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Abstinence Rates (abstinence + rate)
Kinds of Abstinence Rates Selected AbstractsCombined counseling and bupropion therapy for smoking cessation: identification of outcome predictorsDRUG DEVELOPMENT RESEARCH, Issue 3 2006Maria Caterina Grassi Abstract Because some smoking-induced pathologies improve upon discontinuation, strategies have been developed to help smokers quit. The aim of this study was to measure the rate of smokers still abstinent one year after one cycle of a six-week group counseling given alone or in combination with a seven-week period of daily administration of bupropion. We also evaluated the predictor validity of nicotine dependence intensity at enrollment, administering both the Fageström Tolerance Questionnaire (FTQ) and the Severity of Dependence Scale (SDS). Visual Analogue Scale (VAS), to measure the intensity of "smoke craving," was also administered. Two hundred twenty-nine subjects trying to quit smoking were enrolled. Bupropion therapy was accepted by 110 subjects, but only 50 completed the 7-week cycle of therapy. Abstinence rates at one year were 68.0 and 56.6%, respectively, in the group that used bupropion for the scheduled 7 weeks and in the group that discontinued bupropion, and 35.3% in the group with counseling therapy alone. SDS (but not FTQ) scores at enrollment, VAS values for craving at the end of the program, and bupropion therapy were the variables selected by Linear Discriminant Analysis to assign subjects to the Smoker or Non-smoker group, with a global correctness of 70.9%. In conclusion, the efficacy of bupropion largely depends upon its interaction with psychological factors, such as the level of nicotine dependence, craving for nicotine, and the subject's commitment to quit smoking. Drug Dev. Res. 67:271,279, 2006. © 2006 Wiley-Liss, Inc. [source] Subjective social status affects smoking abstinence during acute withdrawal through affective mediatorsADDICTION, Issue 5 2010Lorraine R. Reitzel ABSTRACT Objectives Direct and mediated associations between subjective social status (SSS), a subjective measure of socio-economic status, and smoking abstinence were examined during the period of acute withdrawal among a diverse sample of 421 smokers (33% Caucasian, 34% African American, 33% Latino) undergoing a quit attempt. Methods Logistic regressions examined relations between SSS and abstinence, controlling for socio-demographic variables. Depression, stress, positive affect and negative affect on the quit day were examined as potential affective mediators of the SSS-abstinence association, with and without adjusting for pre-quit mediator scores. Results SSS predicted abstinence to 2 weeks post-quit. Abstinence rates were 2.6 (postquit week 1) and 2.4 (postquit week 2) times higher in the highest versus the lowest SSS quartile. Depression and positive affect mediated the SSS,abstinence relationships, but only depression maintained significance when adjusting for the baseline mediator score. Conclusions Among a diverse sample of quitting smokers, low SSS predicted relapse during acute withdrawal after controlling for numerous covariates, an effect accounted for partially by quit day affective symptomatology. Smokers endorsing lower SSS face significant hurdles in achieving cessation, highlighting the need for targeted interventions encompassing attention to quit day mood reactivity. [source] Multimodal techniques for smoking cessation: a review of their efficacy and utilisation and clinical practice guidelinesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 11 2008V. I. Reus Summary Aims:, Nicotine addiction is a complex, chronic condition with physiological and psychological/behavioural aspects that make smoking cessation extremely difficult. This paper reviews current recommendations for smoking cessation and the efficacy of pharmacotherapy and behavioural modification techniques, used either alone or in combination, for smoking cessation. Results:, Abstinence rates for pharmacotherapies range from ,16% to ,30% at 1-year follow-up, with efficacy odds ratios (ORs) compared with placebo of ,1.7 for nicotine replacement therapy (NRT), ,1.9 for bupropion sustained release and ,3.0 for varenicline. Behaviour modification therapies have achieved quit rates of between 8% and 43% for up to 1 year, with ORs in comparison to no treatment of between ,1.2 and ,2.2. No direct comparisons have been made between pharmacotherapy alone and psychological behaviour strategies alone. However, combining physiological approaches with counselling significantly increases the odds of quitting compared with either technique alone. Conclusions:, Applying multimodal techniques for the treatment of nicotine addiction is the recommended approach and has demonstrated the potential to improve rates of permanent abstinence in smokers attempting cessation. While the numbers of patients receiving help and advice regarding smoking cessation is increasing, the multimodal approach appears to be currently underutilised by clinicians and therefore smoking cessation strategies are not being optimised. [source] Integrating Tobacco Cessation Treatment into Mental Health Care for Patients with Posttraumatic Stress DisorderTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 5 2006Miles McFall PhD The integration of tobacco cessation treatment into mental health care for posttraumatic stress disorder (PTSD), known as Integrated Care (IC), was evaluated in an uncontrolled feasibility and effectiveness study. Veterans (N = 107) in PTSD treatment at two outpatient clinics received IC delivered by mental health practitioners. Outcomes were seven-day point prevalence abstinence measured at two, four, six, and nine months post-enrollment and repeated seven-day point prevalence abstinence (RPPA) obtained across three consecutive assessment intervals (four, six, and nine months). Abstinence rates at the four assessment intervals were 28%, 23%, 25%, and 18%, respectively, and RPPA was 15%. The number of IC sessions and a previous quit history greater than six months predicted