Effective Cessation Strategies for Smokers with Schizophrenia

Despite availability of smoking cessation aids with proven efficacy and tolerability in those with schizophrenia, addiction to tobacco-derived nicotine remains highly prevalent among those with schizophrenia spectrum disorders. While smokers with serious mental illness have been excluded from most large nicotine-dependence treatment studies, and these treatments are woefully underutilized for smokers with psychiatric illness, a growing evidence base is available to guide cessation treatment for smokers with schizophrenia. The aim of this review is to present the evidence on safety and efficacy of smoking cessation interventions for those with schizophrenia spectrum illness. Smokers with schizophrenia spectrum disorders should receive varenicline or bupropion with or without nicotine replacement therapy in combination with behavioral treatment. Clinical practice guidelines now recommend duration of treatment be 12 weeks, but evidence indicates that maintenance pharmacotherapy for 1 year improves sustained abstinence rates. Controlled trials have found no evidence that in patients with serious mental illness, the use of pharmacotherapeutic cessation aids worsens psychiatric symptoms or increases the rate of psychiatric adverse events. Converging evidence indicates that a majority of smokers with serious mental illness want to quit smoking and that available pharmacotherapeutic cessation aids combined with behavioral support are both effective for, and well tolerated by, these smokers.