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Objective: The majority of cigarette smokers have a lifetime diagnosis of substance abuse and/or mental illness, and treatment outcomes for smokers with these comorbidities are generally reported to be worse than for smokers without comorbidities. We sought to examine the effect of specific substance abuse/mental illness diagnoses compared to one another on treatment outcomes. Method: A retrospective chart review of naturalistic treatment for nicotine dependence was performed on male smokers (N = 231) who enrolled in the Greater Los Angeles Veterans Affairs Mental Health Clinic Smoking Cessation Program (Los Angeles, Calif.) over a 1.5-year period (January 2004 to June 2005). Subjects in this program, who were diagnosed with nicotine dependence on the basis of a DSM-IV-based interview and a Fagerstrom Test for Nicotine Dependence score of ≥ 3, underwent comprehensive treatment for nicotine dependence (including, but not limited to, group psychotherapy, nicotine replacement therapy, and bupropion hydrochloride). Quitting smoking was defined as a report of at least 1 week of abstinence and an exhaled carbon monoxide less than or equal to 8 parts per million at the final clinic visit. Results: Of the total group, 36.4% (84/231) quit smoking at the end of treatment. Quit rates were affected by the presence of specific diagnoses, with smokers with a history of alcohol abuse/dependence or schizophrenia/ schizoaffective disorder having poorer response rates than smokers without such diagnoses. Other substance abuse and mental illness diagnoses did not affect quit rates. Conclusion: Lower quit rates among patients with alcohol abuse/dependence or schizophrenia/ schizoaffective disorder may be due to the severity of these conditions and suggest that specialized treatment is needed for these populations of smokers. Smokers with most comorbid diagnoses are successfully treated with standard treatment methods.

BACKGROUND: Human and animal studies point to 3 dimensions of personality that change during pharmacotherapy with a selective serotonin reuptake inhibitor (SSRI). Specifically, harm avoidance has been found to decrease, social dominance has been found to increase, and hostility in social situations has been found to decrease with SSRI treatment. We sought to determine personality changes in subjects with either major depressive disorder (MDD) or obsessive-compulsive disorder (OCD) treated with paroxetine. We also sought to determine whether or not these personality changes were associated with disease state (MDD vs. OCD) or treatment response (responders vs. nonresponders). METHOD: Thirty-seven subjects diagnosed with either MDD or OCD (according to DSM-IV criteria) completed the Cattell 16 Personality Factor Inventory (16-PF) before and after treatment with paroxetine. Treatment response was defined as a Clinical Global Impressions-Improvement rating of "much" or "very much" improved and a drop in Hamilton Rating Scale for Depression score of at least 50% for MDD or Yale-Brown Obsessive Compulsive Scale score of at least 30% for OCD. RESULTS: No significant differences were found between subjects with MDD and OCD in personality change with treatment. In the whole group, treatment responders had a greater decrease than nonresponders in 16-PF factors relating to harm avoidance. An increase in social dominance factors and a decrease in factors relating to hostility in social situations were found, but these changes were not significantly different between responders and nonresponders. CONCLUSION: These findings indicate that certain personality dimensions change with SSRI treatment and that some of these changes are independent of clinical treatment response.