Skip to main content Accessibility help
×
Home

Effectiveness of Varenicline in Psychiatric Patients with Co-Morbid Polysubstance Dependence

  • Jungjin Kim (a1), Prashant Kaul (a1), Thomas L. Schwartz (a1) and James Megna (a1)

Abstract

Introduction: Individuals with substance use disorders (SUDs) and mental health disorders (MHDs) have greater prevalence of smoking and suffer greater tobacco-related morbidity and mortality. Varenicline is the latest FDA-approved smoking-cessation agent and few studies have investigated the use of varenicline in this difficult-to-treat population.

Aims: This study examines the smoking cessation outcomes and tolerability of varenicline when used to help quit smoking in 16 patients enroled in both psychiatric and substance abuse programme.

Methods: A retrospective chart review was conducted on 16 patient charts. Patient demographics, psychiatric disorder diagnoses, substance use history, dosing, side effects, number of cigarettes used pre/post varenicline use and the number of complete smoking cessation outcomes were tabulated.

Results: After varenicline intervention, 25% of those who completed treatment completely quit smoking. Thirty-one per cent were able to substantially cut back the amount that they smoked to one cigarette per day. The average reduction in cigarettes was 16 per day (64%), and all but one patient tolerated varenicline.

Conclusions: The authors observed reasonable clinical benefit when varenicline was used to help quit smoking in patients with comorbid SUDs and MHDs. Better-controlled future studies with larger sample sizes will help further determine clinical utility of varenicline in this difficult-to-treat nicotine-dependent population.

Copyright

Corresponding author

Address for correspondence: Thomas Schwartz, Department of Psychiatry, SUNY Upstate Medical University, Syracuse NY 13210. Email: schwartt@upstate.edu

References

Hide All
Baker, A., Richmond, R., Haile, M., Lewin, T. J., Carr, V. J., Taylor, R. L., et al. (2006). A randomized controlled trial of a smoking cessation intervention among people with a psychotic disorder. American Journal of Psychiatry, 163 (11), 19341942.
Bobo, J. K. (1989). Nicotine dependence and alcoholism epidemiology and treatment. Journal of Psychoactive Drugs, 21 (3), 323329.
Dani, J. A., & Harris, R. A. (2005). Nicotine addiction and comorbidity with alcohol abuse and mental illness. Nature Neuroscience, 8 (11), 14651470.
Diaz, F. J., Rendon, D. M., Velasquez, D. M., Susce, M. T., de Leon, J. (2006). Datapoints: Smoking and smoking cessation among persons with severe mental illnesses. Psychiatric Services, 57 (4), 462.
DiFranza, J. R., & Guerrera, M. P. (1990). Alcoholism and smoking. Journal of Studies on Alcohol and Drugs, 51 (2), 130135.
Gonzales, D., Rennard, S. I., Nides, M., Oncken, C., Azoulay, S., Billing, C. B. et al. (2006). Varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs sustained-release bupropion and placebo for smoking cessation: a randomized controlled trial. JAMA: The Journal of the American Medical Association, 296 (1), 47–55.
Gunnell, D., Irvine, D., Wise, L., Davies, C., & Martin, R. M. (2009). Varenicline and suicidal behaviour: a cohort study based on data from the General Practice Research Database. British Medical Journal, 339:b3805.
Henningfield, J. E., Fant, R. V., Buchhalter, A. R., & Stitzer, M. L. (2005). Pharmacotherapy for nicotine dependence. CA: A Cancer Journal For Clinicians, 55 (5), 281299.
Hughes, J. R., & Kalman, D. (2006). Do smokers with alcohol problems have more difficulty quitting? Drug and Alcohol Dependence, 82 (2), 91102.
Jorenby, D. E., Hays, J. T., Rigotti, N. A., Azoulay, S., Watsky, E. J., Williams, K. E. et al. (2006). Efficacy of varenicline, an alpha4beta2 nicotinic acetylcholine receptor partial agonist, vs placebo or sustained-release bupropion for smoking cessation: a randomized controlled trial. JAMA: The Journal of the American Medical Association, 296 (1), 5663.
Lasser, K., Boyd, J. W., Woolhandler, S., Himmelstein, D. U., McCormick, D., & Bor, D. H. (2000). Smoking and mental illness: A population-based prevalence study. JAMA: The Journal of the American Medical Association, 284 (20), 26062610.
Lawrence, D. M., Holman, C. D., Jablensky, A.V., & Hobbs, M.S. (2003). Death rate from ischaemic heart disease in Western Australian psychiatric patients 1980–1998. British Journal of Psychiatry, 182:3136.
Marks, J. L., Hill, E. M., Pomerleau, C. S., Mudd, S. A., & Blow, F.C. (1997). Nicotine dependence and withdrawal in alcoholic and nonalcoholic ever-smokers. Journal of Substance Abuse Treatment, 14 (6), 521527.
Masuhara, J. E., Heath, T., & Okoli, C. (2013). Outcomes of a tobacco treatment programme for individuals with severe and persistent mental illness attending a community mental health team. Journal of Smoking Cessation, doi:10.1017/jsc.2013.17
Oncken, C., Gonzales, D., Nides, M., Rennard, S., Watsky, E., Billing, C. B. et al. (2006). Efficacy and safety of the novel selective nicotinic acetylcholine receptor partial agonist, varenicline, for smoking cessation. Archives of Internal Medicine, 166 (15), 15711577.
Pfizer. (2012). Citing Websites. In CHANTIX® (varenicline) tablets. Retrieved 21 August 2013, from http://labeling.pfizer.com/ShowLabeling.aspx?id=557.
Pomerleau, C. S., Marks, J. L., Pomerleau, O.F. (2000). Who gets what symptom? Effects of psychiatric cofactors and nicotine dependence on patterns of smoking withdrawal symptomatology. Nicotine & Tobacco Research, 2 (3), 275280.
Tonstad, S., Davies, S., Flammer, M., Russ, C., & Hughe, J. (2010). Psychiatric adverse events in randomized, double-blind, placebo-controlled clinical trials of varenicline: a pooled analysis. Drug Safety, 33 (4), 289301.
Vaillant, G. E., Schnurr, P. P., Baron, J. A., & Gerber, P. D. (1991). A prospective study of the effects of cigarette smoking and alcohol abuse on mortality. Journal of General Internal Medicine, 6 (4), 299304.
Xian, H., Scherrer, J. F., Madden, P. A., Lyons, M. J., Tsuang, M., True, W. R. et al. (2005). Latent class typology of nicotine withdrawal: genetic contributions and association with failed smoking cessation and psychiatric disorders. Psychological Medicine, 35 (3), 409419.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed