Ending The Tobacco Holocaust Chapter 11 References and Footnotes:
Ending The Tobacco Holocaust: how Big Tobacco affects our health, pocketbook and political freedom, and what we can do about it.
Chapter 11: Smoking Cessation.
2 Hunt, W. A., Barnett, L. W., Branch, L. G., “Relapse rates in addiction programs.” Journal of Clinical Psychology. October 1971;27(4):455–6.
3 Personal communication with Maureen Forrester, director of smoking cessation services at Kaiser Permanente’s Santa Teresa facility. These results are not documented in a study in a peer-reviewed journal, so they should be taken with a grain of salt until such a study is published.
4 Sonderskov, J., Olsen, J., Sabroe, S., et al, “Nicotine patches in smoking cessation: a randomized trial among over-the-counter customers in Denmark.” American Journal of Epidemiology. 1997;145:309–318.
5 Leischow, S. J., Nilsson, F., Franzon, M., et al, “Efficacy of the nicotine inhaler as an adjunct to smoking cessation.” American Journal of Health Behavior. 1996;20:364–371.
6 Schneider, N. G., Olmstead, R., Nilsson, F., et al, “Efficacy of a nicotine inhaler in smoking cessation: a double-blind, placebo-controlled trial.” Addiction. 1996;91:1293–1306.
7 Tonnesen, P., Norregaard, J., Mikkelsen, K., et al, “A double-blind trial of a nicotine inhaler for smoking cessation.” Journal of the American Medical Association. 1993;269:1268–1271.
8 Foulds, J., Nicorette nasal spray: a novel nicotine therapy. Prescriber. 1994;19:21–25.
9 Blondal, T., Franzon, M., Westin, A., A double-blind randomized trial of nicotine nasal spray as an aid in smoking cessation. European Respiratory Journal. 1997;10:1585–1590.
10 Kornitzer, M., Boutsen, M., Dramaix, M., et al, “Combined use of nicotine patch and gum in smoking cessation: a placebo controlled clinical trial.” American Journal of Preventive Medicine. 1995;24:41–47.
11 Blondal, T., Gudmundsson, L. J., Olafsdottir, I., et al, “Nicotine nasal spray with nicotine patch for smoking cessation: randomised trial with six year follow up.” British Medical Journal. 1999;318:285–289.
12 Hurt, R. D., Sachs, D. P., Glover, E. D., et al, “A comparison of sustained-release buproprion and placebo for smoking cessation.” New England Journal of Medicine. 1997;337:1195–1202.
13 According to the manufacturer, Bupropion is a relatively weak inhibitor of the neuronal uptake of norepinephrine, serotonin, and dopamine, and does not inhibit monoamine oxidase, and, according to the manufacturer while the mechanism of action of Bupropion, as with other antidepressants, is unknown, it is presumed that this action is mediated by noradrenergic and/or dopaminergic mechanisms.
14 Jorenby, D. E., Leischow, S. J., Nides, M. A., et al, A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. New England Journal of Medicine. 1999; 340(9):685–91.
15 Prochazka, A. V., Weaver, M. J., Keller, R. T., et al, “A randomized trial of nortriptyline for smoking cessation.” Archives of Internal Medicine. 1998; 158;2035–2039.
16 Hall, S. M., Reus, V. I., Munoz, R. F., et al, “Nortriptyline and cognitive-behavioral therapy in the treatment of cigarette smoking.” Archives of General Psychiatry. 1998;55:683–690.
18 According to the manufacturer, Varenicline binds with high affinity and selectivity at alpha4beta2 neuronal nicotinic acetylcholine receptors. The efficacy of CHANTIX in smoking cessation is believed to be the result of varenicline’s activity at a sub-type of the nicotinic receptor where its binding produces agonist activity, while simultaneously preventing nicotine binding to alpha4beta2 receptors. Electrophysiology studies in vitro and neurochemical studies in vivo have shown that varenicline binds to alpha4beta2 neuronal nicotinic acetylcholine receptors and stimulates receptor-mediated activity, but at a significantly lower level than nicotine. Varenicline blocks the ability of nicotine to activate alpha4beta2 receptors and thus to stimulate the central nervous mesolimbic dopamine system, believed to be the neuronal mechanism underlying reinforcement and reward experienced upon smoking. Varenicline is highly selective and binds more potently to alpha4beta2 receptors than to other common nicotinic receptors (>500-fold alpha3beta4, >3500-fold alpha7, >20,000-fold alpha1betagammadelta), or to non-nicotinic receptors and transporters (>2000-fold). Varenicline also binds with moderate affinity (Ki = 350 nM) to the 5-HT3 receptor.
