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Vets with traumatic stress can kick smoking habit

StressAug 26, 05

Veterans with Post-Traumatic Stress Disorder have a high rate of smoking and a poor rate of quitting, but new research shows that adding smoking-cessation therapy to their routine mental health care may help.

This “integrated” care, researchers found, was more successful in helping vets kick the smoking habit than the traditional approach of sending them to a specialized smoking-cessation clinic.

Post-Traumatic Stress Disorder, or PTSD, is a common mental health problem among combat veterans and others exposed to a traumatic event. Along with the typical symptoms of the disorder—including flashbacks to the trauma, Insomnia, Depression and anxiety—many veterans with PTSD smoke; their smoking rate is roughly double that of other vets.

They also have a tough time quitting. Studies show that people with PTSD have a quit rate that’s only half of that among smokers without a psychiatric disorder.

In the new study, researchers with the U.S. Department of Veterans Affairs and the University of Washington in Seattle looked at whether integrating smoking-cessation therapy into the routine care of PTSD could help more veterans give up the habit.

The researchers randomly assigned 66 veterans to receive either integrated care or standard care, in which smokers are referred to specialized clinics for cessation therapy.

They found that over the next 9 months, patients who received integrated care were five times more likely than their fellow veterans to abstain from smoking.

The researchers, led by Dr. Miles McFall of the VA Puget Sound Health Care System in Seattle, report the findings in the American Journal of Psychiatry.

Patients in the integrated-care group received medications—such as nicotine patches or gum—from the psychiatrist or nurse practitioner managing their drug treatment for PTSD. They also regularly attended counseling sessions.

Those in the standard-care group also received medication and counseling, but at a separate clinic. All of the patients were assessed at 2, 4, 6 and 9 months after the start of therapy.

Overall, 52 percent of veterans in integrated care were able to stop smoking at some point during the follow-up, versus only 25 percent of those in standard care. At any one assessment point, McFall’s team found, patients in integrated care were five times more likely to have stopped smoking.

They also gave higher ratings to the quality of their care and reported greater satisfaction with their therapy than their fellow veterans did.

McFall and his colleagues speculate that integrated care was more successful at “engaging” patients in their smoking-cessation therapy. Continuous contact with the same psychiatrists and nurses, the researchers note, may have allowed better monitoring and management of relapse problems.

They call for more studies into the integrated approach to smoking cessation, in PTSD and other mental health conditions as well. In general, the researchers point out, people with psychiatric disorders have “extraordinarily high” rates of smoking, as high as 50 percent.

SOURCE: American Journal of Psychiatry, July 2005.

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