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.

中文翻译：

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具有复杂社会心理挑战的孕妇对烟草依赖的强化行为和药物治疗：一例报告。

多达95％的使用其他物质的妇女在怀孕期间也吸烟。具有挑战性的社会心理环境和其他导致高度依赖烟草的障碍导致很少成功戒烟。该病例报告描述了对高度依赖烟草的34岁孕妇的治疗方法，该孕妇具有近期吸毒，精神疾病和外伤史，并参加了“戒烟激励计划”。据报道白天和晚上都大量吸烟。还指出了广泛的戒烟尝试历史，以及强烈希望在怀孕期间停止吸烟。利用广泛的行为支持进行治疗，其中包括对经证实的一氧化碳禁欲的经济刺激和基于电话的咨询，以及尼古丁替代疗法（NRT），提供协助戒烟。在该计划中，出色的吸收和对治疗各个方面的坚持性使戒烟得以实现并维持了24周。为了减轻强烈的戒断症状并保持禁欲，需要使用远高于建议的妊娠剂量的NRT。每天监测一氧化碳，持续戒酒的经济激励措施以及定期的电话支持对于保持动力和防止吸烟复发至关重要。程序后吸烟复发确实发生了，这很普遍，这突显了需要为行为和社会问题复杂的孕妇提供长期的大力支持。鉴于在此类人群中吸烟流行，