CLINICAL
AND
RESEARCH
REPORTS
Transdermal
Neil
Hartman,
Jeffery
M.D.,
Nicotine and Smoking in Psychiatric Patients Ph.D.,
N. Wilkins,
Gregory
M.D.,
B. Leong,
and Murray
M.D.,
Behavior
Shirley
E. Jarvik,
M.
M.D.,
Glynn,
Ph.D.,
Ph.D.
The authors used a double-blind crossover design to observe the effect of transdermally administered nicotine on the smoking behavior of 13 psychiatric patients who were not trying to stop smoking. The patients smoked significantly fewer cigarettes while receiving nicotine than while receiving placebo. These data suggest that transdermally administered nicotine can be a useful adjunct in treating nicotine-addicted psychiatric patients in a nonsmoking environment. (Am
J Psychiatry
1991;
148:374-375)
C
iganette smoking, which is addictive and health damaging (1), is especially prevalent among psychiatnic patients (2). As more psychiatric facilities limit smoking in order to reduce smokers’ morbidity and nonsmokers’ exposure to secondhand smoke (3), cigarette consumption will become increasingly troublesome. Smoking cessation programs, especially those incorporating behavioral techniques and nicotine chewing gum, have had an impressive impact on shortterm smoking rates in nonpsychiatmic subjects (1, 4, 5). However, little work has focused on developing or implementing interventions for psychiatric patients. Impedirnents to designing successful smoking cessation programs for psychiatric patients may include less desire to quit smoking and impaired cognitive functioning, which may preclude following detailed instructions regarding techniques such as self-monitoring and appropriate use of nicotine gum. Therefore, for psychiatric patients in a smoke-free hospital setting, reduction of nicotine withdrawal symptoms by means of a technique that does not require strong motivation to quit on the need to follow complicated instructions might be extremely useful. Moreover, such a technique might yield greaten smoking cessation mates for motivated individuals with higher 1evels of cognitive functioning. Tmansdemmal nicotine administration has shown promising preliminary results in reducing smoking rates (6-8). This technique may have special benefits
Presented in part at the 142nd annual meeting of the American Psychiatric Association, San Francisco, May 6-1 1, 1989. Received Nov. 21, 1989; revision received July 25, 1990; accepted Aug. 31, 1990. From the Department of Psychiatry and the Biobehavioral Sciences, University of California, Los Angeles, and the Psychiatry Service, Brentwood Division, West Los Angeles VA Medical Center. Address reprint requests to Dr. Hartman, Psychiatry Service (B116A-Ward 209C), West Los Angeles VA Medical Center, 11301 Wilshire Blvd., Los Angeles, CA 90073.
374
for psychiatric patients because it is uncomplicated and appears to have an impact on smoking even among individuals who have expressed little desire to quit. The pilot study reported here was designed to ascertain whether transdermal nicotine administration would reduce the number of cigarettes smoked by a group of psychiatric patients.
METHOD We obtained informed consent from 14 competent men (three inpatients and 1 1 outpatients) who were voluntarily receiving psychiatric services, smoked at least 10 cigarettes per day, were free of substantial cardiovascular and pulmonary disease, and did not have a current substance use disorder. Patients did not have to indicate any desire to quit smoking and were given $10 in coupons redeemable at the hospital canteen for participating in the study. Four of the patients were white, seven black, two Asian, and one Hispanic. They reported smoking an average of 22.9 cigarettes per day (mange=10-30) and had been smoking for 19.0 years (rangc=9-44). Their mean age was 40.9 years (rangc=31-59). A double-blind, within-subjects crossover design was used. Patients were randomly assigned to receiving 24 pA of a solution containing either 30% nicotine base (8 mg) on water (placebo) applied to the nondominant forearm during session 1 and receiving the other solution during session 2 one week later. Each solution was covered by a 3-cm square patch of polyethylene wrap secured at the edges by surgical tape. The solutions were applied at 10:00 a.m., and patients were provided with unlimited access to their preferred brand of cigarettes for the next 7 hours. To maintain the double-blind design, the investigator responsible for ran-
Am
J
Psychiatry
148:3,
March
1991
CLINICAL
dom assignment (N.H.) had no further contact with patients during the sessions. The patients were told that the patch might influence smoking behavior, to try and ignore the patch, and to smoke as they normally would during the session and during the week between sessions. They spent the entire 2 days in the clinic, where lunch and entertainment (video movies and board games) were provided so that study personnel could observe them at all times and ensure that each patient collected his cigarettes in his own container.
The results for the 13 patients completing the protocol are given in table 1 A repeated measures analysis of variance with number of butts collected after session 1 and session 2 as the dependent variable revealed no significant effect of repeated experimental sessions (F= 0.03, df=1, 11, n.s.) or for order of patch wearing (F=0.02, df=1, 11, n.s.) but did indicate a significant interaction between session and order of patch wearing (F=S.84, df=1, 11, p
AND
RESEARCH
REPORTS
Transdermal
Neil
Hartman,
Jeffery
M.D.,
Nicotine and Smoking in Psychiatric Patients Ph.D.,
N. Wilkins,
Gregory
M.D.,
B. Leong,
and Murray
M.D.,
Behavior
Shirley
E. Jarvik,
M.
