Advertisement
Mayo Clinic Proceedings Home

Outcomes From a Patient-Centered Residential Treatment Plan for Tobacco Dependence

      Abstract

      St. Helena Hospital launched the first US residential stop-smoking program, The St. Helena Center for a Smoke-Free Life, in 1969. This observational report describes the center's treatment outcome rate for using a patient-centered approach to the use of tobacco dependence medications and behavioral treatment for patients who participated in the program from January 1, 2005 through December 31, 2007. A total of 284 patients used long-acting (nicotine patch, bupropion, and varenicline) and/or short-acting medications (nicotine nasal spray, nicotine gum, nicotine lozenge, and nicotine oral inhaler) alone or in combination during treatment and after discharge. Seven patients chose to use no medications. Patients using nicotine patch received a mean ± SD dose of 33.3±15.7 mg of nicotine in 16 hours (range, 5-90 mg). The 12-month 7-day point prevalence smoking abstinence rate after participation in the intensive, 1-week, residential program was 57.0%. Recommendations are discussed for future research and for implementing aspects of the St. Helena program in other treatment settings.

      Abbreviations and Acronyms:

      FTND (Fagerström Test for Nicotine Dependence)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mokdad A.H.
        • Marks J.S.
        • Stroup D.F.
        • Gerberding J.L.
        Actual causes of death in the United States, 2000.
        JAMA. 2004; 291: 1238-1245
        • Centers for Disease Control and Prevention
        Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000-2004.
        MMWR Morb Mortal Wkly Rep. 2008; 57: 1226-1228
        • US Department of Health and Human Services
        The Health Consequences of Smoking: A Report of the Surgeon General.
        US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA2004 (DHHS Publication (CDC) 90-8416)
        • Wewers M.E.
        • Bailey W.C.
        • Carlsen K.H.
        • et al.
        An official American Thoracic Society workshop report: tobacco control initiatives within the American Thoracic Society.
        Proc Am Thorac Soc. 2010; 7: 1-7
        • Fiore M.C.
        • Jaen C.R.
        • Baker T.B.
        • et al.
        Treating Tobacco Use and Dependence: 2008 Update: Clinical Practice Guideline.
        US Dept of Health and Human Services, Public Health Service, Rockville, MD2008
      1. Hodgkin J.E. Celli B.R. Connors G.L. Pulmonary Rehabilitation: Guidelines to Success. 4th ed. Mosby Elsevier, St. Louis, MO2009
        • Sachs D.P.L.
        • Leone F.T.
        • Farber H.J.
        • et al.
        American College of Chest Physicians Tobacco-Dependence Treatment Tool Kit.
        3rd ed. American College of Chest Physicians, Northbrook, IL2009
        • Croghan I.T.
        • Offord K.P.
        • Evans R.W.
        • et al.
        Cost-effectiveness of treating nicotine dependence: the Mayo Clinic experience.
        Mayo Clin Proc. 1997; 72: 917-924
        • Croghan I.T.
        • Offord K.P.
        • Patten C.A.
        • Hurt R.D.
        Cost-effectiveness of the AHCPR guidelines for smoking.
        JAMA. 1998; 279: 836-837
        • Cromwell J.
        • Bartosch W.J.
        • Fiore M.C.
        • Hasselblad V.
        • Baker T.
        Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation.
        JAMA. 1997; 278: 1759-1766
        • Hughes J.R.
        • Keely J.
        • Naud S.
        Shape of the relapse curve and long-term abstinence among untreated smokers.
        Addiction. 2004; 99: 29-38
        • Hurt R.D.
        • Dale L.C.
        • Offord K.P.
        • Bruce B.K.
        • McClain F.L.
        • Eberman K.M.
        Inpatient treatment of severe nicotine dependence.
        Mayo Clin Proc. 1992; 67: 823-828
        • Beck A.T.
        • Steer R.A.
        • Brown G.K.
        Manual for the Beck Depression Inventory - II.
        Psychological Corp, San Antionio, TX1996
        • Heatherton T.F.
        • Kozlowski L.T.
        • Frecker R.C.
        • Fagerstrom K.O.
        The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire.