RPPA. Stopping smoking was not associated with worsening PTSD or depression. [source] Reduced nicotine content cigarettes: effects on toxicant exposure, dependence and cessationADDICTION, Issue 2 2010Dorothy K. Hatsukami ABSTRACT Aims To examine the effects of reduced nicotine cigarettes on smoking behavior, toxicant exposure, dependence and abstinence. Design Randomized, parallel arm, semi-blinded study. Setting University of Minnesota Tobacco Use Research Center. Interventions Six weeks of: (i) 0.05 mg nicotine yield cigarettes; (ii) 0.3 mg nicotine yield cigarettes; or (iii) 4 mg nicotine lozenge; 6 weeks of follow-up. Measurements Compensatory smoking behavior, biomarkers of exposure, tobacco dependence, tobacco withdrawal and abstinence rate. Findings Unlike the 0.3 mg cigarettes, 0.05 mg cigarettes were not associated with compensatory smoking behaviors. Furthermore, the 0.05 mg cigarettes and nicotine lozenge were associated with reduced carcinogen exposure, nicotine dependence and product withdrawal scores. The 0.05 mg cigarette was associated with greater relief of withdrawal from usual brand cigarettes than the nicotine lozenge. The 0.05 mg cigarette led to a significantly higher rate of cessation than the 0.3 mg cigarette and a similar rate as nicotine lozenge. Conclusion The 0.05 mg nicotine yield cigarettes may be a tobacco product that can facilitate cessation; however, future research is clearly needed to support these preliminary findings. [source] Extended cognitive behavior therapy for cigarette smoking cessationADDICTION, Issue 8 2008Joel D. Killen ABSTRACT Primary aim Examine the effectiveness of extended cognitive behavior therapy (CBT) in promoting longer-term smoking abstinence. Design Open-label treatment phase followed by extended treatment phase. Randomization conducted prior to entry into open-label treatment phase; analysis based on intention-to-treat to avoid threat of selection bias. Setting Community smoking cessation clinic. Participants A total of 304 adult smokers (,18 years of age; ,10 cigarettes/day). Intervention Open-label (8 weeks): all participants received bupropion SR, nicotine patch, CBT. Extended treatment (12 weeks): participants received either CBT + voicemail monitoring and telephone counseling or telephone-based general support. Measurements Seven-day point prevalence abstinence, expired-air carbon monoxide. Results At week 20 follow-up, CBT produced a higher 7-day point prevalence abstinence rate: 45% versus 29%, P = 0.006; at 52 weeks the difference in abstinence rates (31% versus 27%) was not significant. History of depression was a moderator of treatment. Those with a positive history had a better treatment response at 20 weeks when assigned to the less intensive telephone support therapy (P < 0.05). Conclusion The superiority of CBT to 20 weeks suggests that continued emphasis on the development of cognitive and behavioral strategies for maintaining non-smoking during an extended treatment phase may help smokers to maintain abstinence in the longer term. At present, the minimum duration of therapy is unknown. [source] Relationship between menthol cigarettes and smoking cessation among African American light smokersADDICTION, Issue 12 2007Kolawole S. Okuyemi ABSTRACT Aims To determine whether African American light smokers who smoked menthol cigarettes had lower cessation when treated with nicotine replacement therapy and counseling. Design Data were derived from a clinical trial that assessed the efficacy of 2 mg nicotine gum (versus placebo) and counseling (motivational interviewing counseling versus Health Education) for smoking cessation among African American light smokers (smoked , 10 cigarettes per day). Participants The sample consisted of 755 African American light smokers. Measurements The primary outcome variable was verified 7-day point-prevalence smoking cessation at 26 weeks follow-up. Verification was by salivary cotinine. Findings Compared to non-menthol smokers, menthol smokers were younger and less confident to quit smoking (P = 0.023). At 26 weeks post-randomization, 7-day verified abstinence rate was significantly lower for menthol smokers (11.2% versus 18.8% for non-menthol, P = 0.015). Conclusions Among African American light smokers, use of menthol cigarettes is associated with lower smoking cessation rates. Because the majority of African American smokers use menthol cigarettes, a better understanding of the mechanism for this lower quit rate is needed. [source] Rapid detoxification from opioid dependence under general anaesthesia versus standard methadone tapering: abstinence rates and withdrawal distress experiencesADDICTION BIOLOGY, Issue 3 2003PAUL KRABBE The aim of this work was to study abstinence rates and withdrawal effects of rapid detoxification of opioid-dependents under general anaesthesia (RD-GA) compared to standard methadone tapering (SMT) using a prospective clinical trial with a follow-up of 3 months, as a preliminary study at the Novadic addiction centre in St Oedenrode and St Joseph Hospital in Veghel, the Netherlands. Thirty opioid-dependent patients took part. Outcome measures included urine toxicology screening for opiates to determine abstinence and presence of objective and subjective opioid withdrawal distress symptoms. Statistically significant differences in abstinence rate between RD-GA and SMT were present after one (RD-GA 100% vs. SMT 40%, p <0.01) and 2 months (RD-GA 93% vs. SMT 33%, p <0.01). After 3 months the difference in abstinence was still substantial, but no longer statistically significant (RD-GA 67% vs. SMT 33%, p =0.14). Objective and subjective withdrawal symptoms showed largely identical outcomes and were equally low in the two groups for those who remained in the study. There was a considerably higher percentage of abstinence in the RD-GA group after 1, 2 and 3 months of follow-up accompanied by relatively mild withdrawal symptoms of shorter duration. However, if one completes SMT the data suggest a greater chance of staying clean in the long term than those completing RD-GA. [source] Latest news and product