M.D.,
Glynn,
Ph.D.,
Ph.D.
The authors used a double-blind crossover design to observe the effect of transdermally administered nicotine on the smoking behavior of 13 psychiatric patients who were not trying to stop smoking. The patients smoked significantly fewer cigarettes while receiving nicotine than while receiving placebo. These data suggest that transdermally administered nicotine can be a useful adjunct in treating nicotine-addicted psychiatric patients in a nonsmoking environment. (Am
J Psychiatry
1991;
148:374-375)
C
iganette smoking, which is addictive and health damaging (1), is especially prevalent among psychiatnic patients (2). As more psychiatric facilities limit smoking in order to reduce smokers’ morbidity and nonsmokers’ exposure to secondhand smoke (3), cigarette consumption will become increasingly troublesome. Smoking cessation programs, especially those incorporating behavioral techniques and nicotine chewing gum, have had an impressive impact on shortterm smoking rates in nonpsychiatmic subjects (1, 4, 5). However, little work has focused on developing or implementing interventions for psychiatric patients. Impedirnents to designing successful smoking cessation programs for psychiatric patients may include less desire to quit smoking and impaired cognitive functioning, which may preclude following detailed instructions regarding techniques such as self-monitoring and appropriate use of nicotine gum. Therefore, for psychiatric patients in a smoke-free hospital setting, reduction of nicotine withdrawal symptoms by means of a technique that does not require strong motivation to quit on the need to follow complicated instructions might be extremely useful. Moreover, such a technique might yield greaten smoking cessation mates for motivated individuals with higher 1evels of cognitive functioning. Tmansdemmal nicotine administration has shown promising preliminary results in reducing smoking rates (6-8). This technique may have special benefits
Presented in part at the 142nd annual meeting of the American Psychiatric Association, San Francisco, May 6-1 1, 1989. Received Nov. 21, 1989; revision received July 25, 1990; accepted Aug. 31, 1990. From the Department of Psychiatry and the Biobehavioral Sciences, University of California, Los Angeles, and the Psychiatry Service, Brentwood Division, West Los Angeles VA Medical Center. Address reprint requests to Dr. Hartman, Psychiatry Service (B116A-Ward 209C), West Los Angeles VA Medical Center, 11301 Wilshire Blvd., Los Angeles, CA 90073.
374
for psychiatric patients because it is uncomplicated and appears to have an impact on smoking even among individuals who have expressed little desire to quit. The pilot study reported here was designed to ascertain whether transdermal nicotine administration would reduce the number of cigarettes smoked by a group of psychiatric patients.
METHOD We obtained informed consent from 14 competent men (three inpatients and 1 1 outpatients) who were voluntarily receiving psychiatric services, smoked at least 10 cigarettes per day, were free of substantial cardiovascular and pulmonary disease, and did not have a current substance use disorder. Patients did not have to indicate any desire to quit smoking and were given $10 in coupons redeemable at the hospital canteen for participating in the study. Four of the patients were white, seven black, two Asian, and one Hispanic. They reported smoking an average of 22.9 cigarettes per day (mange=10-30) and had been smoking for 19.0 years (rangc=9-44). Their mean age was 40.9 years (rangc=31-59). A double-blind, within-subjects crossover design was used. Patients were randomly assigned to receiving 24 pA of a solution containing either 30% nicotine base (8 mg) on water (placebo) applied to the nondominant forearm during session 1 and receiving the other solution during session 2 one week later. Each solution was covered by a 3-cm square patch of polyethylene wrap secured at the edges by surgical tape. The solutions were applied at 10:00 a.m., and patients were provided with unlimited access to their preferred brand of cigarettes for the next 7 hours. To maintain the double-blind design, the investigator responsible for ran-
Am
J
Psychiatry
148:3,
March
1991
CLINICAL
dom assignment (N.H.) had no further contact with patients during the sessions. The patients were told that the patch might influence smoking behavior, to try and ignore the patch, and to smoke as they normally would during the session and during the week between sessions. They spent the entire 2 days in the clinic, where lunch and entertainment (video movies and board games) were provided so that study personnel could observe them at all times and ensure that each patient collected his cigarettes in his own container.
The results for the 13 patients completing the protocol are given in table 1 A repeated measures analysis of variance with number of butts collected after session 1 and session 2 as the dependent variable revealed no significant effect of repeated experimental sessions (F= 0.03, df=1, 11, n.s.) or for order of patch wearing (F=0.02, df=1, 11, n.s.) but did indicate a significant interaction between session and order of patch wearing (F=S.84, df=1, 11, p
