A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder
Open accessAbstract
OBJECTIVE: Despite extremely high rates of smoking among individuals with psychotic disorders and the associated financial and health costs, few studies have investigated the efficacy of smoking cessation interventions among this group. The purpose of this study was to compare an integrated psychological and nicotine replacement therapy intervention for people with a psychotic disorder with routine care alone. METHOD: The authors recruited 298 regular smokers with a psychotic disorder residing in the community and randomly assigned them to a routine care comparison condition (N=151) or an eight-session, individually administered smoking cessation intervention (N=147), which consisted of nicotine replacement therapy, motivational interviewing, and cognitive behavior therapy. Outcome variables included continuous and point-prevalence abstinence rates, smoking reduction status, and changes in symptoms and functioning. RESULTS: While there were no overall differences between the treatment group and comparison group in abstinence rates, a significantly higher proportion of smokers who completed all treatment sessions stopped smoking at each of the follow-up occasions (point-prevalence rates: 3 months, 30.0% versus 6.0%; 6 months, 18.6% versus 4.0%; and 12 months, 18.6% versus 6.6%). Smokers who completed all treatment sessions were also more likely to have achieved continuous abstinence at 3 months (21.4% versus 4.0%). There was a strong dose-response relationship between treatment session attendance and smoking reduction status, with one-half of those who completed the intervention program achieving a 50% or greater reduction in daily cigarette consumption across the follow-ups, relative to less than one-fifth of the comparison subjects. There was no evidence of any associated deterioration in symptoms or functioning. CONCLUSIONS: These findings demonstrate the utility of a nicotine replacement therapy plus motivational interviewing/cognitive behavior therapy smoking cessation intervention among individuals with a psychotic disorder. Further development of more efficacious interventions is required for those who do not respond to existing interventions.
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One study has compared a specialized smoking cessation program for patients with schizophrenia with an ordinary program developed for people in the general population and found no differences in cessation rates between the two programs.
“No studies have compared smoking cessation programs with no intervention, but one study has compared a specialized smoking cessation program for patients with schizophrenia with an ordinary program developed for people in the general population and found no differences in cessation rates between the two programs (Baker et al. 2006).”
From Excess early mortality in schizophrenia. (2014) · cites this paper as Baker et al. 2006
The Study Design section says the trial compared a smoking cessation intervention for people with psychotic disorders against treatment as usual plus smoking-cessation booklets—not an ordinary cessation program developed for the general population. Overall Changes in Smoking reports no significant difference in abstinence rates between the randomized groups at 3, 6, or 12 months, supporting only the cessation-rate portion of the claim. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn some cases, greater session attendance or treatment completion has been positively associated with outcomes, but this association is not ubiquitous, suggesting individual differences in dose-response.
“In some cases, a greater number of sessions attended or treatment completion have shown positive associations with outcomes (Baker et al., 2006; Fiore, 2008; Smits et al., 2016; Whiteley et al., 2012), but this is not ubiquitous, suggesting individual differences in dose-response exist (Baldwin et al., 2009; Barkham et al., 2006; Owen et al., 2016; Reese et al., 2011).”
From Identifying attendance patterns in a smoking cessation treatment and their relationships with quit success (2017) · cites this paper as Baker et al., 2006
Outcome assessors were blinded in only six of the 18 controlled studies (33%).
“outcome assessors were blinded in only six studies (33%; Baker et al. 2006;Forbes et al. 2012;Mills et al. 2012;Forsyth et al. 2017;Shawyer et al. 2017;Kelly et al. 2020).”
From Effect of community mental health care programs in Australia: A systematic review (2020) · cites this paper as Baker et al. 2006
Four of five therapeutic studies examining substance misuse reported significant reductions in participants' consumption of alcohol, tobacco, and other drug use.
“Four of five studies that examined substance misuse reported significant reductions in participants' consumption of alcohol (Forbes et al. 2012), tobacco (Baker et al. 2006;Ashton et al. 2015) and other drug use (Nagel et al. 2009).”
From Effect of community mental health care programs in Australia: A systematic review (2020) · cites this paper as Baker et al. 2006
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- Authors
- Baker, A., Richmond, R., Haile, M., Lewin, T. J., Carr, V. J., Taylor, R. L., Jansons, S., & Wilhelm, K.
- Affiliations
- University of Newcastle Australia (AU)
- Venue
- American Journal of Psychiatry
- Published
- 2006-11
- Volume
- 163
- Issue
- 11
- Pages
- 1934-1942
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2171976686
- Semantic Scholar
- 10e81863de60a889825bb4f6cd5477528cc6dffd
- Cited by
- 255
- References
- 34
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 4 · 2023: 5 · 2022: 8 · 2021: 8 · 2020: 9 · 2019: 11 · 2018: 14 · 2017: 10 · 2016: 13 · 2015: 21 · 2014: 14 · 2013: 20 · 2012: 27
- FWCI
- 9.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- GlaxoSmithKline
- University of New South Wales
- Medical Research Council
- National Health and Medical Research Council (141708)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- smoking cessation, psychosis, nicotine replacement therapy, motivational interviewing, cognitive behavioral therapy, abstinence rates, dose-response relationship, treatment attendance
- MeSH terms
- Smoking Prevention, Adult, Combined Modality Therapy, Counseling, Female, Humans, Interviews as Topic, Male, Motivation, Nicotine, Psychotic Disorders, Smoking, Comorbidity, Cognitive Behavioral Therapy, Smoking Cessation, Treatment Outcome
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