developmentsPRESCRIBER, Issue 17 2008Article first published online: 15 SEP 200 Small AED suicide risk Antiepileptic drugs (AEDs) are associated with a small increase in the risk of suicidal thoughts, the MHRA has warned. In the latest Drug Safety Update (2008;2:Issue 1) the MHRA says that, compared with placebo, AEDs are associated with an additional two cases of suicidal thoughts and behaviour per 1000 patients (0.43 vs 0.22 per cent). This may occur as early as one week after starting treatment. It is unclear whether the risk varies among AEDs. Also in this issue, the MHRA warns of an increased risk of tumour progression and reduced survival in patients with cancer treated with recombinant erythropoietin. Other topics include the use of lenalidomide (Revlimid) and thalidomide for multiple myeloma; new restrictions on the use of moxifloxacin (Avelox) due to adverse effects; and a reminder that metronidazole should be administered orally, not by intravenous injection, for the treatment of C. difficile -associated diarrhoea. Low-fat diet least effective option? A low-fat diet is associated with less weight loss and less favourable metabolic changes over two years than a low-carbohydrate (Watkins) diet or a Mediterranean diet in 322 moderately obese patients (mean BMI 30kg per m2; N Eng J Med 2008;359:229,41). Estimated energy intake was similar for all diets. Mean weight loss in all randomised patients was 2.9kg for the low fat diet, 4.4kg for the Mediterranean diet and 4.7kg for the low-carbohydrate diet. The low-carbohydrate diet was associated with greater increases in HDL-cholesterol and greater reductions in triglycerides and total cholesterol/HDL-C ratio compared with the low-fat diet. Among people with diabetes, fasting plasma glucose and insulin resistance were decreased only in those assigned to the Mediterranean diet, and only the low carbohydrate diet significantly decreased HbA1c. Stopping post-MI statins Patients who stop taking a statin first prescribed after an acute MI almost double their risk of death compared with nonusers, a new study shows (Eur Heart J; published online 29 July 2008; doi: 10.1093/eurheartj/ehn346). The analysis of 9939 MI survivors in the General Practice Research Database showed that, compared with patients who had never used a statin, the risk of death was unchanged for those previously taking a statin who continued treatment after MI. The risk was reduced by 28 per cent for those who started a statin post-MI and continued it but, in those who started a statin but then stopped it, the hazard ratio for death was 1.88 (CI 95% 1.13-3.07). Stopping control medication (aspirin, beta-blockers or proton pump inhibitors) did not alter the risk of death. Smoking quit rates with NRT and varenicline Differences in quit rates between nicotine replacement therapy (NRT) and varenicline (Champix) are small, according to a multinational study (Thorax 2008;63:717,24). The trial compared transdermal NRT (21mg to 7mg per day over 10 weeks) with varenicline (1mg twice daily for 12 weeks). Over the final four weeks of treatment, the abstinence rate was significantly higher with varenicline (56 vs 43 per cent). After one year, the four-week abstinence rates were 26 and 20 per cent respectively (p = 0.056) and seven-day point prevalence abstinence rates at 6 or 12 months were not significantly different. Varenicline reduced craving, withdrawal symptoms and smoking satisfaction compared with NRT but at the cost of a higher incidence of nausea (37 vs 10 per cent). Azithromycin goes OTC The MHRA has announced that azithromycin will be available without prescription for the treatment of Chlamydia infection. Under the brand Clamelle, azithromycin will be supplied from pharmacies to over-16s who have tested positive for infection but have no symptoms; their partners may also be treated. A urine testing kit will be marketed to pharmacists. Product news Sodium valproate (Epilim Chronosphere) is now available as modified-release granules to be taken with food or a drink; 30 sachets, in five strengths from 50750mg, cost £30. Boehringer Ingelheim has introduced a higher strength of its telmisartan/hydrochlorothiazide combination (Micardis Plus) for hypertension; 80mg/25mg costs £14.18 for a month's supply. Copyright © 2008 Wiley Interface Ltd [source] Varenicline for smoking cessation: A placebo-controlled, randomized studyRESPIROLOGY, Issue 3 2009Chen WANG ABSTRACT Background and objective: Varenicline tartrate, a novel, selective, nicotinic acetylcholine receptor partial agonist, has been developed specifically as a smoking cessation drug. This study evaluated the efficacy of a standard regimen of varenicline compared with placebo for smoking cessation in 333 subjects in China, Singapore and Thailand. Methods: This 24-week, randomized, double-blind, placebo-controlled trial of varenicline, 1 mg bd, consisted of a 12-week treatment period followed by a 12-week non-treatment follow-up period. The primary study end-point was the 4-week continuous abstinence rate defined as the proportion of subjects who reported total abstinence from smoking and other nicotine products from weeks 9,12. A key secondary end-point was the continuous abstinence rate from weeks 9,24, defined as the proportion of subjects who achieved the primary end-point as well as total abstinence from all tobacco products from weeks 13,24. Results: Both end-points were achieved by a significantly higher proportion of subjects in the varenicline group than in the placebo group. The 4-week continuous abstinence end-point was achieved by 50.3% and 31.6% in the varenicline and placebo groups, respectively (P = 0.0003), while continuous abstinence from weeks 9,24 was achieved by 38.2% and 25.0% of subjects, respectively (P = 0.0080). The treatment effect was generalizable by treatment centre and country. Varenicline was safe and appeared to be well tolerated by most subjects. Conclusion: Varenicline was significantly more efficacious for smoking cessation than placebo over a 12-week treatment period and a further 12-week non-treatment follow-up period in smokers from China, Singapore