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NICE Underpinning Review
The aim of this review is to assess the effectiveness of smoking cessation and temporary abstinence interventions in mental health services, including strategies for referring people to stop smoking or hospital based stop smoking services, for the populations of interest.
Overall, the evidence from the review suggested:
Behavioural Therapy (with no pharmacotherapy)
Very few well conducted high quality studies have been performed to assess the effectiveness of high intensity behavioural therapy for smoking cessation or reduction. However, the evidence to date suggests high intensity behavioural therapy may be effective in populations with specific mental health disorders.
Bupropian
Several well conducted high quality studies have been performed to assess the effectiveness of bupropion for smoking cessation or reduction. The evidence to date suggests bupropion is effective for smoking cessation in the short term in populations with schizophrenia.
Nicotine Replacement Therapy (NRT)
Very few well conducted high quality studies have been performed to assess the effectiveness of NRT for smoking cessation or reduction. The evidence to date is mixed regarding whether NRT is effective in populations with mental health disorders.
Varenicline
No well conducted high quality studies have been performed to assess the effectiveness of varenicline for smoking cessation or reduction. The evidence to date suggests varenicline may have some effectiveness for reducing smoking.
Other pharmacotherapies
Very few well conducted moderate to high quality studies have been performed to assess the effectiveness of other pharmacotherapies for smoking cessation or reduction. The evidence to date suggests clozapine (an atypical [new generation] antipsychotic medication) may be effective for reducing smoking.
Combinations of interventions
Very few well conducted high quality studies have been performed to assess the effectiveness of combinations of interventions as compared to control. The evidence to date suggests the combination of bupropion with NRT may be effective for smoking cessation.
Contingency payments (with or without pharmacotherapy)
Very few well conducted high quality studies have been performed to assess the effectiveness of contingency payment with or without pharmacotherapies for smoking cessation or reduction. The evidence to date suggests the combination of contingency payments with bupropion was effect for reducing smoking in specific mental health populations.
Effectiveness of interventions by type of anti-psychotic medication
There were several well conducted high quality studies that have been performed to assess the difference in effectiveness of interventions for smoking cessation by the type of anti-psychotic medication used. The evidence to date is mixed regarding whether the effectiveness differs between using typical and atypical antipsychotic medication.