Mortality following inpatient addictions treatment. Role of tobacco use in a community-based cohort
R. D. Hurt, K. P. Offord, I. T. Croghan, L. Gomez-Dahl, T. E. Kottke, R. M. Morse and L. J. Melton 3rd
Nicotine Dependence Center, Mayo Clinic, Rochester MN 55905, USA.
OBJECTIVE: To determine the impact of tobacco- and alcohol-related deaths
on overall mortality following inpatient treatment for alcoholism and other
nonnicotine drugs of dependence. DESIGN: Population-based retrospective
cohort study. SETTING: Olmsted County, Minnesota (the Rochester
Epidemiology Project), and the Inpatient Addiction Program (IAP) at Mayo
Clinic, Rochester. PATIENTS: All 845 Olmsted County residents admitted to
an inpatient addiction program for treatment of alcoholism and other
nonnicotine drugs of dependence during the period 1972 through 1983.
METHODS: Patients were followed up through the medical record linkage
system of the Rochester Epidemiology Project through December 1994 to
obtain vital status, and death certificates were obtained for those who
died. The underlying cause of death was classified as alcohol related,
tobacco related, both, or neither based on the classification from the
Centers for Disease Control and Prevention. The observed number of deaths
by underlying cause were compared with the expected number using
cause-specific 1987 death rates for the white population of the United
States. All-cause mortality was also compared with that expected for
persons in the West North Central Region of the United States of like age,
sex, and year of birth. Univariate and multivariate assessments were made
to identify predictors of all-cause mortality from baseline demographic
information. RESULTS: At admission, the mean (SD) age of the 845 patients
was 41.4 (14.5) years, and 35% were women. Altogether, 78% had alcohol as
their only nonnicotine drug of dependence and 18% had alcohol and other
nonnicotine drugs of dependence, while 4% were classified as having a
nonalcohol, nonnicotine drug dependence alone. At admission, 75% were
current and 8% former cigarette smokers, 3% were current cigar or pipe
smokers, and 2% were current users of smokeless tobacco. Follow-up after
the index IAP admission totaled 8913 person-years (mean [SD] of 10.5 [5.6]
years per patient). Death certificates were obtained for 96% (214) of the
222 patients who died. Of these 214 deaths, 50.9% (109) had a
tobacco-related and 34.1% (73) had an alcohol-related underlying cause
(P<.001). The cumulative mortality significantly exceeded that expected
(P<.001); at 20 years, the observed mortality was 48.1% vs an expected
18.5%. Multivariate predictors of mortality, even after adjusting for
expected mortality, were older age at admission (P<.001) and male sex
(P<.001). CONCLUSIONS: Patients previously treated for alcoholism and/or
other nonnicotine drug dependence had an increased cumulative mortality
that was due more to tobacco-related than to alcohol-related causes.
Nicotine dependence treatment is imperative in such high-risk patients.
Smoking and alcoholism target genes associated with plasticity and glutamate transmission in the human ventral tegmental area
Flatscher-Bader et al.
Hum Mol Genet 2008;17:38-51.
ABSTRACT
| FULL TEXT
Smoking kills (alcoholics)! shouldn't we do something about it?
Littleton et al.
Alcohol Alcohol 2007;42:167-173.
ABSTRACT
| FULL TEXT
Predicting Alcohol Misusers' Readiness and Ability to Quit Smoking: a Critical Review
Heffner et al.
Alcohol Alcohol 2007;42:186-195.
ABSTRACT
| FULL TEXT
Is cigarette smoking related to alcohol use during the 8 years following treatment for adolescent alcohol and other drug abuse?
Myers et al.
Alcohol Alcohol 2007;42:226-233.
ABSTRACT
| FULL TEXT
Timevarying predictors of smoking cessation among individuals in treatment for alcohol abuse and dependence: findings from project match
Friend and Pagano
Alcohol Alcohol 2007;42:234-240.
ABSTRACT
| FULL TEXT
Results from two pharmacotherapy trials show alcoholic smokers were more severely alcohol dependent but less prone to relapse than alcoholic non-smokers
Schmidt and Smolka
Alcohol Alcohol 2007;42:241-246.
ABSTRACT
| FULL TEXT
Training in Tobacco Treatments in Psychiatry: A National Survey of Psychiatry Residency Training Directors
Prochaska et al.
Acad. Psychiatry 2006;30:372-378.
ABSTRACT
| FULL TEXT
How Prepared Are Psychiatry Residents for Treating Nicotine Dependence?
Prochaska et al.
Acad. Psychiatry 2005;29:256-261.
ABSTRACT
| FULL TEXT
Use of Oral Topiramate to Promote Smoking Abstinence Among Alcohol-Dependent Smokers: A Randomized Controlled Trial
Johnson et al.
Arch Intern Med 2005;165:1600-1605.
ABSTRACT
| FULL TEXT
Smoking Cessation Services in U.S. Methadone Maintenance Facilities
Richter et al.
Psychiatr. Serv. 2004;55:1258-1264.
ABSTRACT
| FULL TEXT
Treating Opioid Dependence: Growing Implications for Primary Care
Krantz and Mehler
Arch Intern Med 2004;164:277-288.
ABSTRACT
| FULL TEXT
ALCOHOL-ATTRIBUTABLE MORTALITY IN A HIGH PER CAPITA CONSUMPTION COUNTRY -- GERMANY
John and Hanke
Alcohol Alcohol 2002;37:581-585.
ABSTRACT
| FULL TEXT
Tobacco Use Outcomes Among Patients With Lung Cancer Treated for Nicotine Dependence
Cox et al.
JCO 2002;20:3461-3469.
ABSTRACT
| FULL TEXT
Tobacco Use Outcomes of Adolescents Treated Clinically for Nicotine Dependence
Patten et al.
Arch Pediatr Adolesc Med 2001;155:831-837.
ABSTRACT
| FULL TEXT
Towards a molecular epidemiology of alcohol dependence: analysing the interplay of genetic and environmental risk factors
HEATH et al.
Br. J. Psychiatry 2001;178
:s33-s40.
ABSTRACT
| FULL TEXT
Cigarette Smoking
Bergen and Caporaso
JNCI J Natl Cancer Inst 1999;91:1365-1375.
ABSTRACT
| FULL TEXT
Common Genetic Vulnerability for Nicotine and Alcohol Dependence in Men
True et al.
Arch Gen Psychiatry 1999;56:655-661.
ABSTRACT
| FULL TEXT
Patients with Alcohol Problems
O'Connor and Schottenfeld
NEJM 1998;338:592-602.
FULL TEXT
Smoking and Suicidality Among Psychiatric Patients
Tanskanen et al.
Am. J. Psychiatry 1998;155:129-130.
ABSTRACT
| FULL TEXT
