Treating Tobacco Dependence in Adolescents With Co-occurring Psychiatric Disorders
Condition: Tobacco Use Cessation; Tobacco Use Disorder
MeSH terms: Tobacco Use Disorder; Mental Disorders; Problem Behavior
Study type: Interventional
Phase: Phase 3

Summary: 
      This research aims to identify efficacious strategies for treating tobacco dependence among
      adolescent smokers with co-occurring psychiatric disorders. Adolescent smoking remains a
      significant public health issue with 23% of high school students reporting smoking a
      cigarette in the past month1. Smoking rates are two to four times higher among adolescents
      with psychiatric disorders such as attention deficit disorders, conduct disorder, depression,
      anxiety disorders, and alcohol and illicit drug dependencies2-4.

      Empirical investigations of adolescent tobacco treatment interventions number less than 50
      with many of the studies criticized for methodological problems (i.e., follow up < 6 months,
      poor retention, lack of control or comparison groups)2,5, 6. There have been no unequivocal
      successes; however, promising interventions include stage-based, cognitive behavioral (CBT),
      and multicomponent treatments2, 7. Additionally, the nicotine patch is well tolerated and
      safe among adolescents8 and rarely abused9. Less than a third of adolescent tobacco users
      report intention to quit in the near future2, 10, 11; thus, it seems critical that cessation
      interventions for this complex group be designed to assist smokers at all stages of readiness
      through the quitting process. A stepped care approach has the potential of matching more
      intensive services to those ready for and in need of greater treatment. Interventions
      delivered in health care settings have the appeal of broad reach.

      The primary specific aims of this research are to evaluate, in a randomized clinical trial
      (N=160), the efficacy of a stepped care intervention for treating smoking among adolescents
      recruited from outpatient psychiatry settings. To our knowledge, this would be the first
      study to examine outpatient psychiatry settings for treating tobacco dependence in
      adolescents. The stepped care intervention combines expert-system contacts, individual CBT
      sessions, and 12-weeks of nicotine replacement therapy (NRT).
    


Intervention name(s): Tobacco Use Cessation
Intervention type(s): Behavioral
Intervention description(s): The proposed intervention will proceed in three steps. Step 1, provided to all intervention participants, includes multimedia, stage-based, expert-system contacts at intake, 3- and 6-months follow-up supported with brief (15-min) motivational counseling sessions. Step 2, reserved for intervention participants interested in quitting, consists of 12-weeks of individual CBT sessions for smoking cessation. Step 3, a 12-week course of nicotine patch, will be offered to adolescents who enter the CBT Cessation Treatment, who do not have any medical contraindications, and who smoke an average of 5 cigarettes or more per day in the past month.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment