BACKGROUND: Tobacco use remains a significant cause of morbidity and mortality globally. Although there has been a steady decline in the overall smoking prevalence in North America during the last decade some subsets of the population continue to smoke at high rates, particularly individuals with a history of substance use disorders (SUD) and/or psychiatric disorders (PD). Studies suggest that individuals with SUD’s and PD’s often have disproportionately higher smoking-related mortality. Studies further suggest that in clinical samples an estimated 75% of individuals with PD and up to 90% of individuals with PD concurrently smoke. This high prevalence of smoking among individuals with SUD and PD clearly warrants a need for targetted efforts to reduce the disease burden and increased mortality risk among these often disparate sub-populations. Such findings have prompted some to suggest the need for treatments with greater intensity (in terms of duration and combination of different therapy approaches). The Tobacco Dependence Clinic (TDC) is such an innovative program which provides tailored tobacco dependence treatment using combined behavioural counseling and pharmacotherapy for clients accessing Mental Health and Addiction Services based in Vancouver, BC, Canada.

OBJECTIVES: Among individuals with SUD and/or PD accessing a tobacco dependence treatment program in Mental Health and Addictions Services the objectives of our study are to: a) examine program completion and smoking cessation outcomes and b) examine predictors of program completion and smoking cessation.

METHODS: Participants of the TDC receive a structured 8 week group therapy program, with an additional support group of up to 18 weeks. In addition participants receive up to 6 months of tailored pharmacotherapy for smoking cessation. A retrospective chart review of data from 540 participants enrolled in the TDC between September 2007 and May 2011 were analyzed. Outcome measures include 7-day point-prevalence abstinence (validated by expired carbon monoxide) at end of treatment.

RESULTS: Based on an intent-to-treat analysis (n=540), end-of-treatment smoking abstinence rate was 31%. For individuals who completed the program (n=406), the abstinence rate was 41%. There were no significant differences in smoking cessation by diagnostic categories with smoking cessation rates ranging from 31.4% among individuals with a history of heroin misuse to 50% among individuals with a history of schizophrenia. Significant predictors of treatment completion were: a) being female and b) older age. Among program completers (n=406), significant predictors of successful smoking abstinence at the end-of-treatment were: a) having a lower expired CO level at baseline, and b) staying in treatment for a greater number of weeks.

CONCLUSIONS: Smoking cessation programs tailored to the needs of individuals with SUD and/or PD is an important approach to reducing the high prevalence of smoking (relative to the general population) and the disproportionate morbidity and mortality associated with tobacco use in this population. Providing specialized smoking cessation programs in mental health and addictions settings is well received by clients who are motivated to quit smoking. If given access to such intensive and tailored smoking cessation treatment, individuals with SUD and/or PD can successfully quit smoking at rates similar to the general population. Important policy and practice implications involve the need for adequate resource allocation and buy-in from staff and management in mental health and addictions settings. Moreover, there is the need for longer treatment duration and combination therapy for smokers with co-occurring SUD and PD in such settings.

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A presentation at the 15th World Conference on Tobacco or Health, Singapore.