For people with serious mental illness who are trying to quit smoking, extending their treatment with the smoking cessation drug Chantix (varenicline) may help them avoid a relapse, according to a new study.
After a standard 12-week course of treatment with the drug, study participants who quit smoking continued to receive the drug along with a type of treatment that helps alter behavior, called cognitive behavioral therapy, for another 40 weeks. After receiving the extended treatment, they were three times more successful in avoiding cigarettes than those who only received the behavioral therapy and a placebo (fake) pill, the study found.
"We know that relapsing to smoking is a big problem for smokers without psychiatric illness, but relapsing after a course of smoking cessation medication appears to happen even more rapidly in those with schizophrenia and related disorders," study author Dr. Eden Evins, director of the Massachusetts General Hospital Center for Addiction Medicine, said in a hospital news release.
"Maintenance therapy to help these patients sustain abstinence could reduce an important source of stigma, along with their heavy burden of smoking-related illness," Evins said.
In contrast with other U.S. adults, the prevalence of smoking among those with serious mental illness is even higher now than it was in 1965, the study authors said. Yet, while most people with schizophrenia or bipolar disorder smoke, adults with serious mental illness are rarely offered even a standard course of medication to help them stop smoking, the researchers pointed out in the news release.
The new study, published in the Jan. 8 issue of the Journal of the American Medical Association, involved 203 patients being treated at 10 mental health centers in six states for schizophrenia, a related condition known as schizoaffective disorder or bipolar disorder. During the first 12 weeks of treatment, the participants received a daily dose of Chantix (a prescription drug) and weekly group behavioral therapy sessions.
Of the 203 participants, 87 were considered to be abstinent. These patients were randomly assigned to continue to receive Chantix or a placebo for an additional 40 weeks. Although both groups continued to receive behavioral therapy, these sessions became less frequent over the course of the 12-month study.
Based on self-reporting and levels of exhaled carbon monoxide, the researchers found that 60 percent of the participants who received the extended treatment with Chantix remained abstinent. Meanwhile, 19 percent of the placebo group had managed to continue to avoid cigarettes.
Half of those in the placebo group smoked within 35 days of stopping the drug. In contrast, it took nearly one year for half of those in the Chantix group to relapse, the investigators found.
Although behavioral therapy alone was not enough to prevent relapse in the placebo group, the researchers pointed out that most of the patients in the Chantix group who relapsed did so after the behavioral therapy was cut back. They concluded that behavioral therapy likely plays a supportive role in treatment with Chantix.
"Since we don't know yet how well varenicline would work without cognitive behavioral therapy, we would recommend that these patients be offered both therapies together to support smoking cessation and continued abstinence," Evins said in the news release.
Study funding included two grants from the U.S. National Institute on Drug Abuse.
The researchers said more studies are needed to examine the effectiveness of combinations of treatment involving medication and other forms of behavioral support, such as telephone quit lines.
-- Mary Elizabeth Dallas
