Violence and nicotine replacement therapy in a high dependency mental health unit.

Introduction: Nicotine withdrawal is associated with aggression on mental health wards. This study examined whether the introduction of an inhaled form of Nicotine Replacement Therapy (NRT) improved acceptability and reduced observed aggression on a high dependency mental health unit (HDU), at a tertiary level metropolitan hospital.

Method: This retrospective cohort study included tobacco smokers admitted to the HDU over two consecutive years, following a smoking ban at the hospital. Transdermal patch and gum forms of NRT were available in the first year, with an inhaled form introduced the following year. Aggression was quantified using the Brøset violence checklist. Statistical analysis included the chi-squared test of independence and student's t-test.

Results: Of the 89 people admitted, 85% smoked tobacco. Of these, 71% had a history of violence and 33% had been incarcerated for this. NRT use increased from 26% to 33% in the second year. Use of NRT was associated with a significant reduction in aggression across the study period, and the overall aggression was lower in the second year.

Conclusion: Greater choice of NRT agents can lead to improved use and acceptance, associated with reduced inpatient aggression. Acceptance, dosing and administration of NRT can all be improved by assertive policy.