        Br J Addict. 1991; 86: 1119-1127
        • Hatsukami D.K.
        • Hughes J.R.
        • Pickens R.W.
        • Svikis D.
        Tobacco withdrawal symptoms: an experimental analysis.
        Psychopharmacology (Berl). 1984; 84: 231-236
        • Miller W.R.
        • Rollnick S.
        Motivational Interviewing: Preparing People for Change.
        2nd ed. Guilford Press, New York, NY2002
        • Davila D.G.
        • Hurt R.D.
        • Offord K.P.
        • Harris C.D.
        • Shepard Jr., J.W.
        Acute effects of transdermal nicotine on sleep architecture, snoring, and sleep-disordered breathing in nonsmokers.
        Am J Respir Crit Care Med. 1994; 150: 469-474
        • Hughes J.R.
        • Keely J.P.
        • Niaura R.S.
        • Ossip-Klein D.J.
        • Richmond R.L.
        • Swan G.E.
        Measures of abstinence in clinical trials: issues and recommendations.
        Nicotine Tob Res. 2003; 5: 13-25
        • Bars M.P.
        • Banauch G.I.
        • Appel D.
        • et al.
        “Tobacco Free With FDNY”: the New York City Fire Department World Trade Center Tobacco Cessation Study.
        Chest. 2006; 129: 979-987
        • Steinberg M.B.
        • Greenhaus S.
        • Schmelzer A.C.
        • et al.
        Triple-combination pharmacotherapy for medically ill smokers: a randomized trial.
        Ann Intern Med. 2009; 150: 447-454
        • Hays J.T.
        • Wolter T.D.
        • Eberman K.M.
        • Croghan I.T.
        • Offord K.P.
        • Hurt R.D.
        Residential (inpatient) treatment compared with outpatient treatment for nicotine dependence.
        Mayo Clin Proc. 2001; 76: 124-133
        • Hays J.T.
        • Croghan I.T.
        • Schroeder D.R.
        • et al.
        Residential treatment compared with outpatient treatment for tobacco use and dependence.
        Mayo Clin Proc. 2011; 86: 203-209
        • Sundblad B.M.
        • Larsson K.
        • Nathell L.
        High rate of smoking abstinence in COPD patients: smoking cessation by hospitalization.
        Nicotine Tob Res. 2008; 10: 883-890
        • Swan G.E.
        • Jack L.M.
        • Javitz H.S.
        • McAfee T.
        • McClure J.B.
        Predictors of 12-month outcome in smokers who received bupropion sustained-release for smoking cessation.
        CNS Drugs. 2008; 22: 239-256
        • Swan G.E.
        • McClure J.B.
        • Jack L.M.
        • et al.
        Behavioral counseling and varenicline treatment for smoking cessation.
        Am J Prev Med. 2010; 38: 482-490
        • Dale L.C.
        • Hurt R.D.
        • Offord K.P.
        • Lawson G.M.
        • Croghan I.T.
        • Schroeder D.R.
        High-dose nicotine patch therapy: percentage of replacement and smoking cessation.
        JAMA. 1995; 274: 1353-1358
        • Hatsukami D.K.
        • Dahlgren L.
        • Zimmerman R.
        • Hughes J.R.
        Symptoms of tobacco withdrawal from total cigarette cessation versus partial cigarette reduction.
        Psychopharmacology (Berl). 1988; 94: 242-247
        • Hurt R.D.
        • Dale L.C.
        • Offord K.P.
        • et al.
        Serum nicotine and cotinine levels during nicotine-patch therapy.
        Clin Pharmacol Ther. 1993; 54: 98-106
        • Lawson G.M.
        • Hurt R.D.
        • Dale L.C.
        • et al.
        Application of serum nicotine and plasma cotinine concentrations to assessment of nicotine replacement in light, moderate, and heavy smokers undergoing transdermal therapy.
        J Clin Pharmacol. 1998; 38: 502-509
        • Sachs D.P.
        Tobacco dependence treatment: time to change the paradigm.
        Chest. 2006; 129: 836-839
        • Tonnesen P.
        • Paoletti P.
        • Gustavsson G.
        • et al.
        Higher dosage nicotine patches increase one-year smoking cessation rates: results from the European CEASE trial.
        Eur Respir J. 1999; 13: 238-246
        • Ebbert J.O.
        • Croghan I.T.
        • Sood A.
        • Schroeder D.R.
        • Hays J.T.
        • Hurt R.D.
        Varenicline and bupropion sustained-release combination therapy for smoking cessation.
        Nicotine Tob Res. 2009; 11: 234-239