Multimodal treatment for smoking cessation with varenicline in alcoholic, methadone-maintained, and psychotic patients: A one-year follow-up
More details
Hide details
Group of Research SAMIS, Mental Health Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Spain
Addiction Unit, Mental Health Department, Hospital de Sant Pau, Barcelona, Spain
Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clínic, IDIBAPS, Barcelona, Spain
Tobacco Control Unit, Institut Català d’Oncologia, IDIBELL, Barcelona, Spain
Research Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
Antonia Raich   

Group of Research SAMIS, Mental Health Department, Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain
Publish date: 2018-12-11
Tob. Induc. Dis. 2018;16(December):58
*Tobacco Group of the Catalan Network for Addiction Treatment: Montse Ballbè, Margarita Cano, Blanca Carcolé, Teresa Fernández, Àngela Martínez, Sílvia Mondon, Gemma Nieva, Cristina Pinet, Antònia Raich, Pilar Roig, Imma Serra, Jaume Serrano
Numerous studies have evaluated the efficacy and safety of varenicline for smoking cessation in smokers in the general population and, to a lesser extent, among the psychiatric population. However, few studies have evaluated varenicline in patients with other addictions. The present study was conducted to assess outcomes of a multimodal treatment for smoking cessation intervention with varenicline in a sample of alcohol and substance use disorders and patients with psychotic disorders.

This was a prospective, multicenter study. The patient sample comprised alcoholics in remission, methadone-maintained patients, and patients with psychotic disorders, all of whom wanted to stop smoking. All participants received multimodal treatment for smoking cessation therapy (psychological therapy plus varenicline). Smoking abstinence and changes in the psychopathological state of patients were assessed at predefined time points during a 12-month follow-up. The probability of tobacco abstinence after one year of treatment was computed using Kaplan-Meier life tables.

The probability of abstinence at one year was 0.225 (95% CI: 0.143- 0.319). By group, the probabilities were as follows: patients with psychotic disorders 0.254 (95% CI: 0.118-0.415); alcoholics 0.237 (95% CI: 0.098- 0.409); and methadone-maintained patients 0.177 (95% CI: 0.065-0.335). Patients with previous quit attempts had a higher probability of achieving abstinence at one year (p<0.01).

The results of this study support the use of multimodal treatment with varenicline in patients with alcohol addiction in remission, patients on methadone maintenance, and patients with stable psychotic disorders. Previous smoking cessation attempts were predictive of smoking cessation success in these patients.

