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May 20, 1988, Vol 259, No. 19 >
ARTICLE | May 20, 1988

Heavy Smokers, Smoking Cessation, and Clonidine: Title and subTitle BreakResults of a Double-blind, Randomized Trial FREE

Alexander H. Glassman, MD; Fay Stetner, MS, MPA; B. Timothy Walsh, MD; Pamela S. Raizman, MSW; Joseph L. Fleiss, PhD; Thomas B. Cooper, MA; Lirio S. Covey, PhD
[+] Author Affiliations

Reprint requests to Department of Clinical Psychopharmacology, New York State Psychiatric Institute, 722 W 168th St, New York, NY 10032 (Dr Glassman).


JAMA. 1988;259(19):2863-2866. doi:10.1001/jama.1988.03720190031026
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References

Seventy-one heavy smokers who had failed in previous attempts to stop smoking participated in a randomized clinical trial to test the efficacy of clonidine as an aid in smoking cessation. The success rate in clonidine-treated subjects (verified by serum cotinine concentration) was more than twice that in the placebo-treated subjects. When the data were stratified by gender, a strong effect present in women was not apparent in men. After six months, cessation rates remained significantly higher among smokers treated with clonidine than those receiving placebo. The data also revealed an unexpectedly high prevalence (61%) of a history of major depression in this sample and a significant negative effect of such a history on cessation regardless of treatment. These findings, highly suggestive of an important role of clonidine in smoking cessation, warrant further studies to establish the long-term (≥12 months) efficacy of this drug and to replicate the association between nicotine dependence and depression.

(JAMA 1988;259:2863-2866)

