Comorbidity, Smoking Behavior and Treatment OutcomeKeuthen N.J.a · Niaura R.S.b · Borrelli B.a · Goldstein M.b · DePue J.b · Murphy C.a · Gastfriend D.a · Reiter S.R.a · Abrams D.b
aDepartment of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, Mass.; bDivision of Behavioral and Preventive Medicine, Miriam Hospital and Brown University Medical School, Providence, R.I., USA
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Background: A sizeable sector of the population continues to smoke cigarettes despite our efforts to prevent and treat this addiction. We explored the relationships between lifetime comorbidity, psychiatric symptomatology, smoking behavior and treatment outcome to better understand vulnerability to smoking and treatment response. Methods: One hundred and twenty smokers at two sites were enrolled in a multicenter, double-blind, randomized, 10-week smoking cessation trial with fluoxetine and behavioral treatment. The Structured Clinical Interview for DSM-III-R and Hamilton Depression Rating Scale were administered prior to treatment initiation. Self-report measures were used to assess psychiatric symptoms throughout treatment and during a 6-month follow-up period. Results: Overall 62.3% of our sample were diagnosed with a lifetime mood, anxiety or substance use disorder despite stringent study exclusion criteria. Lifetime comorbidity was shown to be related to higher smoking rates and nicotine dependence, depressed mood and greater self-report of anxiety and stress. Lifetime comorbidity, however, alone or in combination with treatment condition, failed to predict treatment outcome (at posttreatment or follow-up). Baseline depression scores (Beck Depression Inventory, BDI) were related to treatment outcome only for smokers without a positive history of any psychiatric disorder or depression, with lower BDI scores more frequent in those who were abstinent. Conclusions: High prevalence rates of lifetime psychiatric illness and substance use disorders are reported for chronic smokers. Subsyndromal psychiatric symptoms may play a role in smoking behavior in combination with diagnosable disorders. Clinicians need to carefully assess both psychiatric diagnoses and symptoms in chronic smokers to optimize patient-treatment matching.
© 2000 S. Karger AG, Basel
- Breslau N, Kilbey M, Andreski P: Nicotine dependence, major depression, and anxiety in young adults. Arch Gen Psychiatry 1991;48:1069–1074.
- Breslau N, Kilbey M, Andreski P: DSM-III-R nicotine dependence in young adults: Prevalence, correlates and associated psychiatric disorders. Addiction 1994;89:743–754.
- Lumley MA, Downey K, Stettner L, Wehmer F, Pomerleau OF: Alexithymia and negative affect: Relationship to cigarette smoking, nicotine dependence, and smoking cessation. Psychother Psychosom 1994;61:156–162.
- Breslau N, Kilbey M, Andreski P: Nicotine withdrawal symptoms and psychiatric disorders: Findings from an epidemiologic study of young adults. Am J Psychiatry 1992;149:464–469.
- Covey LS, Glassman AH, Stetner F: Depression and depressive symptoms in smoking cessation. Compr Psychiatry 1990;31:350–354.
- Covey LS, Glassman AH, Stetner F, Becker J: Effect of history of alcoholism or major depression on smoking cessation. Am J Psychiatry 1993;150:1546–1547.
- Glassman AH, Helzer JE, Covey LS, Cottler LB, Stetner F, Tipp JE, Johnson J: Smoking, smoking cessation, and major depression. JAMA 1990;264:1546–1549.
Abrams DB, Rohsenow DJ, Niaura RS, Pedraza M, Longabaugh R, Beattie M, Binkoff JA, Noel NE, Monti PM: Smoking and treatment outcome for alcoholics: Effects on coping skills, urge to drink, and drinking rates. Behav Ther 1992;23:283–297.
Abrams DB: Integrating basic, clinical, and public health research for alcohol-tobacco interactions. NIAAA Alcohol Research Monograph: Alcohol and Tobacco: From Basic Science to Policy, 1995.
Hughes JR: Clinical implications of the association of smoking and alcoholism. NIAAA Alcohol Research Monograph: Alcohol and Tobacco: From Basic Science to Policy, 1995.
- Shiffman S: Relapse following smoking cessation: A situational analysis. J Consult Clin Psychol 1982;50:71–86.
- Shiffman S: A cluster-analytic classification of smoking relapse episodes. Addict Behav 1986;11:295–307.
- Anda RF, Williamson DF, Escobedo LG, Mast EE, Giovino GA, Remington PL: Depression and the dynamics of smoking. JAMA 1990;264:1541–1545.
