A novel treatment can suppress significant withdrawal symptoms more effectively than the usual care, according to a UW-CTRI paper published in the journal Addiction.
This innovative approach, developed by UW-CTRI Research Director Dr. Tim Baker, suggests the process of quitting smoking can be divided into phases, each with different opportunities for intervention. Starting treatment while preparing to quit, and intensifying treatment during a quit attempt, may both help more people quit successfully.
The innovation, tested in the UW-Partnership to Assist and Serve Smokers (UW-PASS) Study, also showed that the optimized, multi-component intervention reduced craving (both before and after the target quit day) and anhedonia (after quitting). Anhedonia is the inability to feel happiness doing things one normally would enjoy.
UW-PASS featured Baker’s Phase-Based Model of Cessation via a randomized control trial of 623 adult daily smokers motivated to quit smoking and recruited from primary-care clinics within two health-care systems—Dean Health System and Aurora Health Care. They were randomized to either Abstinence‐Optimized Treatment or recommended usual care. Participants in both conditions completed four clinic visits and six telephone follow‐up assessments for a year after their quit date; those in Abstinence‐Optimized Treatment completed three additional visits for counseling to quit smoking.
Abstinence‐Optimized Treatment suppressed craving more than usual care during the week preceding the quit date, when psychosocial treatment was available in both conditions but mini‐lozenges were available only in Abstinence‐Optimized Treatment. That suppression of craving continued to 10 days after the quit date, a period when those participants received intensive psychosocial support and combination medications, while the usual care group received patch monotherapy and much less psychosocial support. Anhedonia was also significantly lower for the first 12 days of the quit attempt in Abstinence‐Optimized Treatment versus usual care.
Improved management of craving and anhedonia may be attributable to: psychosocial components in Abstinence‐Optimized Treatment, nicotine mini‐lozenges, and/or higher rates of patch use in Abstinence‐Optimized Treatment than in regular care.
Among participants who had access to both mini-lozenges and patches in the Abstinence-Optimized Treatment, more mini-lozenges were used in addition to patches when withdrawal symptoms (craving and anhedonia) were especially bad early in the quit attempt. This pattern of results indicates that spikes in mini‐lozenge use might occur in response to more severe withdrawal. Later in the quit attempt, using more lozenges was associated with reduced anhedonia, however.
Sometimes, more ad-lib use of the medication may quell symptoms, or may reflect greater abstinence motivation or distress, wrote the authors from UW-CTRI: Dr. Nayoung Kim, Dr. Danielle McCarthy, Dr. Jessica Cook, Dr. Megan Piper, Dr. Tanya Schlam and Baker.
More broadly, the dynamic effects observed from time‐varying effect models of treatment and withdrawal highlight the value of a phase‐based approach to smoking treatment and of examining time as a moderator of treatment effects.
UW-PASS was funded by a $9 million five-year grant from the National Cancer Institute. In this study, led by Baker and UW-CTRI Director Dr. Michael Fiore, medical assistants at partnering clinics identified smokers and asked if they were interested in being contacted about a study. They invited all smokers, whether they were willing to quit or not. If the patient was interested, an e-mail was generated from the electronic medical record to UW-PASS staff, employed by UW-CTRI, who conducted screening, orientation, patient visits and follow up. All participants have completed treatment.
Kim N, McCarthy DE, Cook JW, Piper ME, Schlam TR, Baker TB. Time‐Varying Effects of ‘Optimized Smoking Treatment’ on Craving, Negative Affect and Anhedonia. Addiction. 23 August 2020.