Veterans with PTSD have high rates of smoking (34%-86% vs. 18% in the general population) and have substantial difficulties with quitting tobacco. Only 23% of individuals with PTSD quit smoking compared to 50% of the general population. As a result, Veterans with PTSD are at high risk of developing severe health problems and poor physical functioning. Fifty percent of these long-term smokers will die of a smoking-related cause and on average, will lose 25 years of their life compared to non-smokers. Despite the significant morbidity and mortality associated with smoking, no smoking cessation treatments exist that intensively target PTSD symptoms as an obstacle to quit smoking, although this is a significant barrier to quitting for many Veterans. n addition, no smoking cessation treatments have a large emphasis on improving the functioning of Veterans with PTSD and tobacco dependence, although both PTSD and tobacco use negatively affect functioning across physical, mental health, and social domains. The goal of this SPiRE project is to evaluate Acceptance and Commitment Therapy for Veterans with PTSD and Tobacco Use (ACT-PT), which is an acceptance and mindfulness-based smoking cessation treatment for Veterans with PTSD and tobacco dependence. ACT-PT specifically targets smoking cravings related to PTSD symptoms and memories of trauma, in addition to difficulties managing PTSD symptoms. negative affect and nicotine withdrawal symptoms during quit attempts. ACT-PT includes structured intervention components that guide Veterans to replace smoking as a coping strategy for PTSD symptoms and memories with alternative coping strategies (e.g., mindfulness, acceptance). And healthy living activities (e.g., engaging in work, expanding social networks, engaging in physical exercise) that are consistent with Veterans' values. This emphasis on substantially improving health-related quality of life and functioning across several areas makes ACT-PT particularly innovative and different from existing treatments. However, research is needed on the relative feasibility, acceptability, and efficacy of ACT-PT compared to standard smoking cessation treatments. The proposed SPiRE (I21) will involve a randomized clinical trial study of 50 Veteran smokers with PTSD and tobacco dependence randomized to one of two different types of psychosocial treatment 10 individual sessions of ACT-PT (n= 25) versus 10 individual sessions of the American Lung Association's Freedom From Smoking Program [FFS] (n=25) with all participants receiving 12 weeks of the nicotine patch. This study has two primary aims: 1) evaluate the relative feasibility and acceptability of the two interventions (including ease of recruitment, randomization proportion, staff and Veteran acceptance of the treatment, retention rates, treatment adherence, fidelity, ease of the assessment process), and 2) evaluate the preliminary efficacy of ACT-PT vs. FFS with the primary outcomes of tobacco use, PTSD symptoms, health-related quality of life, and functional impairment.
Smoking is the leading preventable cause of death for Veterans with PTSD. Veterans with PTSD have high rates of smoking and significant difficulties with quitting, which puts them at high risk chronic and severe medical problems and high mortality rates. In addition, both PTSD and Tobacco Dependence are associated with poor functioning. Current tobacco treatments do not intensively target PTSD symptoms as barriers to quitting, and do not heavily focus on improving functioning across several life areas. The proposed study will provide important information on a targeted tobacco cessation treatment for Veterans with PTSD, which focuses on improving tobacco abstinence rates for Veterans with PTSD, improving PTSD symptoms, and improving quality of life across physical, mental health, and social domains. This treatment capitalizes on the improvement in functioning associated with quitting tobacco and improving on it by focusing on replacing smoking with life goals and activities consistent with Veterans' values.
| Kelly, Megan M; Sido, Hannah; Rosenheck, Robert (2016) Rates and correlates of tobacco cessation service use nationally in the Veterans Health Administration. Psychol Serv 13:183-92 |
| Kelly, Megan M; Jensen, Kevin P; Sofuoglu, Mehmet (2015) Co-occurring tobacco use and posttraumatic stress disorder: Smoking cessation treatment implications. Am J Addict 24:695-704 |
