In contrast with the treatment of other substance
use disorders, psychosocial treatment is underutilized and has not evolved to
be the cornerstone of treatment. This limited utilization of psycho-social
treatments does not match the very positive outcomes from either psychosocial
treatments alone (25% 1-year abstinence with BT) or when combined with NRT or
bupropion (50% improve-ment compared with NRT or bupropion alone), however, it
does match the lack of health care coverage for this service.
As in treating other substance use disorders, the
core psychotherapy approaches are motivational enhancement ther-apy (MET),
cognitive–behavioral therapy (CBT) (relapse pre-vention), and 12-Step
facilitation. Psychosocial interventions, particularly BT, have been shown to
increase abstinence rates significantly. However, only 7% of smokers attempting
to quit smoking are willing to participate in BT (Ferry et al., 1992). In addition, it is more expensive than
pharmacotherapy and more labor-intensive.
All nicotine dependence treatment practice
guidelines recom-mend the integration of nicotine dependence treatment
medica-tions (NRT and bupropion) with behavioral and supportive psy-chosocial
treatment approaches. Empirical evidence supports the finding that medications
double the quit rate compared with pla-cebo, and face-to-face BT can double the
quit rate compared with minimal psychosocial intervention. BT also can increase
medica-tion compliance. Integrated treatment further increases the quit rate by
another 50% and triples the outcome rate compared with a control group (Fiore et al., 1990).
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