Miss Erin Forbes

Background: Mental health service users are more likely to smoke tobacco and are as likely to make quit attempts as people not experiencing SMI, but they are less likely to succeed. Quitting tobacco can be harder for people experiencing SMI due to higher levels of nicotine dependence, more severe withdrawal, and many other complex factors. The Quitlink study was a randomized controlled trial combining a tailored 8-week Quitline intervention delivered by dedicated Quitline counsellors plus combination nicotine replacement therapy for people who experience SMI. The purpose of this paper is to report on the medium- and longer-term findings from interviews conducted at 5 and 8 months. Methods: As a part of the broader Quitlink study, participants were invited to qualitative interviews at 2, 5 and 8 months following recruitment, in line with quantitative follow-up time points. Interviews were conducted with 28 participants in the Quitlink trial (intervention group n = 12, control group n = 16). Interviews were transcribed and analyzed with a thematic analysis methodology using NVivo 12. Key themes were determined using inductive coding. Results: Six key themes were identified. These included: internal/external attributions for tobacco smoking, social relationships and relapse, the role of hopefulness in quitting, the role of clinicians in initiating and maintaining a quit attempt, increasing cessation literacy, and efficacy of the study intervention. Overall, findings suggested that participants' quit attempts were often precarious and vulnerable, but active support and feelings of social connectedness were key to supporting participants to initiate a quit attempt and maintain gains. Conclusions: People who experience SMI can make attempts to quit smoking tobacco with support from clinicians and social networks. Connectedness and hope are significant enablers of making and sustaining quit attempts. Trial registration: The Quitlink trial was registered with ANZCTR (www.anzctr.org.au): ACTRN12619000244101 prior to the accrual of the first participant and updated regularly as per registry guidelines.

Objectives: This review aimed to identify free, high-quality, smoking cessation mobile applications (apps) that adhere to Australian smoking cessation treatment guidelines. Methods: A systematic search of smoking cessation apps was conducted using Google. The technical quality of relevant apps was rated using the Mobile Application Rating Scale. The content of apps identified as high quality was assessed for adherence to smoking cessation treatment guidelines. Results: 112 relevant apps were identified. The majority were of poor technical quality and only six 'high-quality' apps were identified. These apps adhered to Australian treatment guidelines in part. The efficacy of two apps had been previously evaluated. Conclusions: In lieu of more substantial research in this area, it is suggested that the high-quality apps identified in this review may be more likely than other available apps to encourage smoking cessation. Implications for public health: Smoking cessation apps have the potential to address many barriers that prevent smoking cessation support being provided; however few high-quality smoking cessation apps are currently available in Australia, very few have been evaluated and the app market is extremely volatile. More research to evaluate smoking cessation apps, and sustained funding for evidence-based apps, is needed.

Clinical guidelines recommend Self-Management and Recovery Training (SMART Recovery) and 12-step models of mutual aid as important sources of long-term support for addiction recovery. Methodologically rigorous reviews of the efficacy and potential mechanisms of change are available for the predominant 12-step approach. A similarly rigorous exploration of SMART Recovery has yet to be undertaken. We aim to address this gap by providing a systematic overview of the evidence for SMART Recovery in adults with problematic alcohol, substance, and/or behavioral addiction, including (i) a commentary on outcomes assessed, process variables, feasibility, current understanding of mental health outcomes, and (ii) a critical evaluation of the methodology. We searched six electronic peer-reviewed and four gray literature databases for English-language SMART Recovery literature. Articles were classified, assessed against standardized criteria, and checked by an independent assessor. Twelve studies (including three evaluations of effectiveness) were identified. Alcohol-related outcomes were the primary focus. Standardized assessment of nonalcohol substance use was infrequent. Information about behavioral addiction was restricted to limited prevalence data. Functional outcomes were rarely reported. Feasibility was largely indexed by attendance. Economic analysis has not been undertaken. Little is known about the variables that may influence treatment outcome, but attendance represents a potential candidate. Assessment and reporting of mental health status was poor. Although positive effects were found, the modest sample and diversity of methods prevent us from making conclusive remarks about efficacy. Further research is needed to understand the clinical and public health utility of SMART as a viable recovery support option.