UCSF researchers find psychological intervention and drugs aid in short term smoking cessation---but not long term

Both drugs and psychological intervention alone or together can help smokers stay away from cigarettes for the short term but not long term, according to a study on smoking cessation at the University of California, San Francisco. This was the first smoking cessation study that compared nortriptyline, a drug used to treat depression, and a drug that has FDA approval for smoking cessation treatment—- sustained release bupropion—-as well as psychological intervention.

Sharon Hall, PhD, UCSF professor of psychiatry at UCSF’s Langley Porter Psychiatric Institute, is lead author of the study “Psychological Intervention and Antidepressant Treatment in Smoking Cessation” to be published in the October issue of the Archives of General Psychiatry.
During a year-long study of 220 cigarette smokers, sustained-release bupropion and nortriptyline were compared to placebo; then the researchers examined the efficacy of the drugs with psychological intervention and with medical management alone.  Outcome measures were biologically-verified abstinence from cigarettes at 12 weeks; 24 weeks, 36 weeks and 52 weeks.
Results of the study confirmed that psychological intervention produced higher 7-day biochemically verified abstinence rates than medical management alone.  Each of the drugs administered also produced higher abstinence rates than placebo. 

However, the researchers found that both drugs and psychological intervention have limited efficacy in producing sustained abstinence ( helping smokers remain continuously abstinent over a one year period) and adding psychological intervention to either of the two drugs did not increase abstinence rates.

“We know a lot about how nicotine replacement treatment (nicotine gum and nicotine patch) interacts with psychological treatment,” Hall said. “We know it is usually more effective when provided with psychosocial treatment.  However, the impact of psychosocial interventions and other drugs on cigarette smoking is unknown,” she explained.  “Drugs to help smokers quit differ in ease of use, mode of administration, side effects, and effects on mood and withdrawal symptoms.  All of these components may contribute to differences in the role of psychosocial interventions,”  Hall said. 

“This study indicates we do have some useful tools for helping smokers quit, but we need to study how best to produce permanent cessation,”  Hall said.

Participants in the study were recruited from the general public and had been smoking more than 10 cigarettes per day.  The participants were invited to receive a baseline assessment, including a physical examination, EKG and blood draw.  The participants were then stratified by the number of cigarettes smoked, gender, history of depression versus not, and randomly assigned to one of the six experimental groups:  1) buproprion versus nortriptyline versus placebo; 2) medical management alone; and 3) medical management plus psychological intervention.

Medical management was provided by five licensed psychiatric and internal medicine residents who provided written information about smoking cessation and each week monitored the progress toward a quit date for each participant.

Psychological intervention was provided to specific participants assigned to participation in five group sessions, in addition to the medical management already described.  This intervention provided health-related information for mood management and smoking cessation as well as discussion of smoking cessation. 

A core element was the development of a quit-smoking plan and weekly modification of the plan.  Nortriptyline, a generic drug, may be a less expensive alternative for those who wish to quit smoking than bupropion.  However, it has more side effects, and is generally considered a second choice medication for cessation.

## Co-authors of the study include:

* Gary L. Humfleet, PhD, UCSF associate clinical professor of psychiatry;
* Victor I. Reus, MD, UCSF professor of psychiatry; Ricardo F. Muñ
* oz, PhD, UCSF professor of psychiatry and chief psychologist at San Francisco General Hospital Medical Center;
* Diane T. Hartz, PhD, statistician, and Roland Maude-Griffin, BA.

Funding for the study was provided by the National Institute on Drug Abuse.