World Health Organization. WHO report on the global tobacco epidemic, 2008. The MPOWER package. Published, 2008. Accessed July 12, 2018.
Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence study. JAMA. 2000;284(20):2606-2610. doi:10.1001/jama.284.20.2606
Grant BF, Hasin DS, Chou SP, Stinson FS, Dawson DA. Nicotine dependence and psychiatric disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry. 2004;61(11):1107-1115. doi:10.1001/archpsyc.61.11.1107
Vanable PA, Carey MP, Carey KB, Maisto SA. Smoking among psychiatric outpatients: relationship to substance use, diagnosis, and illness severity. Psychology of Addictive Behaviors. 2003;17(4):259. doi:10.1037/0893-164x.17.4.259
Purvis TL, Nelson LA, Mambourg SE. Varenicline use in patients with mental illness: an update of the evidence. Expert Opinion on Drug Safety. 2010;9(3):471-482. doi:10.1517/14740331003657133
Brown S. Causes of the Excess Mortality of Schizophrenia. The British Journal of Psychiatry. 2000;177(3): 212-217. doi:10.1192/bjp.177.3.212
Osborn DJ, Levy G, Nazareth I, Petersen I, Islam A, King MB. Relative Risk of Cardiovascular and Cancer Mortality in People with Severe Mental Illness from the United Kingdom’s General Practice Research Database. Archives of General Psychiatry. 2007;64(2):242-249. doi:10.1001/archpsyc.64.2.242
Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz N, Curry SJ. Treating Tobacco Use and Dependence: 2008 Update U.S. Public Health Service Clinical Practice Guideline Executive Summary. Respiratory Care. 2008;53(9):1217-1222.
Ranney L, Melvin C, Lux L, McClain E, Lohr KN. Systematic review: smoking cessation intervention strategies for adults and adults in special populations. Annals of Internal Medicine. 2006;145(11):845-856. doi:10.7326/0003-4819-145-11-200612050-00142
Thurgood SL, McNeill A, Clark-Carter D, Brose LS. A systematic review of smoking cessation interventions for adults in substance abuse treatment or recovery. Nicotine & Tobacco Research, 2016;18(5):993-1001. doi:10.1093/ntr/ntv127
Anthenelli RM, Benowitz NL, West R, et al. Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. The Lancet. 2016;387(10037):2507-2520. doi:10.1016/S0140-6736(16)30272-0
Etter J. Cytisine for Smoking Cessation: A Literature Review and a Meta-Analysis. Archives of Internal Medicine. 2006;166(15):1553-1559. doi:10.1001/archinte.166.15.1553
Oncken C, Gonzales D, Nides M, et al. Efficacy and safety of the novel selective nicotinic acetylcholine receptor partial agonist, varenicline, for smoking cessation. Archives of Internal Medicine. 2006;166(15):1571-1577. doi:10.1001/archinte.166.15.1571
Aubin HJ, Bobak A, Britton JR, et al. Varenicline versus transdermal nicotine patch for smoking cessation: results from a randomised open-label trial. Thorax. 2008;63(8):717-724. doi:10.1136/thx.2007.090647
Jorenby DE, Hays JT, Rigotti NA, et al. Efficacy of varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. JAMA. 2006;296(1):56-63. doi:10.1001/jama.296.1.56
Rigotti NA, Pipe AL, Benowitz NL, Arteaga C, Garza D, Tonstad S. Efficacy and Safety of Varenicline for Smoking Cessation in Patients With Cardiovascular Disease. Circulation. 2010;121(2):221-229. doi:10.1161/CIRCULATIONAHA.109.869008
Tashkin DP, Rennard S, Hays JT, Ma W, Lawrence D, Lee TC. Effects of varenicline on smoking cessation in patients with mild to moderate COPD: a randomized controlled trial. Chest Journal. 2011;139(3):591-599. doi:10.1001/jama.296.1.64
Kotz D, Viechtbauer W, Simpson C, van Schayck OC, West R, Sheikh A. Cardiovascular and neuropsychiatric risks of varenicline: a retrospective cohort study. Lancet Respir Med. 2015;3(10):761-768. doi:10.1016/s2213-2600(15)00320-3
Pichot P, Lopez-Ibor J, Valdes M. DSM-IV: breviario criterios diagnosticos. 1. Barcelona: Masson; 1997: 136.
Lopez-Castroman J, Cerrato L, Beziat S, Jaussent I, Guillaume S, Courtet P. Heavy tobacco dependence in suicide attempters making recurrent and medically serious attempts. Drug and Alcohol Dependence. 2016;160:177-182. doi:10.1016/j.drugalcdep.2016.01.004
Middleton ET, Morice AH. Breath Carbon Monoxide as an Indication of Smoking Habit. Chest. 2000;117(3):758-763. doi:10.1378/chest.117.3.758
Raich A, Ballbè M, Nieva G, et al. Safety of Varenicline for Smoking Cessation in Psychiatric and Addicts Patients. Substance Use & Misuse. 2016;51(5):649-657. doi:10.3109/10826084.2015.1133646
Garcia-Portilla, Garcia-Alvarez, Saiz PA, et al. Effectiveness of a Multi-Component Smoking Cessation Support Programme (McSCSP) for Patients with Severe Mental Disorders: Study Design. International Journal of Environmental Research and Public Health. 2014;11(1):373-389. doi:10.3390/ijerph110100373
Ballbè M, Bruguera E, Vega MC, et al. Guia de intervención clínica en el consumo de tabaco en pacientes con trastorno mental. Barcelona: Xarxa Catalana d’Hospitals sense Fum, Institut Català d’Oncologia, Departament de Salut de la Generalitat de Catalunya; 2012: 22-27. Accessed July 12, 2018.
Benli AR, Erturhan S, Oruc MA, Kalpakci P, Sunay D, Demirel Y. A comparison of the efficacy of varenicline and bupropion and an evaluation of the effect of the medications in the context of the smoking cessation programme. Tobacco Induced Diseases. 2017;15(February). doi:10.1186/s12971-017-0116-0
Grant KM, Kelley SS, Smith LM, Agrawal S, Meyer JR, Romberger DJ. Bupropion and nicotine patch as smoking cessation aids in alcoholics. Alcohol. 2007;41(5):381-391. doi:10.1016/j.alcohol.2007.03.011
Hurt RD, Offord KP, Croghan IT, et al. Mortality following inpatient addictions treatment: Role of tobacco use in a community-based cohort. JAMA. 1996;275(14):1097-1103. doi:10.1001/jama.275.14.1097
Nahvi S, Ning Y, Segal KS, Richter KP, Arnsten JH. Varenicline efficacy and safety among methadone maintained smokers: a randomized placebo‐controlled trial. Addiction. 2014;109(9):1554-1563. doi:10.1111/add.12631
Hitsman B, Moss TG, Montoya ID, George TP. Treatment of tobacco dependence in mental health and addictive disorders. Can J Psychiatry. 2009;54:368-378. doi:10.1177/070674370905400604
Stein MD, Weinstock MC, Herman DS, Anderson BJ, Anthony JL, Niaura RA. Smoking cessation intervention for the methadone-maintained. Addiction. 2006;101(4):599-607. doi:10.1111/j.1360-0443.2006.01406.x
Stein MD, Caviness CA, Kurth ME, Audet D, Olson J, Anderson BJ. Varenicline for Smoking Cessation Among Methadone-Maintained Smokers: A Randomized Clinical Trial. Drug and Alcohol Dependence. 2013;133(2):486-493. doi:10.1016/j.drugalcdep.2013.07.005
Janke van Holst R, Schilt T. Drug-related decrease in neuropsychological functions of abstinent drug users. Current Drug Abuse Reviews. 2011;4(1):42-56. doi:10.2174/1874473711104010042
Martínez C, Guydish J, Le T, Tajima B, Passalacqua E. Predictors of quit attempts among smokers enrolled in substance abuse treatment. Addictive Behaviors. 2015;40:1-6. doi:10.1016/j.addbeh.2014.08.005
Piñeiro B, López-Durán A, del Río EF, Martínez U, Brandon TH, Becoña E. Motivation to quit as a predictor of smoking cessation and abstinence maintenance among treated Spanish smokers. Addictive Behaviors. 2016;53:40-45. doi:10.1016/j.addbeh.2015.09.017