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This book is a comprehensive guide to the screening, management, and treatment of female patients with addictions. There are a range of clinical issues specific to women with substance use disorders and substance abuse during pregnancy is known to have deleterious effects on neonates. This book focuses on the effective care of the addicted patient and discusses novel outpatient therapy, therapeutic substitution, abstinence therapy, and the importance of counseling in the delivery of care. Topics include the physiology of nicotine, opiates, EtOH, and other substances of abuse; the role of receptors and neurotransmitters in addiction; the effects of tobacco and substance abuse on women’ s health; and tobacco cessation methods. Featuring practical approaches to gender-responsive treatment, Tobacco Cessation and Substance Abuse in Women’s Healthcare is a valuable resource for obstetricians, gynecologists, family medicine practitioners, and residents hoping to expand their knowledge of tobacco cessation and substance abuse in women’s health.
This newly revised and expanded edition of Women's Drug and Substance Abuse: A Comprehensive Analysis and Reflective Synthesis offers a unique analysis and synthesis of theory, empirical research, and clinical guidance for treating substance abuse among young, middle-aged, and older women of various racial and sociocultural backgrounds in the United States, 2000 to 2018. This text uses the most current research findings to examine the actions and effects of drugs, women’s patterns of medical and personal use and abuse, and common mental disorders associated with drug use. The authors also present their own empirically-based assessment model as well as prevention and treatment approaches specifically designed for women. Also included in the text is a comprehensive, cross-referenced subject index. Clear, comprehensive, accessible, and fully referenced, this book will be an invaluable resource for students and for professionals in all health and social care disciplines. Women's Drug and Substance Abuse is the 18th clinical pharmacology text that the Pagliaros have written over the past 40 years and is the 6th that deals exclusively with drug and substance abuse.
OBJECTIVE: We undertook this systematic review to support the U.S. Preventive Services Task Force in updating its 2015 recommendation on tobacco cessation interventions for adults, including pregnant women. Our review addressed the effectiveness and safety of pharmacotherapy, behavioral interventions, and electronic cigarettes for tobacco cessation. DATA SOURCES: We conducted an overview of reviews for evidence related to pharmacotherapy and behavioral interventions among the general adult population and for behavioral interventions among pregnant women. We searched the following databases and organizations' websites to identify existing reviews through April 2019: PubMed, PsycInfo, the Database of Abstracts of Reviews of Effects, the Cochrane Database of Systematic Reviews, the Centre for Reviews and Dissemination Health Technology Assessment, the Agency of Healthcare Research and Quality, the Canadian Agency for Drugs and Technologies in Health, Center for Disease Control and Prevention's Guide to Community Preventive Services, the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine), the National Health Service Health Technology Assessment Programme, and the Surgeon General. We conducted a search for primary evidence related to the effectiveness and safety of electronic cigarettes (through May 2020) and pharmacotherapy among pregnant women (through May 2020) and did not rely on existing systematic reviews for this evidence. We conducted ongoing surveillance for relevant literature through September 25, 2020. STUDY SELECTION: For the overview of reviews, we included reviews with or without meta-analysis that were published in the English language that systematically reported the effects of tobacco cessation interventions on health, cessation, or adverse outcomes. We excluded nonsystematic meta-analyses and narrative reviews. For primary evidence related to the effectiveness and safety of electronic cigarettes among adults and pharmacotherapy among pregnant women, we included randomized controlled trials and large observational studies that reported health or cessation outcomes at 6 months or more followup or adverse events at any time point. For all evidence, we conducted critical appraisal of all provisionally included reviews and excluded reviews rated as having "critically low" credibility according to AMSTAR-2 criteria and individual studies rated as "poor" quality according to study design-specific risk-of-bias criteria. Data were abstracted by one reviewer and confirmed by another. DATA ANALYSIS: We grouped reviews based on population and intervention and identified one or more reviews within each population and intervention subgroup that represented the most current and applicable evidence to serve as the basis for the main findings ("primary" reviews) and discussed complementary and discordant findings from other included reviews as necessary. We did not reanalyze any of the individual study evidence but presented pooled analyses and existing point estimates from included reviews. We narratively synthesized the primary evidence for electronic cigarettes among adults and pregnant women and medications for smoking cessation among pregnant women and where appropriate, conducted random-effects meta-analyses to pool study results. RESULTS: We included 67 systematic reviews, 33 of which served as the basis for the primary findings. While this review was broadly scoped to include abstinence of all tobacco products, the primary outcome in all cases was abstinence from