and Thailand. No significant side-effects were noted. [source] Out-patient behaviour therapy in alcoholism: treatment outcome after 2 yearsACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2002W. Burtscheidt Burtscheidt W, Wölwer W, Schwarz R, Strauss W, Gaebel W. Out-patient behaviour therapy in alcoholism: treatment outcome after 2 years. Acta Psychiatr Scand 2002: 106: 227,232. © Blackwell Munksgaard 2002. Objective:,The main aim of the study was the evaluation of out-patient behavioural approaches in alcohol dependence. Additionally, the persistence of treatment effects and the impact of psychiatric comorbidity in long-term follow-up was examined. Method:,A total of 120 patients were randomly assigned to non-specific supportive therapy or to two different behavioural therapy programmes (coping skills training and cognitive therapy) each comprising 26 weekly sessions; the follow-up period lasted 2 years. Results:,Patients undergoing behavioural therapy showed a consistent trend towards higher abstinence rates; significant differences between the two behavioural strategies could not be established. Moreover, the results indicate a reduced ability of cognitive impaired patients to cope with short-time abstinence violations and at a reduced benefit from behavioural techniques for patients with severe personality disorders. Conclusion:,Behavioural treatment yielded long-lasting effects and met high acceptance; yet, still in need of improvement is the development of specific programmes for high-risk patients. [source] The effect of stopping smoking on perceived stress levelsADDICTION, Issue 8 2010Peter Hajek ABSTRACT Aims Many smokers believe that smoking helps them to cope with stress, and that stopping smoking would deprive them of an effective stress management tool. Changes in stress levels following long-term smoking cessation are not well mapped. This longitudinal project was designed to provide more robust data on post-cessation changes in perceived stress levels by following a cohort of smokers admitted to hospital after myocardial infarction (MI) or for coronary artery bypass (CAB) surgery, as such patients typically achieve higher continuous abstinence rates than other comparable samples. Design A total of 469 smokers hospitalized after MI or CAB surgery and wanting to stop smoking were seen in the hospital and completed 1-year follow-ups. Ratings of helpfulness of smoking in managing stress at baseline, smoking status (validated by salivary cotinine concentration) and ratings of perceived stress at baseline and at 1-year follow-up were collected. Findings Of the patients, 41% (n = 194) maintained abstinence for 1 year. Future abstainers and future smokers did not differ in baseline stress levels or in their perception of coping properties of smoking. However, abstainers recorded a significantly larger decrease in perceived stress than continuing smokers, and the result held when possible confounding factors were controlled for (P < 0.001). Conclusions In highly dependent smokers who report that smoking helps them cope with stress, smoking cessation is associated with lowering of stress. Whatever immediate effects smoking may have on perceived stress, overall it may generate or aggravate negative emotional states. The results provide reassurance to smokers worried that stopping smoking may deprive them of a valuable coping resource. [source] Motivation and patch treatment for HIV+ smokers: a randomized controlled trialADDICTION, Issue 11 2009Elizabeth E. Lloyd-Richardson ABSTRACT Aims To test the efficacy of two smoking cessation interventions in a HIV positive (HIV+) sample: standard care (SC) treatment plus nicotine replacement therapy (NRT) versus more intensive motivationally enhanced (ME) treatment plus NRT. Design Randomized controlled trial. Setting HIV+ smoker referrals from eight immunology clinics in the northeastern United States. Participants A total of 444 participants enrolled in the study (mean age = 42.07 years; 63.28% male; 51.80% European American; mean cigarettes/day = 18.27). Interventions SC participants received two brief sessions with a health educator. Those setting a quit date received self-help quitting materials and NRT. ME participants received four sessions of motivational counseling and a quit-day counseling call. All ME intervention materials were tailored to the needs of HIV+ individuals. Measurements Biochemically verified 7-day abstinence rates at 2-month, 4-month and 6-month follow-ups. Findings Intent-to-treat (ITT) abstinence rates at 2-month, 4-month and 6-month follow-ups were 12%, 9% and 9%, respectively, in the ME condition, and 13%, 10% and 10%, respectively, in the SC condition, indicating no between-group differences. Among 412 participants with treatment utilization data, 6-month ITT abstinence rates were associated positively with low nicotine dependence (P = 0.02), high motivation to quit (P = 0.04) and Hispanic American race/ethnicity (P = 0.02). Adjusting for these variables, each additional NRT contact improved the odds of smoking abstinence by a third (odds ratio = 1.32, 95% confidence interval = 0.99,1.75). Conclusions Motivationally enhanced treatment plus NRT did not improve cessation rates over and above standard care treatment plus NRT in this HIV+ sample of smokers. Providers offering brief support and encouraging use of nicotine replacement may be able to help HIV+ patients to quit smoking. [source] Varenicline in prevention of relapse to smoking: effect of quit pattern on response to extended treatmentADDICTION, Issue 9 2009Peter Hajek ABSTRACT Aim While older behavioural and pharmacological approaches to preventing relapse to smoking show little efficacy, a recent randomized trial of an extended course of varenicline reported positive results. In this secondary analysis, trial data were examined to see whether smokers who manage to achieve abstinence only later in the original course of treatment are more likely to benefit from having the course extended. Methods A total of 1208 patients abstinent for at least the last week of 12 weeks' treatment with