A Single-Case Experimental Design to Study the Combination of Cognitive-Behavioral Therapy and Pharmacotherapy for Smoking Cessation

Bupropion is an anti-depressant drug which is a category of aminoketones. It is a norepinephrine-dopamine inhibitor, which is considered as a nicotine antagonist and is effective in smoking cessation. The patient was a single 21-year-old girl and she was a student and had been referred to Bijan Addiction Treatment Clinic in Tehran with a complaint of chronic smoking. After a period of abstinence from consumption, she experienced anhedonia syndrome and recurrence of consumption. Data were collected from October to February 2016. We used a reversal (ABAB) design with multiple baselines, in which A was the baseline and B was the intervention phase. The entire course was 12 weeks, during which bupropion was presented. In the baseline A1 and A2, only bupropion was presented, and in B1 and B2 stages, in addition to bupropion, cognitive-behavioral therapy (CBT) was also presented. Cigarette Cravings Index and Heaviness of Smoking Index (HSI) were completed at 24 time points by the subjects. Data were analyzed by semi-parametric test of generalized estimation equation. Data analysis indicated that the addition of CBT to bupropion was associated with a significant reduction in the scores of HSI and Cigarette Cravings Index compared to bupropion alone (P<0.01). These findings can reflect the role of complementary psychological interventions in the treatment of addiction and suggest a promising perspective in linking biological and cognitive indices in response to the addiction challenge.