REFERENCES

1 +
Gold MS, Redmond DE Jr, Kleber HD:  Clonidine in opiate withdrawal. Lancet 1978;;1:929-930.
2 +
Charney DS, Kleber HD:  Iatrogenic opiate addiction: Successful detoxification with clonidine. Am J Psychiatry 1980;;137:989-990.
3 +
Jasinski DR, Johnson RE, Kocher TR:  Clonidine in morphine withdrawal: Differential effects on signs and symptoms. Arch Gen Psychiatry 1985;;42:1063-1066.
4 +
Bjorkqvist SE:  Clonidine in alcohol withdrawal. Acta Psychiatr Scand 1975;;52:256-263.
5 +
Walinder J, Balldin J, Bokstrom K, et al:  Clonidine suppression of the alcohol withdrawal syndrome. Drug Alcohol Depend 1981;;8:345-348.
6 +
Glassman AH, Jackson WK, Walsh BT, et al:  Cigarette craving, smoking withdrawal, and clonidine. Science 1984;;226:864-866.
7 +
Trends in US Cigarette Use, 1965-1980 , US Dept of Health and Human Services publication (PHS) 84-50204. Rockville, Md, Office on Smoking and Health, 1983;, p 369.
8 +
Fagerstrom KO:  Tolerance, withdrawal and dependence on tobacco and smoking termination. Int Rev Appl Psychol 1983;;32:29-51.
9 +
Endicott J, Spitzer RL:  A diagnostic interview: The Schedule for Affective Disorders and Schizophrenia. Arch Gen Psychiatry 1978;;35:837-844.
10 +
American Psychiatric Association, Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980;.
11 +
Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria for a Selected Group of Functional Disorders , ed 3. New York, Biometrics Research Division, New York State Psychiatric Institute, 1977;.
12 +
Mazure C, Gershon ES:  Blindness and reliability in lifetime psychiatric diagnosis. Arch Gen Psychiatry 1979;;36:521-525.
13 +
Lerner I, Schneider N: ALA Guide for Clinic Leaders , videotape 4230 (developed for the American Lung Association). Chicago, MMI Video, September 1984;.
14 +
Davis RA:  The determination of nicotine and cotinine in plasma. J Chromatogr Sci 1986;;24:134-141.
15 +
Russell MAA:  Estimation of smoke dosage and mortality of non-smokers from environmental tobacco smoke. Toxicol Lett 1987;;35:9-18.
16 +
Wald NJ, Boreham J, Bailey A, et al:  Urinary cotinine as marker of breathing other people's tobacco smoke. Lancet 1984;;1:230-231.
17 +
Benowitz NL:  The use of biologic fluid samples in assessing tobacco smoke consumption , in Grabowski J, Bell CS (eds): Measurement in the Analysis and Treatment of Smoking Behavior , Research Monograph 48. Rockville, Md, National Institute of Drug Abuse, 1983;, pp 6-27.
18 +
Shiffman SM:  The tobacco withdrawal syndrome , in Krasnegor N (ed): Cigarette Smoking as a Dependence Process , Research Monograph 23. Rockville, Md, National Institute of Drug Abuse, 1979;, pp 158-184.
19 +
Weissman MM, Kidd KK, Prusoff BA:  Variability in rates of affective disorders in relatives of depressed and normal probands. Arch Gen Psychiatry 1982;;39:1397-1403.
20 +
Weissman MM, Kidd KK,  Prusoff BA: Risk rates for depression. Arch Gen Psychiatry 1984;;41:105-106.
21 +
Mantel N, Haenszel W:  Statistical aspects of the analysis of data from retrospective studies of disease. JNCI 1959;;22:719-748.
22 +
Fleiss JL, Williams JB, Dubros AF:  Logistic regression analysis of psychiatric data. J Psychiatr Res 1986;;20:195-209.
23 +
Hunt WA, Bespalec DA:  An evaluation of current methods of modifying smoking behavior. J Clin Psychol 1974;;30:431-438.
24 +
Lichtenstein E:  The smoking problem: A behavioral perspective. J Consult Clin Psychol 1982;;50:804-819.
25 +
Jarvis MJ, Raw M, Russell MAH, et al:  Randomised, controlled trial of nicotine chewing-gum. Br Med J Clin Res 1982;;285:537-540.
26 +
Schneider NG, Jarvik ME, Forsythe AB, et al:  Nicotine gum in smoking cessation: A placebo-controlled, double-blind trial. Addict Behav 1983;; 8:253-261.
27 +
Hjalmarson AIM:  Effect of nicotine chewing gum in smoking cessation. JAMA 1984;;252:2835-2838.
28 +
Lam W, Sacks HS, Sze PC, et al:  Meta-analysis of randomised, controlled trials of nicotine chewing-gum Lancet 1987;;2:27-30.
29 +
Baldessarini RJ:  Risk rates for depression. Arch Gen Psychiatry 1984;;41:103-104.
30 +
Hughes JR, Hatsukami DK, Mitchell JE, et al:  Prevalence of smoking among psychiatric outpatients. Am J Psychiatry 1986;;143:993-997.
31 +
Kandel DB, Davies M:  Adult sequelae of adolescent depressive symptoms. Arch Gen Psychiatry 1986;;43:255-262.