varenicline were randomized to 3 months continued varenicline or placebo. Overall, 44% of the 12-week abstainers were abstinent from the target quit date (TQD), while the rest stopped smoking later. We examined the relationship between quit pattern and the varenicline versus placebo difference in continuous abstinence rates at week 52 and contributions of baseline patient characteristics. Results With increasing delay in initial quitting, 12-month success rates declined. Participants who had their last cigarette at week 11 of open-label treatment had quit rates at 52 weeks of 5.7% compared with 54.9% in those who last smoked in week 1 [odds ratio (OR) 20.3 (6.3, 65.9); P < 0.0001]. Patients who failed to initiate abstinence in the first week benefited more from extended treatment than patients continuously abstinent from week 1 [OR 1.7 (1.2, 2.4); P = 0.0015 versus OR 1.1 (0.8, 1.5); P = 0.6995, respectively; with the interaction of the quit pattern with treatment effect reaching borderline significance (P = 0.0494)]. No other patient characteristics were related to treatment effect. Conclusions Compared with smokers who quit smoking on their TQD, those who have an initial delay in achieving sustained abstinence have increased risk of relapse even several months later, and may be more likely to benefit from extended treatment with varenicline. [source] Extended treatment of older cigarette smokersADDICTION, Issue 6 2009Sharon M. Hall ABSTRACT Aims Tobacco dependence treatments achieve abstinence rates of 25,30% at 1 year. Low rates may reflect failure to conceptualize tobacco dependence as a chronic disorder. The aims of the present study were to determine the efficacy of extended cognitive behavioral and pharmacological interventions in smokers , 50 years of age, and to determine if gender differences in efficacy existed. Design Open randomized clinical trial. Setting A free-standing, smoking treatment research clinic. Participants A total of 402 smokers of , 10 cigarettes per day, all 50 years of age or older. Intervention Participants completed a 12-week treatment that included group counseling, nicotine replacement therapy (NRT) and bupropion. Participants, independent of smoking status, were then assigned randomly to follow-up conditions: (i) standard treatment (ST; no further treatment); (ii) extended NRT (E-NRT; 40 weeks of nicotine gum availability); (iii) extended cognitive behavioral therapy (E-CBT; 11 cognitive behavioral sessions over a 40-week period); or (iv) E-CBT plus E-NRT (E-combined; 11 cognitive behavioral sessions plus 40 weeks nicotine gum availability). Measurements Primary outcome variable was 7-day point prevalence cigarette abstinence verified biochemically at weeks 24, 52, 64 and 104. Findings The most clinically important findings were significant main effects for treatment condition, time and the treatment × time interaction. The E-CBT condition produced high cigarette abstinence rates that were maintained throughout the 2-year study period [(week 24 (58%), 52 (55%), 64 (55%) and 104 (55%)], and was significantly more effective than E-NRT and ST across that period. No other treatment condition was significantly different to ST. No effects for gender were found. Conclusions Extended cognitive behavioral treatments can produce high and stable cigarette abstinence rates for both men and women. NRT does not add to the efficacy of extended CBT, and may hamper its efficacy. Research is needed to determine if these results can be replicated in a sample with a greater range of ages, and improved upon with the addition of medications other than NRT. [source] Extended cognitive behavior therapy for cigarette smoking cessationADDICTION, Issue 8 2008Joel D. Killen ABSTRACT Primary aim Examine the effectiveness of extended cognitive behavior therapy (CBT) in promoting longer-term smoking abstinence. Design Open-label treatment phase followed by extended treatment phase. Randomization conducted prior to entry into open-label treatment phase; analysis based on intention-to-treat to avoid threat of selection bias. Setting Community smoking cessation clinic. Participants A total of 304 adult smokers (,18 years of age; ,10 cigarettes/day). Intervention Open-label (8 weeks): all participants received bupropion SR, nicotine patch, CBT. Extended treatment (12 weeks): participants received either CBT + voicemail monitoring and telephone counseling or telephone-based general support. Measurements Seven-day point prevalence abstinence, expired-air carbon monoxide. Results At week 20 follow-up, CBT produced a higher 7-day point prevalence abstinence rate: 45% versus 29%, P = 0.006; at 52 weeks the difference in abstinence rates (31% versus 27%) was not significant. History of depression was a moderator of treatment. Those with a positive history had a better treatment response at 20 weeks when assigned to the less intensive telephone support therapy (P < 0.05). Conclusion The superiority of CBT to 20 weeks suggests that continued emphasis on the development of cognitive and behavioral strategies for maintaining non-smoking during an extended treatment phase may help smokers to maintain abstinence in the longer term. At present, the minimum duration of therapy is unknown. [source] Rapid detoxification from opioid dependence under general anaesthesia versus standard methadone tapering: abstinence rates and withdrawal distress experiencesADDICTION BIOLOGY, Issue 3 2003PAUL KRABBE The aim of this work was to study abstinence rates and withdrawal effects of rapid detoxification of opioid-dependents under general anaesthesia (RD-GA) compared to standard methadone tapering (SMT) using a prospective clinical trial with a follow-up of 3 months, as a preliminary study at the Novadic addiction centre in St Oedenrode and St Joseph Hospital in Veghel, the Netherlands. Thirty opioid-dependent patients took part. Outcome measures included urine toxicology screening for opiates to determine abstinence and presence of objective and subjective opioid withdrawal distress symptoms. Statistically significant differences in abstinence rate between RD-GA