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• W2022829596 abstract "The paper by McChargue et al. (2002) raises an important question regarding the treatment of tobacco addiction in schizophrenia—whether smoking abstinence or smoking reduction should be the ultimate goal. The authors discuss four published studies combining pharmacotherapy and psychosocial interventions for smoking cessation/reduction in schizophrenic smokers, and conclude that rates of smoking abstinence at trial end-point and 6-month follow-up assessment are much lower in these patients compared to the general population. Accordingly, they reason that smoking reduction might be a more realistic outcome for schizophrenics, especially since they may derive benefits from nicotine use for clinical and cognitive deficits associated with this disorder. There are several important issues with respect to smoking reduction versus abstinence approaches for tobacco use in schizophrenia. First, harm reduction approaches have not been documented to decrease or eliminate the risk of developing smoking-related medical illnesses in either non-psychiatric or psychiatric smokers (Hughes 1998). This is important because schizophrenic patients seem to be at higher risk for developing cardiovascular disease and lung cancer compared to controls (Tsuang, Perkins & Simpson 1983; Lichterman et al. 2001). Secondly, while there seems to be growing evidence that many of the clinical and cognitive deficits in schizophrenia may be alleviated by nicotine/smoking (Adler et al. 1993; Dalacket al. 1998; George et al. 2002), and that nicotinic receptor function may be abnormal in the disorder (Freedman et al. 1997; Breese et al. 2000), one of the strongest environmental cues that promotes continued smoking is the act of smoking itself. As smoking cues promote smoking urges in schizophrenics (Tidey et al. 2001), it seems highly unlikely that long-term reductions in smoking behavior can be achieved in this population. Thirdly, an important variable that has emerged as a positive predictor of smoking reduction/ cessation in this population is the use of clozapine (George et al. 1995; McEvoy et al. 1995) and other atypical antipsychotic agents. Atypical antipsychotic drugs have been shown to produce a sustained amelioration of sensory gating deficits associated with schizophrenia (Nagamoto et al. 1996; Light et al. 2000), and of negative symptoms and some neuropsychological deficits (Meltzer, Park & Kessler 1999), in contrast to nicotine, that produces transient effects on these outcomes due to nicotinic receptor desensitization (Leonard et al. 2000). Hence, these positive effects of medications for schizophrenia on smoking suggest that optimizing pharmacological treatments for schizophrenia with those for treatment of nicotine dependence (nicotine replacement, bupropion), in combination with modified behavioral treatments, may lead to enhanced smoking cessation outcomes, as observed in one study (George et al. 2000). In that study, long-term smoking abstinence in schizophrenics was linked to achievement of abstinence early in the treatment trial (George et al. 2000), as has been shown in treatment studies of non-psychiatric smokers. Fourthly, the fact that trial end-point smoking abstinence is not enduring at 6-month follow-up assessment is not surprising, as high attrition in smoking abstinence is also seen in studies with non-psychiatric smokers (Hughes et al. 1999). The extended use of available treatments (nicotine replacement, bupropion) combined with relapse–prevention therapy may enhance long-term cessation outcomes in schizophrenic smokers. Thus, it seems premature to conclude that the goal of reducing smoking should be recommended for treating smoking in schizophrenia. However, smoking reduction as a transition to abstinence needs more careful evaluation in this population. More data are needed about the effects of reducing smoking on biomarkers associated with the development of smoking-related medical illness, as well as on whether reducing smoking (compared to not reducing) decreases their incidence. Development of nicotinic receptor agonists (not nicotine) that are safe for use in humans may also assist these patients in achieving long-term smoking abstinence, and remediate clinical and cognitive deficits that accompany schizophrenia. The authors are to be commended on their balanced discussion of this topic and for advocating that multiple smoking treatment strategies need to be evaluated in this population. The increasing interest by investigators, and the growing number of funded studies in this area, should greatly improve such treatment in the future. This work was supported in part by a NARSAD Young Investigator Award, and by National Institute on Drug Abuse grants R01-DA-13672, R01-DA-14039 and K12-DA-00167 to Dr George." @default.
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• W2022829596 date "2002-06-25" @default.
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• W2022829596 title "Treating Tobacco Addiction in Schizophrenia: Where do we go From Here?" @default.
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• W2022829596 doi "https://doi.org/10.1046/j.1360-0443.2002.00154.x" @default.
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