An Open Trial of Relapse Prevention Therapy for Smokers With Schizophrenia

Abstract

Objective: Following successful smoking cessation, smokers with schizophrenia are vulnerable to relapse shortly after treatment discontinuation. Our objective was to assess the feasibility and effectiveness of a 12-month relapse prevention intervention in recently abstinent smokers with schizophrenia. Method: Adult outpatient smokers with schizophrenia received weekly cognitive-behavioral therapy groups, bupropion slow-release, transdermal nicotine patch, and nicotine gum or lozenge for 3 months. Subjects with 7-day point prevalence abstinence at month 3 received an additional 12 months (months 4 through 15) of therapy with bupropion, transdermal nicotine patch, and nicotine gum/lozenge in conjunction with relapse prevention–based cognitive-behavioral therapy groups that were held weekly in month 4, biweekly in months 5 and 6, and monthly in months 7 through 15. Results: Seventeen of 41 participants (41.5%) attained biochemically verified self-report of 7-day point prevalence abstinence at the end of 3 months of treatment and entered relapse prevention treatment. There was an 81% attendance rate at relapse prevention groups. At the end of the 12-month relapse prevention phase (month 15 overall), 11 of 17 (64.7%) demonstrated biochemically verified 7-day point prevalence abstinence, and 10 of 17 (58.8%) reported 4-week continuous abstinence. Almost one-quarter of the sample (23.5%) demonstrated long-term prolonged abstinence through the end of the trial. There were no clinically detected cases of psychiatric symptom exacerbation. One participant, who was managed as an outpatient, self-reported psychiatric symptom exacerbation in the interim period between study visits. Conclusions: Extended-duration smoking cessation treatment is well tolerated and may improve smoking outcomes for recently abstinent smokers with schizophrenia. Controlled trials are warranted.

Keywords:

• schizophrenia
• severe mental illness
• smoking cessation
• nicotine replacement therapy
• bupropion
• cognitive behavioral therapy
• relapse prevention

ACKNOWLEDGMENTS

We would like to thank the members of the Center for Addiction Medicine Manuscript Review Group for their suggested edits to the manuscript (Suzanne Hoeppner, PhD; John Kelly, PhD; Gladys Pachas, MD; Sungwon Roh, MD; Zev Schuman-Olivier, MD; and Luke Stoeckel, PhD). This work was supported by a grant from the Sidney R. Baer Foundation (Drs. Cather, Evins, and Goff), NIMH 5K24MH002025–10 (Dr. Goff), and the National Institutes of Drug Abuse 1K23DA00510 Nicotine and smoking cessation in schizophrenia (Dr. Evins).