and SMT were present after one (RD-GA 100% vs. SMT 40%, p <0.01) and 2 months (RD-GA 93% vs. SMT 33%, p <0.01). After 3 months the difference in abstinence was still substantial, but no longer statistically significant (RD-GA 67% vs. SMT 33%, p =0.14). Objective and subjective withdrawal symptoms showed largely identical outcomes and were equally low in the two groups for those who remained in the study. There was a considerably higher percentage of abstinence in the RD-GA group after 1, 2 and 3 months of follow-up accompanied by relatively mild withdrawal symptoms of shorter duration. However, if one completes SMT the data suggest a greater chance of staying clean in the long term than those completing RD-GA. [source] Characteristics and smoking cessation outcomes of patients returning for repeat tobacco dependence treatmentINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2006E. S. HAN Summary Previous studies of tobacco dependence treatment have reported very low cessation rates among smokers who relapse and return to make a subsequent formal attempt to quit. This retrospective cohort study examined 1745 patients who attended a tobacco dependence clinic between 2001 and 2005, and the characteristics and outcomes of those who relapsed and returned for repeat treatment. Patients who returned for repeat treatment showed higher markers of nicotine dependence and were more likely to have a history of treatment for mental health problems than patients who attended the clinic for only one treatment episode. Among patients who relapsed and returned for repeat treatment, the 26-week abstinence rates were similar for each consecutive quit attempt (23%, 22% and 20%). Clinicians should encourage smokers who relapse after an initial treatment episode to return for treatment, and repeat treatment should focus on addressing high nicotine dependence and potentially co-occurring mental health problems in order to improve cessation outcomes. [source] Disparities in Alcohol-Related Problems Among White, Black, and Hispanic AmericansALCOHOLISM, Issue 4 2009Nina Mulia Background:, This study assesses racial/ethnic disparities in negative social consequences of drinking and alcohol dependence symptoms among white, black, and Hispanic Americans. We examine whether and how disparities relate to heavy alcohol consumption and pattern, and the extent to which social disadvantage (poverty, unfair treatment, and racial/ethnic stigma) accounts for observed disparities. Methods:, We analyzed data from the 2005 U.S. National Alcohol Survey, a nationally representative telephone-based survey of adults ages 18 and older (N = 6,919). Given large racial/ethnic differences in abstinence rates, core analyses were restricted to current drinkers (N = 4,080). Logistic regression was used to assess disparities in alcohol-related problems at 3 levels of heavy drinking, measured using a composite variable incorporating frequency of heavy episodic drinking, frequency of drunkenness, and maximum amount consumed in a single day. A mediational approach was used to assess the role of social disadvantage. Results:, African American and Hispanic drinkers were significantly more likely than white drinkers to report social consequences of drinking and alcohol dependence symptoms. Even after adjusting for differences in heavy drinking and demographic characteristics, disparities in problems remained. The racial/ethnic gap in alcohol problems was greatest among those reporting little or no heavy drinking, and gradually diminished to nonsignificance at the highest level of heavy drinking. Social disadvantage, particularly in the form of racial/ethnic stigma, appeared to contribute to racial/ethnic differences in problems. Conclusions:, These findings suggest that to eliminate racial/ethnic disparities in alcohol-related problems, public health efforts must do more than reduce heavy drinking. Future research should address the possibility of drink size underestimation, identify the particular types of problems that disproportionately affect racial/ethnic minorities, and investigate social and cultural determinants of such problems. [source] The Efficacy of Acamprosate in the Maintenance of Abstinence in Alcohol-Dependent Individuals: Results of a Meta-AnalysisALCOHOLISM, Issue 1 2004Karl Mann Abstract: Background: A number of clinical trials have been undertaken to determine the efficacy of acamprosate in the maintenance of abstinence in alcohol-dependent individuals. However, the reported differences in patient populations, treatment duration, and study endpoints make comparisons difficult. An assessment of the efficacy of treatment with acamprosate was, therefore, undertaken using meta-analytical techniques. Methods: All randomized, placebo-controlled trials (RCTs) that fulfilled predetermined criteria were identified using (1) a language unrestricted search of 10 electronic databases; (2) a manual search of relevant journals, symposia, and conference proceedings; (3) cross-referencing of all identified publications; (4) personal communications with investigators; and (5) scrutiny of Merck-Santé's internal reports of all European trials. Study quality was assessed, independently, by three blinded workers. Key outcome data were identified; some outcome variables were recalculated to ensure consistency across trials. The primary outcome measure was continuous abstinence at 6 months; abstinence rates were determined by estimating Relative Benefit (RB). Results: A total of 19 published 1 unpublished RCTs were identified that fulfilled the selection criteria; 3 were excluded because the documentation available was insufficient to allow adequate assessment. The remaining 17 studies, which included 4087 individuals, 53% of whom received active drug, were of good quality and were otherwise reasonably comparable. There was no evidence of publication bias. Continuous abstinence rates at 6 months were significantly higher in the acamprosate-treated patients (acamprosate, 36.1%; placebo, 23.4%; RB, 1.47; [95% confidence intervals (CI): 1.29,1.69]; p < 0.001). This effect was observed