Co-occurring tobacco use and posttraumatic stress disorder: Smoking cessation treatment implications

Background and Objectives PTSD and cigarette smoking frequently co-occur for reasons that are not well understood. The current behavioral and pharmacological treatments and emerging new treatment targets for smoking cessation are discussed. Methods Here we describe recent research on PTSD and smoking with an emphasis on 1) the clinical characteristics of smokers with PTSD, 2) smoking treatment trials that specifically targeted smokers with PTSD, 3) recent research on stress-response and affect regulation pathways that might link the two disorders and 4) potential ways to leverage new findings on stress response systems and affect regulation mechanisms to improve treatment outcomes for smokers with PTSD. Results Smokers with PTSD have higher rates of smoking compared to the general population and have greater difficulty quitting compared to smokers without PTSD. There have been several studies of adjunctive and integrated smoking cessation interventions for smokers with PTSD, but fewer tailored interventions that intensively target stress-response pathways or affect regulation related to both tobacco use and PTSD. Stress-response pathways and affect regulation appear to be important mechanisms involved in the development and maintenance of smoking in individuals with PTSD. Conclusions and Scientific Significance Additional research that focuses on smokers with PTSD is warranted given that successful tobacco treatment response is low and the negative health effects of each disorder can be greatly amplified. (Am J Addict 2015;XX:1–10)