Extended nortriptyline and psychological treatment for cigarette smoking.
OBJECTIVE
Accepted treatments for cigarette smoking rarely achieve abstinence rates of >35% at 1 year. Low rates may reflect failure to provide extended and multifocal treatment for this complex and chronic addiction. Using a chronic disease model of smoking, the authors undertook a study to determine the effects of long-term antidepressant and psychological treatment.


METHODS
One hundred sixty smokers of > or =10 cigarettes/day were randomly assigned to one of four treatment conditions in a two-by-two (nortriptyline versus placebo by brief versus extended treatment) design. All subjects received 8 weeks of a transdermal nicotine patch, five group counseling sessions, and active or placebo treatment. Interventions for subjects in brief treatment ended at this point. Subjects in extended treatment continued taking drug or placebo to week 52 and received an additional 9 monthly counseling sessions, with checkup telephone calls midway through each session. Subjects were assessed at baseline and weeks 12, 24, 36, and 52. The principal outcome variables were repeated abstinence at each assessment after the first over a 1-year period and a point prevalence of 7 days of abstinence.


RESULTS
At week 52, point-prevalence abstinence rates with missing subjects imputed as smokers were 30% for placebo brief treatment, 42% for placebo extended treatment, 18% for active brief treatment, and 50% for active extended treatment. With missing subjects omitted, these rates were 32%, 57%, 21%, and 56%, respectively.


CONCLUSIONS
Comprehensive extended treatments that combine drug and psychological interventions can produce consistent abstinence rates that are substantially higher than those in the literature.
Hall
Sharon M
SM
University of California-San Francisco, 401 Parnassus Ave., Box 0984, San Francisco, CA 94143-0984, USA. smh@itsa.ucsf.edu
Humfleet
Gary L
GL
Reus
Victor I
VI
Muñoz
Ricardo F
RF
Cullen
Jennifer
J
D000279:Administration, Cutaneous; D000328:Adult; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D001521:Behavior Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003376:Counseling; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009538:Nicotine / Q000008:administration & dosage / Q000627:therapeutic use; D009661:Nortriptyline / Q000627:therapeutic use*; D010919:Placebos; D011615:Psychotherapy, Group / Q000379:methods; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D010919:Placebos; D009538:Nicotine; D009661:Nortriptyline