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Preliminary Evidence That Adherence to Counseling Mediates the Effects of Pretreatment Self-Efficacy and Motivation on Outcome of a Cessation Attempt in Smokers with ADHD.

Nicotine & Tobacco Research 2013;15(2):393-400. [doi: 10.1093/ntr/nts135]

Jaimee L. Heffner, PhD, Daniel F. Lewis, Theresa M. Winhusen, PhD (University of Cincinnati/CinARC, OV Node).

Few studies have evaluated predictors of smoking cessation outcomes in smokers with attention-deficit/hyperactivity disorder (ADHD), which could help to improve suboptimal treatment outcomes in this population. The purpose of this study was to examine pretreatment thoughts about smoking abstinence (i.e., desire to quit, perceived difficulty quitting, and expected success in quitting) as predictors of smoking cessation outcomes in smokers with ADHD and to determine the extent to which treatment adherence mediates these relationships. Participants in this CTN ancillary investigation were adult smokers with ADHD (n=255) who were enrolled in National Drug Abuse Treatment Clinical Trials Network protocol CTN-0029 ("A Pilot Study of Osmotic-Release Methylphenidate in Initiating and Maintaining Abstinence in Smokers with ADHD") and received either osmotic-release oral system methylphenidate (OROS-MPH) or placebo in combination with transdermal nicotine replacement and brief cessation counseling. Bootstrapped logistic regression models were generated to test main effects of thoughts about abstinence on smoking cessation outcomes and to examine treatment adherence as a mediator of these relationships. Desire to quit and expected success in quitting, but not perceived difficulty of quitting, predicted smoking cessation outcomes, as did all of the treatment adherence variables (i.e., percent sessions attended, counselor ratings of counseling adherence, and percent patch adherence). Counseling adherence partially mediated the relationship between smoking cessation outcomes and both pretreatment desire to quit and expected success.

Conclusions: Smokers with ADHD who have higher self-efficacy (i.e., expected success) and motivation (i.e., desire) to quit are more adherent to smoking cessation counseling and have better smoking cessation outcomes. Additional research is needed to determine whether treatment-seeking smokers with ADHD would benefit from an intervention designed to increase self-efficacy and motivation to quit. Interventions such as contingency management, for example, have been shown to increase motivation and self-efficacy for quitting in non-treatment-seeking adult smokers and might effectively promote long-term abstinence in smokers with ADHD as well. (Article (Peer-Reviewed), PDF, English, 2013)

Keywords: Attention Deficit Hyperactivity Disorder (ADHD) | Concerta | CTN platform/ancillary study | Nicotine replacement therapy | Osmotic-Release Methylphenidate (OROS-MPH) | Pharmacological therapy | Smoking | Nicotine & Tobacco Research (journal)

Document No: 907, PMID: 22949577, PMCID: PMC3612001.

Submitted by CTN Dissemination Librarians, 9/11/2012.

Heffner, Jaimee L. search mail
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Winhusen, Theresa M. search mail
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Supported by a grant from the National Institute on Drug Abuse to the University of Washington Alcohol and Drug Abuse Institute.
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