19 “Chantix Now Available for Quitting Smoking.” Aug. 8, 2004. Available at: http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Chantix_Now_Available_for_Quitting_Smoking.asp.
20 Specht, Mary, “New stop-smoking drug shows promise, but so did others.” USA TODAY. Posted 7/31/2006. Available at: http://www.usatoday.com/news/health/2006-07-31-stop-smoking-drug_x.htm?csp=34.
22 These results are not documented in a study in a peer-reviewed journal, so they should be taken with a grain of salt until such a study is published.
23 Cinciripini, P., Lapitsky, L., Seay S, et al, “The effects of smoking schedules on cessation outcome: can we improve on common methods of gradual and abrupt nicotine withdrawal?” Journal of Consulting and Clinical Psychology, 1995; 63(3):388–399, and Cinciripini, P., Wetter, D., McClure, J. “Scheduled Reduced Smoking: effects on smoking abstinence and potential mechanisms of action.” Addictive Behaviors, 1997:22(6): 759–767.
25 (but not the only approach: other approaches include pharmacoproteomics, advances in imaging technology, advances in the understanding of nutritional, environmental, exercise, psychological, social and many other factors, and their integration into personalized medicine)
26 Lerman, C., et al, “Pharmacogenetic investigation of smoking cessation treatment.” Pharmacogenetics 12(8):627–634, 2002. and, A collection of NIDA Notes: Research on Nicotine. NN0031. Zickler, P. Genetic Variation May Increase Nicotine Craving and Smoking Relapse. p. 14]
27 A collection of NIDA Notes: Research on Nicotine. NN0031. Zickler, P. Genetic Variation May Increase Nicotine Craving and Smoking Relapse. p. 14.
Lerman, C., et al, “Pharmacogenetic investigation of smoking cessation treatment.” Pharmacogenetics 12(8):627–634, 2002. and, A collection of NIDA Notes: Research on Nicotine. NN0031. Zickler, P. Genetic Variation May Increase Nicotine Craving and Smoking Relapse. p. 14.
28 Lerman, C., et al, “Pharmacogenetic investigation of smoking cessation treatment.” Pharmacogenetics 12(8):627–634, 2002. and, A collection of NIDA Notes: Research on Nicotine. NN0031. Zickler, P. Genetic Variation May Increase Nicotine Craving and Smoking Relapse. p. 14]
29 Nuzzo, Regina, “For smokers, a shot at quitting.” Los Angeles Times, July 17, 2006. Available at http://www.latimes.com/features/health/la-he-nicotinelab17jul17,0,5595015.story?coll=la-home-health.
30 Tuller, David, “Scientists Testing Vaccines to Help Smokers Quit.” New York Times, July 4, 2006. Available at: http://www.nytimes.com/2006/07/04/health/04vacc.html?ex=1309665600&en=d978add467c2b80a&ei=5088&partner=rssnyt&emc=rss.
31 “Reducing Tobacco Use,” 2000 Surgeon General’s Report, p. 504. Available at http://www.cdc.gov/tobacco/sgr/sgr_2000/index.htm.
33 In addition to the possibility that an alternative method might be shown to work in properly designed and controlled scientific experiments, if one likes a method and thinks it might help, then there might also be a positive placebo effect.
34 This observation and supporting literature were graciously brought to the author’s attention by Dr. Laura Juliano, American University. The quote and supporting references are contained within. Juliano, L. M., Donny, E. C., Houtsmuller, E. J., Stitzer, M. L. “Experimental Evidence for a Causal Relationship Between Smoking Lapse and Relapse.” Journal of Abnormal Psychology, 2006, 115,(1):166–173.
35 Gritz, E. R., Nielsen, I. R., Brooks, L. A., “Smoking cessation and gender: the influence of physiological, psychological and behavioral factors.” Journal of the American Medical Women’s Association, 1996; 51: 35–42.
36 Treating Tobacco Use and Dependence. Washington, D.C., U.S. Public Health Service, 2000.
37 Surgeon General’s Report: Women and Smoking 2001, Washington, D.C. U.S. Public Health Service, 2001.
38 Treating Tobacco Use and Dependence, Washington, D.C., U.S. Public Health Service, 2000.
39 Covey, L. S., Glassman, A. H., Stetner, F., “Major depression following smoking cessation.” American Journal of Psychiatry, 1997; 154: 263–265.
40 Glassman, A. H., Covey, L. S., Stetner, F., Rivelli, S., “Smoking cessation and the course of major depression: a follow-up study.” Lancet June 16, 2001;357(9272):1929–32.
