Dr Brian Hitsman: Improving the treatment of nicotine dependence in clinical populations

A talk on " Improving the treatment of nicotine dependence in clinical populations" by Dr Brian Hitsman from Northwestern University

Summary:
Reducing the prevalence of cigarette smoking among high tobacco burden clinical populations will require both increasing the efficacy of existing treatments and identifying new targeted treatments that address the unique psychological factors that underlie their nicotine dependence. Dr. Hitsman discusses the problem of nicotine dependence in medical (cancer) and mental health (major depression) populations and the efficacy of existing treatments. He will then describe a series of randomized controlled trials involving these special populations that focus on improving treatment reach and efficacy. He presents the results from a recently published trial that evaluated long-term treatment with telephone delivered behaviour therapy and nicotine patch. Two ongoing clinical trials are evaluating targeted interventions for cancer patients and patients with major depressive disorder. Preliminary results from a trial of extended duration treatment with varenicline for cancer patients will be presented. The second trial is evaluating the efficacy of a novel behaviour therapy, behavioural activation for smoking cessation, plus varenicline for patients with major depression. Dr. Hitsman describes the guiding theoretical framework for smoking behaviour in this underserved population, the rationale for the treatment and study design, and the conceptual model of targeted mechanisms (e.g., anhedonia). He concludes with brief discussion of other key issues, including safety, and strategies to improve the success of treating nicotine dependence in clinical populations.