Nicotine patch and paroxetine for smoking cessation.

Smokers (N?=?224) were randomized to 1 of 3 groups: (a) transdermal system (TNS) + placebo; (b) TNS + paroxetine (20 mg); (c) TNS + paroxetine (40 mg). Assignment to treatment was double-blind. Nicotine patch (TNS) treatment was provided for 8 weeks; paroxetine or placebo was provided for 9 weeks. Abstinence rates at Weeks 4, 10, and 26 were as follows: (a) TNS + placebo: 45%, 36%, and 25%; (b) TNS + paroxetine (20 mg): 48%, 33%, and 21 %; (c) TNS + paroxetine (40 mg): 57%, 39%, and 27%. The differences were not statistically significant. The combined treatment was more effective in reducing both craving and depression symptoms associated with smoking cessation. A subgroup analysis comparing compliant participants was also conducted. Abstinence rates at Weeks 4, 10, and 26 were as follows: (a) TNS + placebo: 46%, 35%, and 24%; (b) TNS + paroxetine (20 mg): 64%, 43%, and 33%; (c) TNS + paroxetine (40 mg): 74%, 51%, and 38%. The differences between paroxetine groups and placebo at Week 4 were statistically significant. Although paroxetine may add value to the current standard of care in excess of potential risk, more conclusive evidence is needed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine gum and behavioral treatment in smoking cessation.

120 Ss (who smoked a mean of 30.5 cigarettes/day) were assigned either to intensive behavioral treatment, to nicotine gum in a low-contact treatment, or to the intensive behavioral plus nicotine gum treatment. At each assessment, Ss reported the number of cigarettes smoked in the previous 24 hrs and provided blood samples; assessments were conducted at 0, 3, 12, 26, and 52 wks. Results show that the combined treatment produced higher abstinence rates than the other 2 conditions at all assessments. These differences were significant at 3, 12, and 26 wks, but not at 52 wks. Nicotine dependence was assessed by blood cotinine levels, scores on a dependence scale, and by number of cigarettes smoked at pretreatment. It was found that Ss with high blood cotinines were more likely to be helped by nicotine gum treatment than were less dependent Ss. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine patch and self-help video for cigarette smoking cessation.

A total of 424 smokers were randomized in a 2?×?2 factorial experiment. A pharmacologic factor contained 2 levels: transdermal nicotine patch (TNP; 21 mg) and placebo. A self-help behavioral treatment factor contained 2 levels: video-enhanced self-help treatment manual and self-help treatment manual only. At 2 months, TNP produced a higher level of abstinence (36%) than placebo (20%), p?     

Nicotine gum dose and weight gain after smoking cessation.

The authors examined weight gain in 79 abstinent cigarette smokers during treatment with placebo or with 2 mg or 4 mg of nicotine gum. Results indicated that nicotine gum suppressed weight gain in a linear fashion with increasing nicotine dose. At 90 days postcessation, placebo gum users gained 3.7 kg, 2-mg gum users gained 2.1 kg, and 4-mg gum users gained 1.7 kg. Assessment of nicotine replacement by means of pre- and postcessation salivary cotinine levels revealed that smokers who replaced a greater percentage of their baseline cotinine levels during treatment gained less weight. Percentage of baseline cotinine replaced remained related to weight gain after the number of pieces of gum used was controlled. Implications for smokers hoping to minimize postcessation weight gain are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine and smoking: A review of effects on human performance.

Examined the effects of nicotine administration and cigarette smoking on human performance to clarify the role of such effects in controlling smoking. The results of 101 studies (129 experiments) published in scientific journals from 1970 to 1993 were reviewed. In nonabstinent smokers and nonsmokers, nicotine enhanced finger tapping and motor responses in tests of attention; cognitive functioning was not reliably enhanced. It is unlikely that these limited performance-enhancing effects of nicotine play an important role in the initiation of cigarette smoking. In contrast, data from abstinent smokers support the conclusion that nicotine deprivation functions to maintain smoking in nicotine-dependent persons, in part, because nicotine can reverse withdrawal-induced deficits in several areas of performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine dependence: Psychosocial approaches to the prevention of smoking relapse.

Describes smoking relapse within the context of nicotine dependence and reviews psychosocial relapse prevention methods. Two-thirds of smokers who quit either on their own or with the help of an intervention relapse within the first 3 mo after quitting. Even after several months of abstinence, relapse often occurs. Efforts to reduce or prevent smoking relapse need to address the addictive and reinforcing properties of nicotine and the multiple biopsychosocial relationships among nicotine, affect regulation, cognitive functioning, and body weight. More work is needed in developing more effective smoking cessation and relapse prevention interventions for hard-core smokers, many of whom suffer from psychiatric conditions and come from lower socioeconomic backgrounds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of excessive and rapid smoking in the modification of chronic smoking behavior.

In a study of aversive control of smoking behavior, 27 females and 18 males (mean age, 30.9 yrs; mean yrs as a smoker, 13.1; mean baseline cigarettes/day, 31.6) were randomly assigned to rapid smoking, excessive smoking, or control conditions. Ss attended 6 treatment sessions over a 1-wk period. Prescribed smoking was carried on in both the laboratory and outside environment. A breath test measuring concentration of carbon monoxide in the bloodstream was used as a check on the reliability of self-reports. Overall, there was a statistically reliable treatment effect, according to measures of percentage reductions in smoking and Ss maintaining total abstinence. However, treatment effect had disappeared at 12-mo follow-up. Experimental and control groups showed considerable relapse independent of condition, with only 20% of Ss remaining abstinent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic carbon monoxide poisoning: from smoking to accidental poisoning

The authors describe a case of furosemide possibly inhibiting the hypoprothrombinemic effect of warfarin. The initiation of furosemide dosing in a patient receiving a stable dose of warfarin was associated with an 28% decrease in the international normalized ration (INR). Using normal volunteers, two previous controlled studies of an interaction between warfarin and chlorthalidone, and between warfarin and spironolactone, assert that volume depletion produced by forced diuresis results in the inhibition of warfarin's hypoprothrombinemia. Consistent with this hypothesis, the authors found that their patient's hematocrit (believed to reflect hydration status) correlated with the INR: r2 = 0.78, p < 0.05. This case provides further evidence suggesting that acute diuresis can decrease the hypoprothrombinemic effect of warfarin.     

Behavioral and physiological effects of low-nicotine cigarettes during rapid smoking.

Compared the effects of rapid smoking using medium-tar/nicotine or low-tar/nicotine cigarettes on physiological and behavioral responses in a randomized, double-blind clinical trial with 24 Ss. Results show equivalent heart rate, blood pressure, and carbon monoxide levels after rapid smoking either low- or medium-yield cigarettes. Behavioral topography measures differed significantly when low-nicotine cigarettes were smoked. Also, Ss who did remain abstinent at subsequent follow-up showed less change in rated aversiveness during rapid smoking than Ss who did not remain abstinent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine withdrawal in smokers with current depressive disorders undergoing intensive smoking cessation treatment.

The authors investigated withdrawal in smokers with current threshold and subthreshold depressive disorders (N = 21) who were participating in a pilot study of intensive counseling interventions for smoking cessation. The majority of participants (67%) were taking antidepressants when they entered the trial. Withdrawal symptoms were compared in prolonged abstainers versus nonabstainers across a 12-week treatment period and at the 3-month follow-up assessment visit. Prolonged abstinence was associated with an increase in positive affect and a decrease in depressive symptoms and craving over time. Nonabstinence was associated with little overall change in these variables from treatment onset to the 3-month follow-up. At the 3-month follow-up, 44% of prolonged abstainers were in complete remission of their baseline depressive disorders, compared with 0% remission among nonabstainers. Findings suggest that within the context of an intensive smoking cessation intervention, some smokers with current depressive disorders may experience significant improvement in affective and craving symptoms. Findings also suggest that abstinence may be associated with improvement in affect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine–mecamylamine treatment for smoking cessation: The role of pre-cessation therapy.

The nicotinic antagonist mecamylamine was evaluated in a randomized smoking cessation trial. Four groups of participants (n?=?20 per group) received nicotine plus mecamylamine, nicotine alone, mecamylamine alone, or no drug for 4 weeks before cessation. After the quit-smoking date, all subjects received nicotine plus mecamylamine treatment for 6 weeks. Nicotine skin patches (21 mg/24 hr) and mecamylamine capsules (2.5–5.0 mg twice per day) were used. Precessation mecamylamine significantly prolonged the duration of continuous smoking abstinence; abstinence rates at the end of treatment were 47.5% with mecamylamine and 27.5% without mecamylamine. Nicotine + mecamylamine reduced ad lib smoking, smoking satisfaction, and craving more than either drug alone. Moreover, the orthostatic decrease in blood pressure caused by mecamylamine was offset by nicotine. Mecamylamine before smoking cessation may be an effective adjunct to nicotine patch therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clarification of risk–benefit issues in rapid smoking.

Several articles on rapid smoking have stressed the theorized danger of this smoking abatement procedure while providing little evidence to support the claim. Additionally, they have disregarded the benefits of not smoking. It is argued that this consideration of safety without benefit is simplistic and potentially harmful. An analysis comparing the known risks and benefits is made, and the current literature on the efficacy and safety of rapid smoking is reviewed. Risk–benefit analysis reveals that rapid smoking is safe and effective for healthy Ss, but additional research is required to determine its safety and efficacy for persons with cardiac and pulmonary disease. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of a self-control manual, rapid smoking, and amount of therapist contact on smoking reduction.

Evaluated a self-help treatment manual consisting of stimulus control, rapid smoking, and coping relaxation techniques. 69 Ss, average age 32.6 yrs, who smoked at least 20 cigarettes/day were randomly assigned to (a) a self-help manual with minimal (2 sessions) therapist contact, (b) a self-help manual with high (7 sessions) therapist contact, (c) a high-therapist-contact rapid smoking condition, or to (d) a high-therapist-contact normal-paced smoking condition. Results indicate that while the overall program was moderately effective, groups did not differ on percentage of baseline smoking or on number of Ss abstinent at posttreatment or 3-mo or 6-mo follow-up. Informant reports of Ss' smoking behavior and carbon monoxide analyses of expired air samples confirmed these findings. Ss in the minimal contact condition generally followed through on their programs, required less therapist time, and were at least as successful as those in other groups in terms of long-term results. Implications for self-help manuals for smoking reduction are discussed. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative effects of rapid and normal smoking on heart rate and carboxyhemoglobin.