41 Piasecki, M., Smoking, nicotine and mood. In Nicotine In Psychiatry, edited by Piasecki, M., and Newhouse, P. A. Washington, D.C, (American Psychiatric Press: 2000), pp.131–147.
42 Hall, S. M., Munoz, R. F., Reus, V. U. I., “Cognitive behavioral intervention increases abstinence rates for depressive-history smokers.” Journal of Consulting and Clinical Psychology, 1994; 62: 141–146.
43 Fryer, J. D., Lukas, R. J., “Antidepressants noncompetitively inhibit nicotinic acetylcholine receptor function.” Journal of Neurochemistry, 1999; 72(3): 1117–1124.
44 Inpatient psychiatry issues. Inpatient psychiatrists are also faced with the dilemma that while they would like to have their patients stop smoking, that doing so might destabilize some patients. Greeman and McClellan (Greeman, M., McClellan, T. A. “Negative effects of a smoking ban on an inpatient psychiatry service.” Hospital and Community Psychiatry, 1991; 42(4): 408–412.) studied the effects of a smoking ban on inpatients at a Veterans Affairs medical center over a two-year period. They found that 20% to 25% of patients who smoked had difficulty adjusting to the ban, and that some individuals experienced a major disruption in their treatment. Hughes (Hughes, J. R. “Possible effects of smoke-free inpatient units on psychiatric diagnosis and treatment.” Journal of Clinical Psychiatry, 1993; 54: 109–114.) has noted that nicotine withdrawal could complicate treatment and cloud response to medications. It could also increase anxiety, sleep disturbance, mood and concentration difficulties associated with depression and other psychiatric disorders.
Counter to those concerns, various other studies have noted no significant increase in disruptive events or negative effect on staff morale (Taylor, N. E., Rosenthal, R. N., Chabus, B., et al. “The feasibility of smoking bans on psychiatric units.” General Hospital Psychiatry, 1993; 15: 36–40.), no significant change in the use of psychotropic medications, or seclusion or restraint (Resnick, M. P., Bosworth, E. E. “A smoke-free psychiatric unit.” Hospital and Community Psychiatry, 1989; 40: 525–526.), and possibly decreased anxiety (West, R., Hajek, P. “What happens to anxiety levels on giving up smoking?” American Journal of Psychiatry, 1997; 154(11): 1589–1592.) as demonstrated by a significant decrease in anxiety with smoking cessation in non-psychiatric individuals.
Regarding a policy for smoke-free inpatient units, the issue might be evaluated specifically for each inpatient facility, and also on a patient by patient basis, given the pharmacokinetic and pharmacodynamic effects of cigarette smoking. Pies (Pies, R. “Smoke, schizophrenia and cytochromes.” Psychiatric Times, 1998; 12(Monograph): 22–23.) has suggested that blanket policies may not be in the best interests of patients, but that it is reasonable to encourage smoking reduction among chronically ill psychiatric patients. Piasecki (Piasecki, M. Smoking, nicotine and mood. In Nicotine In Psychiatry, edited by Piasecki, M., and Newhouse, P. A. Washington, D.C, (American Psychiatric Press: 2000), pp.131–147.) has noted that ideally, either a psychiatrically ill patient would receive a nicotine replacement product during inpatient hospitalization, or nicotine withdrawal would be done when the patient is more stable. Hurt et al (Hurt, R. D., Lowell, C. D., Offord, K. P., et al. “Inpatient treatment of severe nicotine dependence.” Mayo Clinic Proceedings, 1992; 67: 823–828.) has noted that the structure and support of a nonsmoking inpatient unit might be helpful for certain patients who want to stop smoking, but who have failed in a less structured environment. They also noted that inpatient detoxification might be indicated for patients who are at increased risk for psychiatric sequelae, but who have an urgent medical need to stop smoking.
Inpatient clinicians should monitor for the potential of negative effects associated with smoking cessation, especially given the ability of nicotine withdrawal to mimic psychiatric symptoms, and to alter drug levels and induce side and adverse effects.
It is of utmost importance that all psychiatrists, as physicians first, consider the general health of their patients. Given the extremely adverse effects of cigarette smoking on morbidity and premature mortality rates, psychiatrists might evaluate how to become more active in smoking cessation efforts for their patients. Psychiatrists need to address smoking cessation issues specific to psychiatric patients. For a more recent update on this issue, please see the following book: Smith, P. M. and Taylor, C. B. Implementing an Inpatient Smoking Cessation program. Laurence Erlbaum Associates, Publishers. 2006. Mahwah, New Jersey.