combustible cigarette smoking. Among adults, combined pharmacotherapy and behavioral interventions significantly increased smoking abstinence by 83 percent versus usual care or minimal support control groups not using medication (risk ratio [RR] 1.83 [95% confidence interval [CI], 1.68 to 1.98]). Furthermore, all seven FDA-approved medications for smoking cessation were found to be effective in increasing smoking quit rates compared with placebo or nondrug arms at 6 or more months followup. The pooled RR for abstinence for nicotine replacement therapy (NRT, all forms) was 1.55 (95% CI, 1.49 to 1.61), for bupropion, 1.64 (95% CI, 1.52 to 1.77), and for varenicline, 2.24 (95% CI, 2.06 to 2.43). Combined NRT versus a single form of NRT showed a statistically significantly greater cessation effect (RR 1.25 [95% CI, 1.15 to 1.36]). Pooled analysis of trials directly comparing NRT and bupropion did not suggest a difference between the two types of pharmacotherapy; however, varenicline has been shown to be superior to both NRT and bupropion in achieving abstinence at 6 months or greater, although there are fewer trials testing these differences. Although less evidence is available, certain medications such as nortriptyline and cytisine used for tobacco cessation have shown potential benefits. None of the drugs were associated with serious adverse events, including major cardiovascular adverse events or serious neuropsychiatric events. Compared with various controls, behavioral interventions such as in-person advice and support from clinicians including physician advice, nurse advice, individual counseling with a cessation specialist, group behavioral interventions, telephone counseling, mobile phone-based interventions, interactive and tailored internet-based interventions, and the use of incentives had modest but significantly increased relative smoking cessation at 6 or more months (15% to 88% range in relative effects). For example, the pooled RR of physician advice versus no advice was 1.76 (95% CI, 1.58 to 1.96) for smoking cessation at 6 or more months' followup. There was a lack of clear benefit of motivational interviewing, decision aids, print-based, nontailored self-help materials, real-time video counseling, biofeedback (feedback on smoking exposure, smoking-related disease, or smoking-related harms), exercise, acupuncture, hypnotherapy, and system change interventions compared with controls; however, there was substantially less evidence related to each of these interventions. While some reviews found evidence of potential effect modification by specific intervention, population, or study design characteristics, there was no one factor that consistently predicted greater treatment effects, and nearly every subgroup analysis was found to be statistically significant. Few reviews on behavioral interventions captured information on potential harms, and none suggested serious adverse events that arose. We identified five trials that addressed the effectiveness and harms of the use of electronic cigarettes among adults. No trials testing the effects of electronic cigarettes for smoking cessation among pregnant women were identified. Results were mixed on smoking cessation effectiveness at 6 to 12 months among smokers intending to quit when compared with placebo devices or NRT. Four additional trials also reported on potential short-term harms of electronic cigarette use for cessation; none suggested relatively higher rates of serious adverse events. Among pregnant women, smoking cessation during late pregnancy was greater among women receiving any type of behavioral intervention, with evidence most clear for counseling versus controls (RR 1.31 [95% CI, 1.16 to 1.47]). Behavioral interventions were also associated with an increase in mean birthweight of babies as well as a decreased risk of low birth weight. We identified one new trial of NRT among pregnant women, but no new trials testing the effects of bupropion or varenicline in this population. For NRT, rates of validated cessation among women allocated to NRT (5.4% to 28.2%) compared with placebo (5.0% to 25.4%) were not statistically different (pooled RR 1.11 [95% CI, 0.79 to 1.56]). Benefits of NRT on infant health outcomes were seen in a few trials, but that evidence was limited. There was no clear evidence of harms from behavioral interventions or associated with NRT use during pregnancy, but harms also could not be ruled out given sparse reporting, low statistical power for evaluating rare harms, and limitations of observational study comparisons. LIMITATIONS: The comprehensiveness of our overview of reviews is limited by the recency and quality of the source reviews; with exceptions, we did not describe or cite individual trials because of the large volume of trials represented in the reviews. Furthermore, there are a limited number of trials testing the benefits and harms of electronic cigarettes among adults as well as the use of medications to assist pregnant women stop smoking. Such sparsity in research hampers our ability to make any robust conclusions about their effectiveness and potential harms. CONCLUSIONS: There is strong evidence that a range or pharmacological and behavioral interventions, both individually and in combination, are effective in increasing smoking cessation in adults. Moreover, behavioral interventions can help pregnant women stop smoking. Data on the effectiveness and safety of electronic cigarettes for smoking cessation among adults are limited as are data on the use of tobacco cessation pharmacotherapies among pregnant women. Future research should focus on direct comparisons between different combinations and classes of drugs, adaptations of interventions for diverse populations, and the efficacy and safety of electronic cigarettes.
