A Randomized Trial of Short Psychotherapy Versus Sustained-Release Bupropion for Smoking Cessation

Addiction. 2008 Dec;103(12):2024-31. doi: 10.1111/j.1360-0443.2008.02348.x.

Abstract

Aims: To compare the efficacy and safety of a novel psychological intervention for smoking cessation called psychodynamic model (PDM) training to an active control condition of sustained-release bupropion.

Design: Randomized controlled clinical trial with allocation concealment.

Setting: Private psychiatric practice.

Participants: Seven hundred and seventy-nine adult smokers recruited by advertising.

Interventions: PDM training (n = 366 participants) consisted of a very brief (1.5 days) psychoeducation and a supervised training in autosuggestion techniques (guided imageries) aimed at enhancing self-management, decidedness, assertiveness, security and competence in relationships, natural functions of organs and awareness of bodily functions. Bupropion SR (n = 413) was increased to 150 mg twice daily over 1 week and given over a 8-week period.

Measurements: Twelve-month continuous abstinence confirmed by exhaled carbon monoxide (CO) of 9 parts per million (p.p.m.) or less at all interviews conducted at 3, 6 and 12 months.

Findings: Intention-to-treat analysis revealed Russell standard 12-month continuous abstinence rates of 39.1% in the psychotherapy group versus 12.3% in the bupropion SR group (P < 0.001) with a relative benefit (RB) of 3.16 (2.38-4.26). Completer analysis revealed 12-month continuous abstinence rates of 39.9% in the psychotherapy group versus 22.5% in the bupropion group [P < 0.001; RB 1.78 (1.35-2.34)]. Of note, bupropion abstinence rates were comparable to previous medications/placebo-only comparisons in geographically different samples.

Conclusions: The 1.5-day psychotherapy exceeded bupropion's efficacy, presenting an alternative to pharmacological smoking cessation aids, especially for smokers who reject drugs to treat their substance dependence, at a similar cost (Euro 350) as the bupropion treatment (Euro 355).

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bupropion / adverse effects
  • Bupropion / therapeutic use*
  • Female
  • Humans
  • Imagery, Psychotherapy
  • Male
  • Middle Aged
  • Patient Compliance
  • Psychotherapy, Brief / methods*
  • Smoking / therapy*
  • Smoking Cessation / methods*
  • Tobacco Use Disorder / therapy*
  • Treatment Outcome

Substances

  • Bupropion