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Nicotine withdrawal, relapse of mental illness, or medication side-effect? Implementing a monitoring tool for people with mental illness into quitline counseling

Segan, Catherine J., Baker, Amanda L., Turner, Alyna and Williams, Jill M. 2017, Nicotine withdrawal, relapse of mental illness, or medication side-effect? Implementing a monitoring tool for people with mental illness into quitline counseling, Journal of dual diagnosis, vol. 13, no. 1, pp. 60-66, doi: 10.1080/15504263.2016.1276657.

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Title Nicotine withdrawal, relapse of mental illness, or medication side-effect? Implementing a monitoring tool for people with mental illness into quitline counseling
Author(s) Segan, Catherine J.
Baker, Amanda L.
Turner, AlynaORCID iD for Turner, Alyna orcid.org/0000-0001-7389-2546
Williams, Jill M.
Journal name Journal of dual diagnosis
Volume number 13
Issue number 1
Start page 60
End page 66
Total pages 7
Publisher Taylor & Francis
Place of publication Abingdon, Eng.
Publication date 2017-01
ISSN 1550-4271
Keyword(s) Smoking cessation
medication side effects
mental illness
nicotine withdrawal
quitline
telephone counseling
Summary BACKGROUND: Smokers with mental illness and their health care providers are often concerned that smoking cessation will worsen mental health. Smokers with mental illness tend to be more nicotine-dependent and experience more severe symptoms of nicotine withdrawal, some of which are difficult to distinguish from psychiatric symptoms. In addition, smoking cessation can increase the blood levels and hence side effects of some psychotropic medications. Improved monitoring of nicotine withdrawal and medication side effects may help distinguish temporary withdrawal symptoms from psychiatric symptoms and facilitate targeted treatment to help smokers with mental illness manage the acute phase of nicotine withdrawal. OBJECTIVE: The aim of this research was to examine the acceptability and feasibility to quitline counselors of implementing structured assessments of nicotine withdrawal and common medication side effects in people with mental illness who are quitting smoking using a telephone smoking cessation service. METHODS: Monitoring involves administering (once pre-cessation and at each contact post-cessation) (1) the Minnesota Nicotine Withdrawal Scale, assessing eight symptoms: anger, anxiety, depression, cravings, difficulty concentrating, increased appetite, insomnia, and restlessness and (2) an adverse side effects checklist of 5 to 10 symptoms, for example, dry mouth and increased thirst. Following a 1-day update training in mental health, quitline counselors were asked to offer these assessments to callers disclosing mental illness in addition to usual counseling. Group interviews with counselors were conducted 2 months later to examine implementation barriers and benefits. RESULTS: Barriers included awkwardness in integrating a new structured practice into counseling, difficulty in limiting some callers to only the content of new items, and initial anxieties about how to respond to changes in some symptoms. Benefits included the ability to provide objective feedback on changes in symptoms, as this identified early benefits of quitting, provided reassurance for clients, and provided an opportunity for early intervention where symptoms worsened. CONCLUSIONS: Structured monitoring of withdrawal symptoms and medication side effects was able to be integrated into the quitline's counseling and was valued by counselors and clients. Given evidence of its benefits in this limited pilot study, we recommend it be considered for larger-scale adoption by quitlines.
Language eng
DOI 10.1080/15504263.2016.1276657
Field of Research 170199 Psychology not elsewhere classified
1701 Psychology
Socio Economic Objective 920401 Behaviour and Health
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, Taylor & Francis Group
Persistent URL http://hdl.handle.net/10536/DRO/DU:30093838

Document type: Journal Article
Collection: School of Medicine
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