independently of the method used for assigning missing data. The effect sizes in abstinent rates at 3, 6, and 12 months were 1.33, 1.50, and 1.95, respectively. At 12 months, the overall pooled difference in success rates between acamprosate and placebo was 13.3% (95% CI, 7.8,18.7%; number needed to treat, 7.5). Acamprosate also had a modest but significant beneficial effect on retention (6.01%; [95% CI, 2.90,8.82]; p= 0.0106). Conclusion:: Acamprosate has a significant beneficial effect in enhancing abstinence in recently detoxified, alcohol-dependent individuals. [source] Latest news and product developmentsPRESCRIBER, Issue 17 2008Article first published online: 15 SEP 200 Small AED suicide risk Antiepileptic drugs (AEDs) are associated with a small increase in the risk of suicidal thoughts, the MHRA has warned. In the latest Drug Safety Update (2008;2:Issue 1) the MHRA says that, compared with placebo, AEDs are associated with an additional two cases of suicidal thoughts and behaviour per 1000 patients (0.43 vs 0.22 per cent). This may occur as early as one week after starting treatment. It is unclear whether the risk varies among AEDs. Also in this issue, the MHRA warns of an increased risk of tumour progression and reduced survival in patients with cancer treated with recombinant erythropoietin. Other topics include the use of lenalidomide (Revlimid) and thalidomide for multiple myeloma; new restrictions on the use of moxifloxacin (Avelox) due to adverse effects; and a reminder that metronidazole should be administered orally, not by intravenous injection, for the treatment of C. difficile -associated diarrhoea. Low-fat diet least effective option? A low-fat diet is associated with less weight loss and less favourable metabolic changes over two years than a low-carbohydrate (Watkins) diet or a Mediterranean diet in 322 moderately obese patients (mean BMI 30kg per m2; N Eng J Med 2008;359:229,41). Estimated energy intake was similar for all diets. Mean weight loss in all randomised patients was 2.9kg for the low fat diet, 4.4kg for the Mediterranean diet and 4.7kg for the low-carbohydrate diet. The low-carbohydrate diet was associated with greater increases in HDL-cholesterol and greater reductions in triglycerides and total cholesterol/HDL-C ratio compared with the low-fat diet. Among people with diabetes, fasting plasma glucose and insulin resistance were decreased only in those assigned to the Mediterranean diet, and only the low carbohydrate diet significantly decreased HbA1c. Stopping post-MI statins Patients who stop taking a statin first prescribed after an acute MI almost double their risk of death compared with nonusers, a new study shows (Eur Heart J; published online 29 July 2008; doi: 10.1093/eurheartj/ehn346). The analysis of 9939 MI survivors in the General Practice Research Database showed that, compared with patients who had never used a statin, the risk of death was unchanged for those previously taking a statin who continued treatment after MI. The risk was reduced by 28 per cent for those who started a statin post-MI and continued it but, in those who started a statin but then stopped it, the hazard ratio for death was 1.88 (CI 95% 1.13-3.07). Stopping control medication (aspirin, beta-blockers or proton pump inhibitors) did not alter the risk of death. Smoking quit rates with NRT and varenicline Differences in quit rates between nicotine replacement therapy (NRT) and varenicline (Champix) are small, according to a multinational study (Thorax 2008;63:717,24). The trial compared transdermal NRT (21mg to 7mg per day over 10 weeks) with varenicline (1mg twice daily for 12 weeks). Over the final four weeks of treatment, the abstinence rate was significantly higher with varenicline (56 vs 43 per cent). After one year, the four-week abstinence rates were 26 and 20 per cent respectively (p = 0.056) and seven-day point prevalence abstinence rates at 6 or 12 months were not significantly different. Varenicline reduced craving, withdrawal symptoms and smoking satisfaction compared with NRT but at the cost of a higher incidence of nausea (37 vs 10 per cent). Azithromycin goes OTC The MHRA has announced that azithromycin will be available without prescription for the treatment of Chlamydia infection. Under the brand Clamelle, azithromycin will be supplied from pharmacies to over-16s who have tested positive for infection but have no symptoms; their partners may also be treated. A urine testing kit will be marketed to pharmacists. Product news Sodium valproate (Epilim Chronosphere) is now available as modified-release granules to be taken with food or a drink; 30 sachets, in five strengths from 50750mg, cost £30. Boehringer Ingelheim has introduced a higher strength of its telmisartan/hydrochlorothiazide combination (Micardis Plus) for hypertension; 80mg/25mg costs £14.18 for a month's supply. Copyright © 2008 Wiley Interface Ltd [source] Latest news and product developmentsPRESCRIBER, Issue 4 2008Article first published online: 20 MAR 200 Suicide warning for all antidepressants All antidepressants are to include a warning of the risk of suicide in their product information, the MHRA says. The requirement formerly applied only to SSRIs but, following a US review of safety data, the Agency says the risk is similar for all classes of antidepressants. Patients at increased risk include young people with psychiatric morbidity and those with a history of suicidal ideation. Patients are at increased risk of suicide until remission occurs, and clinical experience shows that the risk is increased during the early stages of recovery. Confusion over type 2 diabetes management Contradictory findings have been reported from two studies of intensive management of type 2 diabetes. The STENO-2 study (N Engl J Med 2008;358:580-91) found that tight control of blood glucose, blood pressure and lipids plus low-dose aspirin in 160 patients with type 2 diabetes and microalbuminuria significantly reduced all-cause mortality, cardiovascular events, cardiovascular death and microvascular complications by 40-60 per cent. The US National Heart, Blood and