Project TEAM

Pharmaceutical and Behavioral Intervention

Although investigators have aided behavioral scientists interested in understanding the power of negative affect to influence smoking habits and cessation attempts, they are only beginning to conduct studies that specifically target the relationship in interventions. Recognizing that modulation of mood is an important reason why people smoke, the panel devising clinical practice guidelines for tobacco cessation recommended one antidepressant, buproprion SR, as a first-line therapy, and one other, Nortriptyline as a second-line pharmaceutical intervention. Buproprion is the only antidepressant approved by the U.S. Food and Drug Administration (FDA) for treatment of tobacco dependence.

In behavioral intervention efforts, Hall and colleagues determined that mood management provided a differentially favorable effect in increasing abstinence among those whose medical history included a bout with depression, and other investigators have employed their methods with some success with smokers who have a history of depression. This effect was primarily due to the poor performance of smokers who received the control as opposed to the mood management intervention. Cinciripini and coworkers found that self-efficacy was the strongest mediator of the effects of depressed mood on abstinence during the post cessation period, accounting for up to 48% of the effect of mood on abstinence. They concluded that building the smoker's sense of self- efficacy during the intervention, particularly during the early stages, may be a significant factor in successful perseverance during the quit attempt.

Future Research

These reports have led investigators to agree with Anda et al., who concluded more than a decade ago that depression plays an important role in the dynamics of cigarette smoking. Part of what remains to be revealed by future research is the scope of that role and, also, a better delineation of depression's role in the dynamics of cessation.

Conclusion

Smoking's effects stretch beyond the individual who smokes to affect the lives of those around him or her, including the unborn and the very small. What we know now is that reasons for smoking may be sown into the smoker's genetic code early on and that only more research will begin to delineate the mechanisms responsible for nicotine dependence and other characteristics of the smoking habit. As more of this information becomes known, it may well transform our perception not only of the mechanisms but of the people they affect. It can also be expected to inform and perhaps also transform behavioral approaches to tobacco cessation therapy.

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