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Va New Non Smoking Program

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Recent VA News Releases

"New Approach to Smoking Cessation Boosts Quit Rates

for Veterans with PTSD

WASHINGTON -- Smoking cessation treatment that is made part of mental

health care for Veterans with Post Traumatic Stress Disorder (PTSD)

improves quit rates, according to a Department of Veterans Affairs (VA)

study published in the Dec. 8 Journal of the American Medical


"The smoking cessation techniques used in this new approach will give

Veterans an important step towards a better quality of life," said VA

Under Secretary for Health Dr. Robert Petzel. "Veterans will be at a

lower risk for cardiovascular or lung disease if they do not smoke."

On measures of smoking abstinence for shorter periods of time,

researchers found that quit rates were as high as 18 percent for the

integrated care group, versus 11 percent for those receiving usual care.

When compared to usual care-referral to a standard smoking cessation

clinic-the new, integrated approach nearly doubled the rate at which

study volunteers stayed smoke-free for a year or longer, from 4.5

percent to almost 9 percent.

Importantly, Veterans in the study who quit smoking showed no worsening

of symptoms of PTSD or depression. In fact, study participants averaged

a 10-percent reduction in PTSD symptoms, regardless of which treatment

they received or whether they quit smoking or not. The findings help

dispel concerns that combining care for PTSD and smoking cessation

detracts from PTSD treatment or makes it less effective.

Study leaders Miles McFall, Ph.D., and Andrew Saxon, M.D., say the

results validate a promising new VA model of care that can make safe,

effective smoking cessation treatment accessible to far more Veterans

with PTSD. The new approach may also be effective for smokers receiving

mental health care for other psychiatric illnesses, they add.

Says McFall, "One of the most important things mental health providers

can do to improve the quality and length of their patients' lives is to

help them stop smoking by using proven, evidence-based practices."

McFall is director of PTSD Programs and Saxon is director of the

Addictions Treatment Center at the VA Puget Sound Health Care System.

Both are professors in the department of psychiatry and behavioral

sciences at the University of Washington.

VA smoking cessation care generally involves a mix of group and

individual counseling, typically in combination with nicotine

replacement therapy or other medication prescribed by a VA health care

provider. In VA's study, Veterans in the integrated-care group worked

with the same therapist on PTSD and smoking issues. Medication for

smoking cessation, if used, was prescribed on an individual basis by the

same medical provider managing pharmacologic treatment of the Veteran's

PTSD symptoms.

The study followed 943 Veterans at 10 VA medical centers nationwide.

Prolonged abstinence from tobacco, as reported by participants, was

confirmed using breath and urine tests to detect evidence of smoking.

Using such "bio-verification" measures in combination with self-reports

is considered the "gold standard" in smoking cessation research, says


Of some 400,000 Veterans being treated for PTSD in the VA health care

system, roughly 30 to 50 percent are smokers, compared to a smoking rate

of about 20 percent among VA enrollees and U.S. adults in general.

Research shows, also, that those with PTSD smoke more heavily than

smokers without PTSD and have an especially hard time quitting.

"We've come a long way in understanding that nicotine dependence for

many Veterans with PTSD is a chronic, relapsing condition that responds

best to intensive treatment extended over time," McFall says. "These

study findings will help us empower more Veterans with the resources

they need to quit smoking. Single-shot, brief episodic care for nicotine

addiction is no match for what is a chronic, relapsing disorder for many

of our Veterans."

Based on the findings and evidence from prior research, VA has begun

piloting the integrated smoking cessation approach as a standard of

practice at six VA medical centers. The researchers say they hope to see

the new approach further expanded over time.

McFall notes that while most of the participants in the study were

Vietnam-era Veterans, integrated smoking cessation care may be

especially beneficial for younger Veterans with PTSD, such as many of

those returning from Iraq or Afghanistan, who stand to benefit greatly

from quitting smoking relatively early in life.

Says McFall, "Ideally, we can help Veterans quit smoking before it

becomes a chronic or intractable condition and causes irreversible

health problems such as cardiovascular or lung disease."

The study was conducted by VA's Cooperative Studies Program. For more

information on CSP, visit www.csp.research.va.gov. "

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With this being said now by the VA does it open up a better chance of the people with COPD to use this to say that the government accepts that the PTSD as likely or not made them smoke more and it was harder for them to quit so it is directly a result associated with their service connected PTSD.

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