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Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Gold MS, Redmond DE Jr, Kleber HD:  Clonidine in opiate withdrawal. Lancet 1978;;1:929-930.
2 +
Charney DS, Kleber HD:  Iatrogenic opiate addiction: Successful detoxification with clonidine. Am J Psychiatry 1980;;137:989-990.
3 +
Jasinski DR, Johnson RE, Kocher TR:  Clonidine in morphine withdrawal: Differential effects on signs and symptoms. Arch Gen Psychiatry 1985;;42:1063-1066.
4 +
Bjorkqvist SE:  Clonidine in alcohol withdrawal. Acta Psychiatr Scand 1975;;52:256-263.
5 +
Walinder J, Balldin J, Bokstrom K, et al:  Clonidine suppression of the alcohol withdrawal syndrome. Drug Alcohol Depend 1981;;8:345-348.
6 +
Glassman AH, Jackson WK, Walsh BT, et al:  Cigarette craving, smoking withdrawal, and clonidine. Science 1984;;226:864-866.
7 +
Trends in US Cigarette Use, 1965-1980 , US Dept of Health and Human Services publication (PHS) 84-50204. Rockville, Md, Office on Smoking and Health, 1983;, p 369.
8 +
Fagerstrom KO:  Tolerance, withdrawal and dependence on tobacco and smoking termination. Int Rev Appl Psychol 1983;;32:29-51.
9 +
Endicott J, Spitzer RL:  A diagnostic interview: The Schedule for Affective Disorders and Schizophrenia. Arch Gen Psychiatry 1978;;35:837-844.
10 +
American Psychiatric Association, Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980;.
11 +
Spitzer RL, Endicott J, Robins E: Research Diagnostic Criteria for a Selected Group of Functional Disorders , ed 3. New York, Biometrics Research Division, New York State Psychiatric Institute, 1977;.
12 +
Mazure C, Gershon ES:  Blindness and reliability in lifetime psychiatric diagnosis. Arch Gen Psychiatry 1979;;36:521-525.
13 +
Lerner I, Schneider N: ALA Guide for Clinic Leaders , videotape 4230 (developed for the American Lung Association). Chicago, MMI Video, September 1984;.
14 +
Davis RA:  The determination of nicotine and cotinine in plasma. J Chromatogr Sci 1986;;24:134-141.
15 +
Russell MAA:  Estimation of smoke dosage and mortality of non-smokers from environmental tobacco smoke. Toxicol Lett 1987;;35:9-18.
16 +
Wald NJ, Boreham J, Bailey A, et al:  Urinary cotinine as marker of breathing other people's tobacco smoke. Lancet 1984;;1:230-231.
17 +
Benowitz NL:  The use of biologic fluid samples in assessing tobacco smoke consumption , in Grabowski J, Bell CS (eds): Measurement in the Analysis and Treatment of Smoking Behavior , Research Monograph 48. Rockville, Md, National Institute of Drug Abuse, 1983;, pp 6-27.
18 +
Shiffman SM:  The tobacco withdrawal syndrome , in Krasnegor N (ed): Cigarette Smoking as a Dependence Process , Research Monograph 23. Rockville, Md, National Institute of Drug Abuse, 1979;, pp 158-184.
19 +
Weissman MM, Kidd KK, Prusoff BA:  Variability in rates of affective disorders in relatives of depressed and normal probands. Arch Gen Psychiatry 1982;;39:1397-1403.
20 +
Weissman MM, Kidd KK,  Prusoff BA: Risk rates for depression. Arch Gen Psychiatry 1984;;41:105-106.
21 +
Mantel N, Haenszel W:  Statistical aspects of the analysis of data from retrospective studies of disease. JNCI 1959;;22:719-748.
22 +
Fleiss JL, Williams JB, Dubros AF:  Logistic regression analysis of psychiatric data. J Psychiatr Res 1986;;20:195-209.
23 +
Hunt WA, Bespalec DA:  An evaluation of current methods of modifying smoking behavior. J Clin Psychol 1974;;30:431-438.
24 +
Lichtenstein E:  The smoking problem: A behavioral perspective. J Consult Clin Psychol 1982;;50:804-819.
25 +
Jarvis MJ, Raw M, Russell MAH, et al:  Randomised, controlled trial of nicotine chewing-gum. Br Med J Clin Res 1982;;285:537-540.
26 +
Schneider NG, Jarvik ME, Forsythe AB, et al:  Nicotine gum in smoking cessation: A placebo-controlled, double-blind trial. Addict Behav 1983;; 8:253-261.
27 +
Hjalmarson AIM:  Effect of nicotine chewing gum in smoking cessation. JAMA 1984;;252:2835-2838.
28 +
Lam W, Sacks HS, Sze PC, et al:  Meta-analysis of randomised, controlled trials of nicotine chewing-gum Lancet 1987;;2:27-30.
29 +
Baldessarini RJ:  Risk rates for depression. Arch Gen Psychiatry 1984;;41:103-104.
30 +
Hughes JR, Hatsukami DK, Mitchell JE, et al:  Prevalence of smoking among psychiatric outpatients. Am J Psychiatry 1986;;143:993-997.
31 +
Kandel DB, Davies M:  Adult sequelae of adolescent depressive symptoms. Arch Gen Psychiatry 1986;;43:255-262.

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