Compared a rapid smoking procedure closely approximating that found in clinical and research practice to normal smoking and a rapid breathing/sham-smoking control. Ss were 3 male and 3 female undergraduates who had smoked for an average of 4.4 yrs with a mean baseline of 24.2 cigarettes/day. Nicotine concentration of cigarettes was systematically varied. Major dependent variables included heart rate (HR) and estimates of blood carboxyhemoglobin (COHb) based on expired respiratory air carbon monoxide. Results show rapid smoking produced significantly greater rise in HR than normal smoking. No carbon monoxide differences were found across the smoking conditions. Individual data indicated that no S exceeded estimated danger levels of COHb or HR increases. Although replication and extension of these findings are necessary, results indicate that rapid smoking is not unduly hazardous to nonsymptomatic young adults. A suggested screening procedure for rapid smoking is presented. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of rapid smoking, warm, smoky air, and attention placebo in the modification of smoking behavior.

Randomly assigned 40 habitual smokers to 1 of 4 treatment groups: warm, smoky air plus rapid smoking; warm, smoky air only; rapid smoking only; an attention-placebo control group. 3 Es, also randomly arranged, saw each S individually for an average of 7.2 sessions, and follow-up data were obtained for 6 mo. posttreatment. All but 1 S was abstinent at termination, and 21 Ss remained abstinent 6 mo. later. A significant Treatment Group * Follow-Up Interval interaction was observed and found to be attributed to the attention-placebo group having a steeper relapse curve. The 3 aversion groups were quite similar and, taken together, were smoking less at the 6-mo follow-up than the controls. There were no differences among Es. The consistency of results with data from a previous study and implications for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Successful treatment of habitual smokers with warm, smoky air and rapid smoking.

Presented either warm smoky air or warm mentholated air to 28 undergraduate habituated smokers and required them to smoke until they could tolerate no further cigarettes. Both groups smoked at a rapid rate, received considerable social reinforcement, and were given comparable expectation of success. All Ss were abstinent at termination after an average of 8 sessions, and 16 of 25 Ss followed up for 6 mo. remained abstinent. The warm smoky air and menthol air groups did not differ, but paradoxically, Ss followed up at 4-wk intervals were more successful than Ss contacted every 2 wk. (24 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nicotine gum and self-help behavioral treatment for smoking relapse prevention: Results from a trial using population-based recruitment.

Smokers aged 18–65 yrs (N?=?1,044) who were able to quit for 24 hr were randomized using a 2?×?2 factorial design to compare nicotine gum to no gum use and self-help materials to no use of materials. All participants were offered a $100 incentive to quit and stay quit for 6 months. Six month abstinence was 27% in the gum groups, compared with 19% in the no-gum group (p?=?.002). Compared with the no-gum group, relapse occurred at a significantly lower rate in the gum group for the entire 12 months of follow-up There was no significant main effect for the self-help materials, no interaction between gum and materials, and no evidence that the effectiveness of gum differed between the sexes or between heavy and light smokers. Nicotine gum is an effective adjunct to minimal-contact smoking cessation materials plus monetary incentive in a population-based sample of smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Utilization of adverse rapid smoking in groups: Efficacy of treatment and maintenance procedures.

18 Ss who had been smoking for an average of 18.5 yrs and were currently smoking an average of 23.6 cigarettes/day participated in a smoking-reduction program that attempted to assess the initial effectiveness of a rapid-smoking procedure administered to groups. Efficacy of maintenance was investigated through the use of a control procedure and 2 presumed maintenance-enhancing strategies: in vivo booster sessions and telephone booster sessions. Results indicate that although 90% of all Ss were abstinent after treatment, booster sessions had no significant effect on maintenance of treatment gains. Within-group analyses showed that although both experimental groups significantly relapsed between posttreatment and the 3-mo follow-up, control Ss did not. Results are discussed in terms of self-set and the attribution of behavior change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two-year efficacy and safety of rapid smoking therapy in patients with cardiac and pulmonary disease.

Tested rapid smoking therapy in 18 smokers (mean age 45.8 yrs) with documented cardiopulmonary disease. Myocardial ischemia and cardiac arrhythmia were monitored in Ss and 3 additional patients after 12 hrs of tobacco abstinence, normal smoking, and rapid smoking. No evidence of myocardial ischemia or significant arrhythmia developed. Results of therapy were followed up biochemically 12- and 24-mo posttreatment and compared to a waiting-list control group. Results show that 50% of Ss had not smoked posttreatment through a 2-yr follow-up period, while all control Ss had smoked by the 2-yr follow-up. It is concluded that rapid smoking therapy is safe and effective in patients with mild to moderate cardiopulmonary disease and for those who have had uncomplicated heart attacks. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)