ATTUD Journal Club Postings

Combined Pharmacotherapy and Behavior Therapy for Smokeless Tobacco Cessation

Although there has much press about e-cigarettes recently, we should not forget that smokeless tobacco use is increasing in the US. For example, in a very recent survey, 2.4% of Americans were currently using smokeless vs 2.3% using e-cigarettes (Lee et al, Preventive Med 62:14-19). A recent Cochrane review concluded that person-to-person counseling was helpful […]

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AHA and ACS Position Statements on Using Electronic Cigarettes for Smoking Cessation

Recently the American Heart Association and the American Cancer Society issued statements on e-cigarettes that include guidelines on whether to recommend e-cigarettes for smoking statement. Both state e-cigarettes should be considered in those who have not responded to or are unwilling to use proven treatments. The AHA statement says “If a patient has failed initial […]

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Keeping Up on Scientific Data on the Efficacy of Treatments for Smoking

Each year the Cochrane Colloboration publishes an update of all their reviews on smoking (www.thecochranelibrary.com). This is an easy way to check up on new treatment findings and whether any prior findings are no longer thought true. I like the Cochrane because it uses the same methods to test all the treatments and really strives […]

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Self Control as a Finite Resource

Although many bemoaned the lack of innovative behavioral therapies for smoking in the 1990s, recently there has been a spate of new treatments‐mindfulness, acceptance therapy, persistence therapy, etc. These new treatments have often arisen from basic psychology theories that have been validated. One of these is the “Strength Model of Self‐Control” that posits one has […]

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New Cochrane Reports on Pre-operative Treatments and Antidepressant Treatment

A new Cochrane meta-analysis examined 13 trials of pre-operative smoking cessation treatment.  Intensive treatment (e.g. 4 sessions prior to surgery plus medications) increased abstinence at the time of surgery (OR = 10.8) and long-term cessation after the surgery (OR = 3.0). Brief treatment increased abstinence slightly at the time of surgery (OR = 1.3) but […]

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Nicotine Replacement Therapy

Oftentimes, surgeons recommend not using nicotine replacement therapies before or after surgery because nicotine is a vasoconstrictor; however, recent studies show that nicotine causes “angiogenesis;” i.e., increased new small arteries in tissue (that would help healing) that could outweigh the negative effects of vasoconstriction Two articles have reviewed this literature (Reuther and Brennan Br J […]

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Is Face‐to‐Face Counseling Worth It

In my prior entries, I have mentioned the need for studies showing that face‐to‐face counseling is worth the extra cost. Such individual treatment can never be as cost‐effective as less‐intensive treatment. In fact, in medicine there are very few cases where more intensive treatment is more cost‐effective. Recently, two studies have tested more vs less […]

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Utility of Face-to-Face Counseling

Many members of ATTUD provide face-to-face individual counseling. Since funding for tobacco treatment often originates from public health funding, many funders are concerned that the increased cost of such treatment is not warranted, given the known efficacy of group and phone counseling. As in many fields, the onus for burden of proof of the utility […]

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Varenicline vs. NRT: An Update

My ATTUD blog in April (“Is Varenicline More Effective than NRT?” – now on ATTUD website) concluded that varenicline was probably more effective than single NRT but whether it was better than dual NRT was unclear. Since then a new study and a new meta-analysis on this question have appeared that you may have heard […]

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The New DSM Criteria for Substance Use Disorder: What Does It Mean for TTSs?

I served as a consultant on nicotine to the DSM-V Workgroup on Substance Use Disorders and thought you might like to know about how The American Psychiatric Association has pretty much decided on the new criteria for substance use disorders (www.dsm5.org). DSM-IV had two categories “Substance Dependence” and “Substance Abuse.” The former included seven criteria […]

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