Over 75% of patients with schizophrenia are nicotine dependent, and most of them die of smoking related illnesses. Few are offered nicotine dependence treatment in primary care or mental health settings. Unfortunately there have been few clinical treatment studies, and there continues to be a great need to develop, test, and disseminate behavioral therapy and medication management approaches for nicotine dependence treatment in mental health settings. Treatment manuals, training programs, and clinical studies are needed. Such therapies should reflect the unique needs of this population, and be """"""""real world applicable."""""""" This grant reapplication responds to the concerns and helpful suggestions of the initial Review Committee and proposes to further develop and pilot test our behavioral therapy approach of Treating Addiction to Nicotine in Schizophrenia (TANS). In response to the Review Committee, this reapplication clarifies and better links TANS to its the empirical foundation, addresses """"""""real world applicability,"""""""" changes the control treatment, and modifies the assessment battery. We propose to develop and test Stage 1 Therapy Development Products (therapy manual, adherence scales, and training program) of TANS and our new control treatment of Nicotine Dependence Medication Management by Mental Health Providers (Medication Management). We agree with the Review Committee's suggestion to compare TANS to a lower intensity control treatment in regards to (1) engagement, retention, and extended abstinence during the initial three months, (2) relapse prevention during months four through six, and (3) longer-term abstinence at later follow-ups. After an initial open trial of 20 subjects to develop the therapy products, we propose to do a larger study of 100 subjects randomized to TANS versus Medication Management. The proposed study is important because it will create two real world applicable psychosocial treatments that could help clinicians in the mental health system better address tobacco and researchers doing medication or Stage II therapy studies. The study will assess whether medication management is sufficient in this population, and whether lengthening treatment will improve long-term outcomes.
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