- Endicott J, Spitzer RL: A diagnostic interview: The Schedule for Affective Disorders and Schizophrenia. Arch Gen Psychiatry 1978;35:837–844.
- Hughes JR, Hatsukami DK, Mitchell JE, Dahlgren LA: Prevalence of smoking among psychiatric outpatients. Am J Psychiatry 1986;143:993–997.
- Breslau N, Kilbey M, Andreski P: Nicotine dependence and major depression. Arch Gen Psychiatry 1993;50:31–35.
- Breslau N: Psychiatric comorbidity of smoking and nicotine dependence. Behav Genet 1995;25:95–101.
- Anthony JC, Folstein M, Romanoski AJ, Von Korff MR, Nestadt GR, Chahal R, Merchant A, Brown CH, Shapiro S, Kramer M, Gruenberg EM: Comparison of the lay Diagnostic Interview Schedule and a standardized psychiatric diagnosis. Arch Gen Psychiatry 1985;42:667–675.
- Ross HE, Swinson R, Larkin EJ, Doumani S: Diagnosing comorbidity in substance abusers: Computer assessment and clinical validation. J Nerv Ment Dis 1994;182:556–563.
- Helzer JE, Robins LN, McEvoy LT, Spitznagel EL, Stolzman RK, Farmer A, Brockington IF: A comparison of clinical and diagnostic interview schedule diagnoses. Arch Gen Psychiatry 1985;42:657–666.
Spitzer RL, Williams JBW, Gibbon M, First MG: Structured Clinical Interview for DSM-III-R-Non-Patient Edition (SCID-NP). Washington, American Psychiatric Press, 1990.
- Dalack GW, Glassman AH, Rivelli S, Covey L, Stetner F: Mood, major depression, and fluoxetine response in cigarette smokers. Am J Psychiatry 1995;152:398–403.
- Covey LS, Glassman AH, Stetner F: Major depression following smoking cessation. Am J Psychiatry 1997;154:2.
- Fagerstrom KO: Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav 1978;3:235–241.
- Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.
- Endicott J, Cohen J, Nee J, Fleiss J, Sarantakos S: Hamilton Depression Rating Scale: Extracted from regular and change versions of the Schedule for Affective Disorders and Schizophrenia. Arch Gen Psychiatry 1981;38:98–103.
- Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J: An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561–571.
- Beck AT, Epstein N, Brown G, Steer RA: An inventory for measuring clinical anxiety: The Beck Anxiety Inventory. J Consult Clin Psychol 1988;56:893–897.
- Holmes TH, Rahe RH: The social readjustment rating scale. J Psychosom Res 1967;11:213–218.
- Shiffman SM, Jarvik ME: Trends in withdrawal symptoms in abstinence from cigarette smoking. Psychopharmacology 1976;50:35–39.
- Blazer D, Kessler RC, McGonagle KA, Swartz MS: The prevalence and distribution of major depression in a national community sample: The National Comorbidity Survey. Am J Psychiatry 1994;151:979–986.
Hall SM, Munoz RF, Reus VI: Smoking cessation, depression, and dysphoria; in Problems of Drug Dependence 1990: Proceedings of the 52nd Annual Scientific Meeting: The Committee on Problems of Drug Dependence, Inc. Rockville, National Institute on Drug Abuse, 1990.
Hall SM, Munoz RF, Reus VI: Depression and smoking treatment: A clinical trial of an affect regulation treatment; in Problems of Drug Dependence 1991: Proceedings of the 53rd Annual Scientific Meeting: The Committee on Problems of Drug Dependence, Inc. Rockville, National Institute on Drug Abuse, 1991.
Ginsberg D, Hall SM, Reus VI, Munoz RF: Mood and depression diagnosis in smoking cessation. Exp Clin Psychopharmacol 1995;3:389–395.
- Lerman C, Audrain J, Orleans CT, Boyd R, Gold K, Main D, Caporaso N: Investigation of mechanisms linking depressed mood to nicotine dependence. Addict Behav 1996;21:9–19.
- Glassman AH, Stetner F, Walsh BT, Raizman PS, Fleisss JL, Cooper TB, Covey LS: Heavy smokers, smoking cessation, and clonidine: Results of a double-blind, randomized trial. JAMA 1988;259:2863–2866.
- Breslau N, Peterson EL, Schultz LR, Chilcoat HD, Andreski P: Major depression and stages of smoking: A longitudinal investigation. Arch Gen Psychiatry 1998;55:161–166.
- Borrelli B, Bock B, King T, Pinto B, Marcus BH: The impact of depression on smoking cessation in women. Am J Prev Med 1996;12:378–387.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.