"This guideline is an updated version of the 1996 Smoking Cessation Clinical Practice Guideline No. 18."--P. ii.
This book constitutes a major new resource for professionals working with hard core smokers and their families. It is designed as a practical, clinically useful and up-to-date guide for all those in a position to intervene: mental health professionals, physicians, dentists, nurses, pharmacists and other health care professionals, clergy, human resource and employee assistance program corporate staff, and teachers and guidance counselors. New research suggests that difficult-to-treat smokers often have emotional problems adjusting to stopping smoking. Some also have psychiatric diagnoses or abuse other substances. These are factors which interfere with their efforts to quit. Because these difficulties have been poorly understood, hard-core smokers have not been provided with adequate resources and skills to overcome their addiction. These smokers are in need of increasingly comprehensive assessment and treatment. Despite massive public health education about the dangers of cigarette smoking, rates of smoking among the population are no longer declining in the United States and the success rates of clinical programs for smokers remain low. Helping the Hard-Core Smoker seeks to explain why current approaches are often inadequate and how best to help today's highly nicotine-dependent smokers who are struggling with their addiction quit.
This unique clinical handbook offers the knowledge, skills, and materials needed to help all types of smokers, even the most hard-core, successfully quit. Provided are assessment tools, treatment planning guidelines, and a series of complete treatment packages, ranging from ultra-brief to more intensive options. Designed for use in a variety of settings by a wide range of providers, the volume is evidence-based and consistent with the latest national guidelines on best practice. The authors, leading scientist-practitioners, incorporate the latest pharmacotherapeutic approaches as well as proven motivational, cognitive, and behavioral techniques. Strategies are presented for tailoring treatment to individual smokers and for preventing relapse. Also included are session-by-session intervention guidelines, helpful case examples, and dozens of requisite handouts and forms, ready to photocopy and use. Key Features No other book presents the full range of empirically supported treatments. Practical: includes step-by-step guidelines, cases, reproducible patient forms. Consistent with best-practice recommendations issued by the Surgeon General, the American Psychiatric Association, and the British Thoracic Society. Describes approaches with and without pharmacotherapy. Photocopy Rights: The Publisher grants individual book purchasers nonassignable permission to reproduce selected materials in this book for professional use. For details and limitations, see copyright page.
BACKGROUND: Tobacco use is the leading preventable cause of disease, disability, and death in the United States. Interventions to help adults quit smoking might stop or reduce tobacco-related illness. PURPOSE: To systematically review evidence for the effectiveness and safety of pharmacotherapy and behavioral tobacco cessation interventions among adults, including pregnant women and those with mental health conditions, and to conduct a de novo search for primary evidence related to electronic nicotine delivery systems for adults. METHODS: We conducted a review of reviews and searched for existing systematic reviews published through August 1, 2014 in the following databases and organizations' websites: PubMed, PsycInfo, the Database of Abstracts of Reviews of Effects, the Cochrane Database of Systematic Reviews, the Centre for Reviews and Dissemination Health Technology Assessment, the Agency of Healthcare Research and Quality, British Medical Journal Clinical Evidence, the Canadian Agency for Drugs and Technologies in Health, Center for Disease Control and Prevention's Guide to Community Preventive Services, the Institute of Medicine, the National Institute for Health and Clinical Excellence, the National Health Service Health Technology Assessment Programme, and the Surgeon General. We included reviews that were published in the English language that systematically reported the effects of tobacco cessation interventions on health, cessation, or adverse outcomes. We excluded nonsystematic meta-analyses and narrative reviews and those that focused on harm reduction or relapse prevention. We conducted an a priori search for primary trial evidence related to the effectiveness and safety of electronic nicotine delivery systems (ENDS) (through March 1, 2015) and a search for pharmacotherapy among pregnant women (through August 15, 2014) to supplement the review of reviews methodology. Two investigators independently reviewed abstracts and full-text articles against a set of a priori inclusion and quality criteria. Discrepancies were resolved by consensus. One reviewer abstracted data into an evidence table and a second reviewer checked these data. We grouped reviews based on population (general adults, pregnant women, individuals with mental health conditions) and intervention (pharmacotherapy, behavioral, or combined interventions). We identified one or more reviews within each population and intervention subgroup that represented the most current and applicable evidence to serve as the basis for the main findings ("primary" reviews) and discussed complementary and discordant findings from other included reviews as necessary. We did not reanalyze any of the individual study evidence; we presented pooled analyses and existing point estimates from included reviews. RESULTS: We included 54 systematic reviews, 22 of which served as the basis