Intensive Behavioural and Pharmacological Treatment for Tobacco Dependence in Pregnant Women with Complex Psychosocial Challenges: A Case Report

Melissa A. Jackson, Amanda L. Brown, Amanda L. Baker, Adrian J. Dunlop, Angela Dunford and Gillian S. Gould
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Melissa A. Jackson: Hunter New England Health Local Health District, Newcastle, New South Wales 2300, Australia
Amanda L. Brown: Hunter New England Health Local Health District, Newcastle, New South Wales 2300, Australia
Amanda L. Baker: School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia
Adrian J. Dunlop: Hunter New England Health Local Health District, Newcastle, New South Wales 2300, Australia
Angela Dunford: John Hunter Hospital, Hunter New England Health Local Health District, New Lambton, New South Wales 2305, Australia
Gillian S. Gould: School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia

IJERPH, 2020, vol. 17, issue 13, 1-8

Abstract: Up to 95% of women who use other substances also smoke tobacco during pregnancy. Challenging psychosocial circumstances and other barriers that contribute to high levels of tobacco dependence result in few quitting successfully. This case report describes the treatment of a highly tobacco dependent 34-year-old pregnant woman with a history of recent substance use, mental illness and trauma, enrolled in the Incentives to Quit Tobacco in Pregnancy program. Heavy smoking, both during the day and overnight, was reported. An extensive history of quit attempts, as well as a strong desire to cease tobacco use during pregnancy, was also noted. Treatment utilising extensive behavioural supports, including financial incentives for carbon monoxide verified abstinence and telephone-based counselling, in combination with nicotine replacement therapy (NRT), was offered to assist cessation. Excellent uptake and adherence to all aspects of treatment saw tobacco cessation achieved and maintained for 24 weeks while on the program. NRT used at doses well above those recommended for pregnancy was required to alleviate strong withdrawal symptoms and maintain abstinence. Daily monitoring of carbon monoxide, financial incentives for continued abstinence and regular phone support were critical to maintaining motivation and preventing relapse to smoking. Post-program relapse to smoking did occur, as is common, and highlights the need for longer-term intensive support for pregnant women with complex behavioural and social problems. Given the prevalence of tobacco smoking in such populations, long-term harm reduction treatment models using extensive behavioural support in combination with NRT should be considered for inclusion in current smoking cessation guidelines.

Keywords: tobacco use; smoking cessation; pregnancy; harm reduction; contingency management; nicotine replacement therapy; counselling; substance use disorders; social disadvantage; mental illness (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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