Lung Institute has announced the end of the intensive treatment arm of the ACCORD study (unpublished). This study was comparing intensive lowering of blood glucose below currently recommended levels (target HbA1C <6 per cent) with conventional management in adults with type 2 diabetes at especially high risk for heart attack and stroke. Although mortality was reduced in both arms compared with other populations, intensive treatment was associated with increased mortality equivalent to three deaths per 1000 patients per year over four years. Another antibiotics campaign The Government has launched another campaign to promote public awareness that antibiotics are not appropriate for viral infections causing coughs, colds and sore throats. Get Well Soon , Without Antibiotics is supported by a national advertising campaign and leaflets and posters encouraging the public to ask advice rather than demand a prescription. Details are available at www.dh.gov.uk. Episenta: once-daily sodium valproate Following a launch to specialists last year, a new once-daily modified-release formulation of sodium valproate is being promoted more widely to GPs. Episenta is licensed for the treatment of all forms of epilepsy and is formulated as modified-release capsules of 150mg and 300mg and sachets of modified-release granules of 500mg and 1000mg. The dose may be administered once or twice daily. Patients may be switched from enteric-coated tablets of valproate to the same dose given as Episenta. Episenta costs £5.70 or £10.90 for 100 × 150mg or 300mg capsules, and £18 or £35.50 for 100 × 500mg or 1000mg sachets. Latest NICE agenda The Department of Health has referred a new batch of topics for appraisal by NICE. Six of seven technology appraisals are for cancer drugs; the last is for dabigatran etexilate for venous thromboembolism. There will be four new clinical guidelines: autism spectrum disorders, hypertension in pregnancy, bed-wetting in children and severe mental illness with substance abuse. Two combined public health and clinical guidelines will address alcohol misuse. Varenicline vs NRT Varenicline (Champix) offers slightly greater smoking cessation rates than nicotine replacement therapy (NRT) in the long term and better symptom improvement, an international study has shown (Thorax 2008; published online:10.1136/ thx.2007.090647). A total of 746 smokers were randomised to treatment with varenicline 1mg twice daily for 12 weeks or transdermal NRT (21mg reducing to 7mg per day) for 10 weeks. Continuous abstinence rates for the last four weeks of treatment were 56 vs 43 per cent. The corresponding rates for one year were 26 and 20 per cent. Varenicline was associated with greater reductions in cravings, withdrawal symptoms and smoking satisfaction, but more nausea (37 vs 10 per cent). Adverse reactions class effect of statins The MHRA has identified several adverse effects that it says are class effects of the statins (Drug Safety Update 2008;1:Issue 7). Following a review of clinical trials and spontaneous reports, it is now apparent that any statin may be associated with sleep disturbance, depression, memory loss and sexual dysfunction; interstitial lung disease has been reported rarely. Product information is being updated to include the new information. Depression, including suicidal ideation, has also been associated with varenicline (Champix), the MHRA says; affected patients should stop treatment immediately. The combination of transdermal nicotine replacement therapy (NRT) and varenicline appears to be associated with a higher incidence of nausea, headache, vomiting, dizziness, dyspepsia and fatigue than NRT alone. The MHRA has also announced that, following the suspension of marketing authorisation for carisoprodol (Carisoma), it is considering a phased withdrawal of the closely-related meprobamate , the main active metabolite of carisoprodol. Following a successful pilot study, the public are being encouraged to report adverse reactions on yellow cards; the MHRA notes that health professionals provide more complete reports but patients include more information about quality of life. The scheme will be promoted via community pharmacies throughout the UK from February 2008. Cochrane: evidence on back pain interventions The latest release of Cochrane reviews includes three meta-analyses assessing interventions for back pain. Overall, NSAIDs were found to be effective as short-term treatment for acute or chronic back pain but the effect size was small. They were comparable with paracetamol but associated with more adverse effects; COX-2 selective NSAIDs were similarly effective, with slightly fewer adverse effects. There was no evidence that antidepressants reduced back pain but intensive individual patient education (lasting 2.5 hours) was effective for acute and subacute back pain and comparable with manipulation and physiotherapy; its effects on chronic pain were unclear. Copyright © 2008 Wiley Interface Ltd [source] Ten-year survival outcome of the nicotine transdermal patch with cognitive behavioural therapyAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2007Robyn L. Richmond Abstract Objective: To follow-up abstainers from the end of their initial treatment over seven points to 10 years. Methods: In the original study there were 305 smokers who were recruited in a double-blind randomised controlled trial. Those subjects who had remained continuously abstinent to seven years (n=20) were followed up to ascertain continuous smoking prevalence to 10 years. Main outcome measure was continuous abstinence. Results: At 10 years, the active nicotine patch group showed significantly higher continuous abstinence rates that were double those of the placebo group (7.9% vs. 2.6%, respectively). The high rate of relapse declined after six months. Conclusions: The nicotine patch leads to superior continuous abstinence over 10 years when compared with placebo. Public health implications: This is the longest follow-up study of continuous smoking abstinence after cognitive behaviour treatment combined with the nicotine patch. [source] | ||||||||||