for the primary findings. Among adults, nine reviews addressed the efficacy and/or harms of nicotine replacement therapy (NRT), bupropion hydrochloride sustained release (bupropion SR), and/or varenicline. None of these reviews reported on health outcomes. All three medications were found to be effective in increasing smoking quit rates compared with placebo or nondrug arms at 6 or more months followup. The pooled risk ratio (RR) for abstinence for NRT was 1.60 (95% confidence interval [CI], 1.53 to 1.68); for bupropion SR, RR 1.62 (95% CI, 1.49 to 1.76); and for varenicline, 2.27 (95% CI, 2.02 to 2.55). Combined NRT versus a single form of NRT showed a statistically significantly greater cessation effect in pooled analysis (RR 1.34 [95% CI, 1.18 to 1.51]). None of the drugs were associated with major cardiovascular adverse events, although NRT produced higher rates of all cardiovascular events (driven by minor events). One review on combined pharmacotherapy and behavioral interventions reported a relative increase in quitting by 82 percent versus nonpharmacotherapy usual care (RR 1.82 [95% CI, 1.66 to 2.00]). We included an additional 33 reviews that addressed behavioral tobacco cessation treatments among adults, including those that focused on specific subpopulations such as older adults. Compared with various controls, behavioral interventions such as in-person advice and support from clinicians, self-help materials, and telephone counseling had modest, but significantly increased, relative smoking cessation at 6 or more months (18% to 96%). For example, the pooled RR of physician advice versus no advice was 1.76 (95% CI, 1.58 to 1.96) for smoking cessation at 6 or more months followup. Only two trials addressed the efficacy and harms related to the use of electronic cigarettes and these trials suggested no benefit on smoking cessation among smokers intending to quit. We included eight reviews that focused on pregnant women that found significant benefits for perinatal health, including increased birth weight and reduced preterm birth. These benefits were evident with behavioral interventions, and suggested by data from some of the NRT trials, although that evidence was limited. Cessation during late pregnancy was greater among women receiving any type of behavioral intervention, with evidence most clear for counseling. Rates of validated cessation among women allocated to NRT (5% to 24%) compared with placebo (0% to 15%) were not statistically different, although few studies contributed data. Our reviews among individuals with depression or schizophrenia provided limited trial evidence on the efficacy of pharmacotherapy or behavioral interventions. There was, however, some evidence of a benefit for bupropion among those with schizophrenia and the addition of a mood management component to behavioral interventions for smokers with depression. CONCLUSIONS: This review of reviews suggests that behavioral interventions and pharmacotherapy, alone or in combination, are effective in helping to reduce rates of smoking among the general adult population. Behavioral interventions, in particular, can assist pregnant women to stop smoking. Data on the effectiveness and safety of electronic nicotine delivery systems are limited. Future research should focus on direct comparisons between different combinations and classes of drugs; the incidence of serious adverse events related to medications for cessation; the efficacy and safety of ENDS; and pharmacotherapies for pregnant women and those with mental health conditions including evidence on health outcomes.
The health and economic costs of tobacco use in military and veteran populations are high. In 2007, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) requested that the Institute of Medicine (IOM) make recommendations on how to reduce tobacco initiation and encourage cessation in both military and veteran populations. In its 2009 report, Combating Tobacco in Military and Veteran Populations, the authoring committee concludes that to prevent tobacco initiation and encourage cessation, both DoD and VA should implement comprehensive tobacco-control programs.
A scientifically informed intervention to help smokers quit for life, based in cognitive-behavioral therapy Cognitive-Behavioral Therapy, Mindfulness, and Hypnosis for Smoking Cessation: A Scientifically Informed Intervention presents a comprehensive program developed by noted experts to help smokers achieve their goal of life-long abstinence from smoking. This brief, cost-effective intervention, called The Winning Edge, incorporates state-of-the-science advances and best clinical practices in the treatment of tobacco addiction and offers participants a unique blend of strategies based on cognitive-behavioral, mindfulness, and hypnotic approaches to achieve smoking cessation. This valuable treatment guide, developed and refined over the past 30 years, provides all of the information necessary for health care providers to implement the program on a group or individual basis. This important resource: Provides a detailed, step-by-step guide to conducting the program, with scripts for providers and handouts for participants Explains the scientific basis for the many strategies of cognitive, behavioral, and affective change in The Winning Edge program Contains information for treatment providers on frequently asked questions, adapting and tailoring the program to the needs of participants, and overcoming challenges, ambivalence, and resistance to stop smoking Written for a wide audience of mental health professionals, Cognitive-Behavioral Therapy, Mindfulness, and Hypnosis for Smoking Cessation: A Scientifically Informed Intervention offers a comprehensive, science-based approach to help participants achieve their goal of a smoke-free life.