Tobacco Dependence Clinical Trial
Official title:
Evaluation of Tobacco Treatment Strategies for Inpatient Psychiatry
This study aims to evaluate, in a randomized controlled trial, tobacco treatments of varying intensities for smokers hospitalized on acute psychiatric inpatient units.
Using a three group additive design, this randomized clinical trial (N=1100) aims to evaluate
tobacco cessation treatments of varying intensities initiated in the acute psychiatric
inpatient setting. The three groups are:
1. Usual Care (N=150) consisting of brief cessation advice, a quit smoking guide, and
nicotine replacement provided during hospitalization;
2. Brief Treatment (N=475) adds a stage-based manual, computer-delivered stage-tailored
individualized feedback and brief cessation counseling sessions during hospitalization
and repeated at months 3 and 6, and access to 12 weeks of nicotine replacement following
hospitalization;
3. Extended Treatment (N=475) builds upon our current brief treatment and provides 12
additional weeks of nicotine replacement (24 weeks total) with individualized,
counselor-delivered motivational and manualized cognitive behavioral cessation
treatment.
This study seeks to determine: (i) whether the initial successes seen in an academic-based
psychiatric hospital can be replicated in a larger and more diverse patient population; and
(ii) if more extended and intensive treatment combining nicotine replacement therapy (NRT)
with individualized, counselor-delivered motivational and manualized cessation-focused
cognitive behavioral counseling (CBT) can outperform our current best practices. Ultimately,
this research could lead to a model smoking cessation intervention for smokers with severe
mental illness and, more generally, may provide a useful model for understanding the nature
and complexity of intervening on comorbidities.
We hypothesize that the extended treatment will outperform the brief treatment, and that both
treatment groups will be more effective than usual care in producing quit attempts and
ultimately abstinence from cigarettes. Secondary specific aims will model the
cost-effectiveness and budgetary impacts of the treatment conditions; examine moderators and
mediators of treatment outcomes; and prospectively examine the relation between changes in
smoking, mental health functioning, and use of other substances over time.
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