Comorbidity, smelting behavior and treatment outcome

Background: A sizeable sector of the population continues to smoke cigarett es despite our efforts to prevent and treat this addiction. We explored the relationships between lifetime comorbidity, psychiatric symptomatology, sm oking behavior and treatment outcome to better understand vulnerability to smoking and treatment response. Methods: One hundred and twenty smokers at two sites were enrolled in a multicenter, double-blind, randomized, 10-week smoking cessation trial with fluoxetine and behavioral treatment. The Stru ctured Clinical Interview for DSM-III-R and Hamilton Depression Rating Scal e were administered prior to treatment initiation. Self-report measures wer e used to assess psychiatric symptoms throughout treatment and during a 6-m onth follow-up period. Results: Overall 62.3% of our sample were diagnosed with a lifetime mood, anxiety or substance use disorder despite stringent s tudy exclusion criteria. Lifetime comorbidity was shown to be related to hi gher smoking rates and nicotine dependence, depressed mood and greater self -report of anxiety and stress. Lifetime comorbidity, however, alone or in c ombination with treatment condition, failed to predict treatment outcome (a t posttreatment or follow-up). Baseline depression scores (Beck Depression Inventory, BDI) were related to treatment outcome only for smokers without a positive history of any psychiatric disorder or depression, with lower BD I scores more frequent in those who were abstinent. Conclusions: High preva lence rates of lifetime psychiatric illness and substance use disorders are reported for chronic smokers. Subsyndromal psychiatric symptoms may play a role in smoking behavior in combination with diagnosable disorders. Clinic ians need to carefully assess both psychiatric diagnoses and symptoms in ch ronic smokers to optimize patient-treatment matching. Copyright (C) 2000 S. Karger AG, Basel.