Relations between motivation to quit smoking cigarettes and treatment outcomes among young US Veterans with posttraumatic stress disorder

Abstract: Tobacco use is a key health concern and preventable cause of death. Although cigarette use has declined among many, rates remain high among people with posttraumatic stress disorder (PTSD), especially US military veterans. Motivation, an internal force that drives individuals to act, is a major feature of cigarette use and smoking cessation. Motivation to quit smoking generally predicts cessation success, yet veterans quit less despite high motivation to do so. This may be due to limited treatment efficacy or adherence, or may relate to PTSD symptoms.The primary aim of this research is to examine how motivation to quit cigarettes and co-occurring PTSD symptoms relate to treatment outcomes among US veterans. Using longitudinal data (n = 64) from a randomized, controlled smoking cessation trial for veterans with PTSD (18-45 years old, 82.8% male, 66.7% white), we examined the relationship between motivation to quit and treatment efficacy. This includes 12-week net changes in self-reported cigarette use, severity of nicotine dependence, and PTSD symptoms. We hypothesized that motivation would positively correlate with treatment efficacy, a connection enhanced by treatment adherence and buffered by baseline PTSD symptoms. We also aimed to explore how another co-occurring diagnosis, depression, may impact these relationships. Motivation to quit cigarettes was significantly and negatively correlated with self-reported use (r = .52, p < .001) and dependence (r = .39, p = .04) and fell shy of significant associations with net changes in PTSD severity (r = .38, p = .051). Treatment adherence trended towards moderating motivation to quit and changes in PTSD symptoms (b = -.33, p =.057). Exploratory analyses further suggest that motivation to quit also negatively correlated with treatment adherence, specifically use of select cessation pharmacotherapy (r = .38, p = .003). Additionally, baseline PTSD severity moderated motivation to quit to enhance pharmacotherapy adherence, with the greatest adherence among those with low symptoms and low motivation, as well as among those with high symptoms and high motivation (b = .44, p = .02). Co-occurring depression symptoms did not significantly moderate motivation to quit and treatment outcomes, but trended towards doing so (b = .40, p =.058).These results suggest that US veterans with PTSD are motivated to stop smoking cigarettes. As motivation increased they reported less cigarette use and dependence. More motivated individuals also opted to receive less pharmacotherapy, except when PTSD symptoms were high. This may be due to higher levels of clinical need or compliance, distress or anxiety exacerbated by nicotine withdrawal, or medication’s impact on motivation. When treating these co-occurring conditions, PTSD symptom severity and medication adherence are important to consider alongside motivation to stop smoking cigarettes.