Smoking abstinence found more effective with residential treatment

In the March issue of Mayo Clinic Proceedings, researchers report that residential treatment for tobacco dependence among heavy smokers greatly improves the odds of abstinence at six months compared with standard outpatient treatment. The study reports that 52 percent of the patients were still not smoking six months after residential treatment, compared with 26 percent in the outpatient treatment setting.

'This means there is hope for patients who are tobacco dependent and feel they have exhausted every other means of trying to quit smoking,' says Taylor Hays, M.D., a Mayo Clinic nicotine dependence specialist and an author of this study.

Smoking relapse rates are the highest during the first weeks of an attempt to quit smoking. Effective treatment for tobacco dependence involves intensive behavioural and pharmacological treatments to achieve long-term smoking abstinence.

'Many patients and health care providers become discouraged when long-term abstinence from smoking can't be achieved. Repeated outpatient treatment is the only option available to most. Our study shows that a 'next step' in more intensive treatment results in a remarkably high success rate compared with the usual approach to re-treatment as an outpatient,' says Dr Hays.

Mayo Clinic researchers compared data from 4,553 cigarette smokers who underwent a tobacco dependence consultation at the Mayo Clinic Nicotine Dependence Centre (NDC) between 2004 and 2007, in either the outpatient or residential setting. Of those smokers, 4,327 received comprehensive outpatient treatment for tobacco dependence and 226 received treatment in an intensive eight-day residential setting. Compared with outpatients, residential patients were more dependent on tobacco, they smoked more heavily and were more likely to have more associated medical and psychiatric illnesses.

'Our residential program offers treatment in a protected environment (away from the usual daily smoking triggers) where we provide group and individual counselling treatment and medication therapy. We are able to focus many hours of contact with patients in a relatively brief time, and this is probably the key to its success,' says Dr Hays. 'Our outpatients receive an individual counselling session followed by telephone or face-to-face follow-up counselling as well as medications. However, treatment is usually spread over several weeks and does not allow the concentrated contact with patients compared with residential treatment.'

The NDC provides comprehensive treatment for people who want to quit using any form of tobacco. The NDC has treated over 40,000 patients since 1988 and treats over 2,000 patients annually. The NDC also educates health professionals on the best ways to treat tobacco dependence and has an active research program to discover new ways to assess and treat people who use tobacco.