure 2.
Figure 2.
Lifetime psychiatric diagnosis distribution and 8-week and 6-month abstinence rates. aNumbers do not add up to total because participants could have more than one specific diagnosis (e.g., a diagnosis of both Generalized Anxiety Disorder and Panic Disorder in their lifetime)
Figure 3.
Figure 3.
Latency to relapse for participants with a lifetime history of SUD compared to those with no lifetime psychiatric history. Cox-regression survival curves illustrate that participants with lifetime SUD relapse sooner than those with no lifetime psychiatric history (HR = 1.20; p = .04, 95% CI = 1.01–1.43).
Figure 4.
Figure 4.
Latency to relapse for participants with a lifetime history of more than one psychiatric diagnosis compared to those with no lifetime psychiatric history. Cox-regression survival curves show that participants with more than one lifetime psychiatric diagnosis relapse sooner than those with no lifetime psychiatric history (HR = 1.25; p = .02, 95% CI = 1.04–1.49).
Figure 5.
Figure 5.
8-week abstinence rates by treatment condition for lifetime psychiatric diagnoses. *p < .05. aResults remained unchanged after race and gender were added as covariates to the model.
Figure 6.
Figure 6.
6-month abstinence rates by treatment condition for lifetime psychiatric diagnosis. None of these abstinence rates were statistically significant across diagnostic condition.
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