Psychosocial and Psychopharmacological Therapies - Nicotine Dependence

Psychosocial Treatments

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.

Combined Psychosocial and Psychopharmacological Therapies

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).