A Reply to the Commentaries on Schizophrenia and Smoking Treatment: more Research is Needed
Year: 2002
Type: article
Abstract: Our paper (McChargue, Gulluver & Hitsman 2002) explores whether patients with schizophrenia need to change smoking behavior at a slower rate and require greater reinforcement for change in order to compensate for any abnormal neurobiological factors that may undermine quit attempts. A review of the literature suggests that an alternative smoking treatment for people with schizophrenia draws upon a harm reduction model, which emphasizes skill acquisition and prompts abstinence once reduced exposure to tobacco toxins have been obtained and stabilized over time. The commentaries echo the importance of the question about how to treat smokers with comorbid schizophrenia. The overall consensus is that consideration of alternative approaches is a valid direction to pursue. However, some caution should be taken when evaluating alterative approaches. The primary concern from the commentaries involves the role harm reduction should play in the treatment of smokers with schizophrenia. To clarify our position, we do not advocate that abstinence-based treatments be abandoned. Our hope is that future research will show more efficacious outcomes resulting from abstinence-based treatments. As George & Vessicchio (2002) suggest, newer and more innovative abstinence-based smoking treatments are being developed that target individuals with schizophrenia. For example, a recent study reports 50% short-term abstinence rates among smokers with schizophrenia who received 300 mg/day of bupropion SR in a placebo-controlled smoking treatment trial (George et al. 2002). One issue that continues to plague smoking treatments for individuals with schizophrenia is the lack of data. For example, it is still unclear whether smokers with schizophrenia are capable of long-term abstinence. We concur with some of the commentators that future smoking treatments incorporate reports of long-term abstinence. However, we are not convinced that long-term abstinence, if achievable for this population, should be routed solely through traditional abstinence-based efforts. Nor are we convinced that harm reduction should be the ultimate goal for this subgroup of smokers. At the very least, we suggest that harm reduction techniques be used as a transitional step to abstinence. To date, harm reduction approaches applied to smokers with schizophrenia remain more conceptual than empirical. The commentaries address many important issues for researchers to consider when evaluating these approaches. First, more data are needed showing that smoking reduction corresponds with reduced biomarkers (George & Vessicchio 2002). In fact, we agree with Hughes (2002) that reduced biomarkers may be a more appropriate measure of harm reduction effects rather than the number of cigarettes smoked per day. Secondly, the evaluation of treatment duration and generalization should also be considered (Gilbert 2002). As Gilbert discusses, in-patient populations are very different from out-patient populations. Harm-reduction techniques are easier to implement in in-patient settings. In contrast, out-patient smokers have different social and environmental influences that may hinder or help harm reduction efforts. Given the inherent differences between in-patients and out-patients, we concur that treatment approaches should be tailored. Thirdly, the use of nicotine replacement therapies (NRT) has been the most widely espoused technique for harm reduction. Many suggest that NRTs be administered for long periods of time and at higher doses. Nevertheless, we concur with Gilbert (2002) in that, if NRTs are considered, researchers should assess the accrued monetary cost of such interventions. In conclusion, many unanswered questions remain. Our hope is that this ‘for debate’ series will start a dialog about how to address extremely difficult to treat under-represented smoking populations. As reflected in many of the commentaries as well as the original paper, much research is needed to adequately evaluate smoking treatment for individuals with schizophrenia. The extent to which harm reduction approaches represent a viable alternative remains to be seen. Supported in part by VA MREP (Dr McChargue), NIH/NIDA 1 K08 DA00467 grant (Dr McChargue) and NIH/NIDA F31 DA05854 (Dr Hitsman).
Source: Addiction
Language: English
Subfield: Physiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2066972237