Ergebnisse einer stationären Rauchentwöhnung bei Suchtpatienten im Rahmen einer 3-wöchigen, qualifizierten Entzugsbehandlung

Zusammenfassung

Ziel:

Überprüft wurde der Effekt eines Rauchentwöhnungsprogramms während einer 3-wöchigen, stationären, qualifizierten Entzugsbehandlung. Dabei standen sowohl die Teilnahmebereitschaft, die Tabakkonsumreduktion bzw. die Tabakabstinenz und der Einfluss auf die Abstinenz von der komorbiden Abhängigkeit im Mittelpunkt der Untersuchung.

Methodik:

153 Suchtpatienten mit komorbider Tabakabhängigkeit wurden eingeschlossen. 88 Probanden nahmen an einem Rauchentwöhnungsprogramm mit kognitiv-behavioraler Gruppentherapie und Rauchentwöhnungsmitteln teil. 31 tabakabhängige Suchtpatienten ohne Rauchabstinenzmotivation bildeten die Vergleichsgruppe. 83% aller Probanden wiesen eine Alkoholabhängigkeit auf.

Ergebnisse:

32,5% aller aufgenommenen tabakabhängigen Patienten nahmen an der Rauchentwöhnung teil. Probanden in der Rauchentwöhnungsgruppe konnten ihren durchschnittlichen Tabakkonsum signifikant zum Entlasszeitpunkt und beim Follow-up nach 3 Monaten reduzieren. 26% bzw. 16% der Probanden erreichten eine Tabakabstinenz zu den beiden Messzeitpunkten. Probanden der Therapie- und Vergleichsgruppe zeigten beim Follow-up identische Abstinenzquoten von der Abhängigkeit, die zur stationären Aufnahme geführt hatte (42,5% und 42,9%). Die Tabakabstinenz war dabei signifikant mit der Substanzabstinenz assoziiert.

Schlussfolgerung:

Die Daten sprechen für eine hohe Bereitschaft zur Teilnahme an einer freiwilligen Rauchentwöhnungsbehandlung, welche erfolgreich im Rahmen einer qualifizierten Entzugstherapie angeboten werden kann, ohne dass hierdurch die Abstinenz von der komorbiden Abhängigkeit gefährdet wird.

Abstract

Objective:

We evaluated an inpatient smoking cessation intervention during a 3-week addiction treatment program. Willingness to participate, tobacco consumption and rates of tobacco abstinence as well as the influence of the concurrent tobacco treatment on the abstinence from the comorbid addiction were assessed.

Methods:

153 smokers were enrolled in this study. 88 patients participated in a smoking cessation program, consisting of a cognitive behavioral group therapy and smoking cessation products. The comparison group comprised nicotine-dependent patients not interested in smoking cessation. 83% of all recruited patients were alcohol dependent.

Results:

Of all admitted smokers, 32.5% could be motivated to enroll in the concurrent smoking cessation program. Participants in the treatment group were able to significantly decrease their average cigarette consumption at discharge and at follow-up, respectively. 26% and 16% of the patients in the treatment group achieved abstinence at discharge and follow-up, respectively. After 3 months, 42.5% and 42.9% of all dependent patients in the treatment and comparison group remained abstinent from the addiction that had led to hospitalization. Tobacco abstinence was significantly associated with abstinence from their comorbid addiction.

Conclusion:

Nicotine-dependent patients could be successfully motivated to participate in a smoking cessation program. Patients achieved significant reductions in daily cigarette consumption and a considerable proportion achieved prolonged tobacco abstinence. The concurrent smoking intervention was not associated with increased substance relapse at follow-up.

Schlüsselwörter

Rauchentwöhnung - Tabak - Nikotin - qualifizierte Entzugsbehandlung - Alkohol

Key words

smoking cessation - tobacco - nicotine - qualified detoxification - alcohol

• Literatur

• 1 Batra A. Tabakabhängigkeit und Raucherentwöhnung bei psychiatrischen Patienten. Fortschritte der Neurologie. Psychiatrie 2000; 68: 80-92
• 2 Batel P, Pessione F, Maitre C. et al. Relationship between alcohol and tobacco dependencies among alcoholics who smoke. Addiction 1995; 90: 977-980
• 3 Ezzati M, Lopez AD, Rodgers A. et al. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360: 1347-1360
• 4 Rehm J, Taylor B, Room R. Global burden of disease from alcohol, illicit drugs and tobacco. Drug and alcohol review 2006; 25: 503-513
• 5 Castellsague X, Munoz N, De Stefani E. et al. Independent and joint effects of tobacco smoking and alcohol drinking on the risk of esophageal cancer in men and women. International journal of cancer Journal international du cancer 1999; 82: 657-664
• 6 Hinds MW, Thomas DB, O'Reilly HP. Asbestos, dental X-rays, tobacco, and alcohol in the epidemiology of laryngeal cancer. Cancer 1979; 44: 1114-1120
• 7 Hurt RD, Offord KP, Croghan IT. et al. Mortality following inpatient addictions treatment. Role of tobacco use in a community-based cohort. J AM Med Ass 1996; 275: 1097-1103
• 8 Pelucchi C, Gallus S, Garavello W. et al. Cancer risk associated with alcohol and tobacco use: focus on upper aero-digestive tract and liver. Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 2006; 29: 193-198
• 9 Gulliver SB, Kamholz BW, Helstrom AW. Smoking cessation and alcohol abstinence: what do the data tell us?. Alcohol research & health: the journal of the National Institute on Alcohol Abuse and Alcoholism 2006; 29: 208-212
• 10 Fiore MC, Jaen CR, Baker TB. et al. Treating tobacco use and dependence: 2008 update US Public Health Service Clinical Practice Guideline executive summary. Respiratory care 2008; 53: 1217-1222
• 11 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen (Stand: 28.02. 2016)“. 2015;
• 12 Dilling H, Mombour W, Schmidt MH. ICD-10 Internationale Klassifikation psychischer Störungen. In. Bern, Göttingen, Toronto, Seattle: Verlag Hans Huber; 2005
• 13 Batra A, Buchkremer G. Nichtrauchen!: Erfolgreich aussteigen in sechs Schritten. Verlag: W. Kohlhammer; 2011
• 14 Heffner JL, Barrett SW, Anthenelli RM. Predicting alcohol misusers' readiness and ability to quit smoking: a critical review. Alcohol and alcoholism 2007; 42: 186-195
• 15 Vaillant GE, Brighton JR, McArthur C. Physicians' use of mood-altering drugs. A 20-year follow-up report. The New England journal of medicine 1970; 282: 365-370
• 16 Hellman R, Cummings KM, Haughey BP. et al. Predictors of attempting and succeeding at smoking cessation. Health education research 1991; 6: 77-86
• 17 Vangeli E, Stapleton J, Smit ES. et al. Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review. Addiction 2011; 106: 2110-2121
• 18 Khuder SA, Dayal HH, Mutgi AB. Age at smoking onset and its effect on smoking cessation. Addictive behaviors 1999; 24: 673-677
• 19 Abdolahinia A, Sadr M, Hessami Z. Correlation between the age of smoking initiation and maintaining continuous abstinence for 5 years after quitting. Acta medica Iranica 2012; 50: 755-759
• 20 Weinberger AH, Platt J, Jiang B. et al. Cigarette smoking and risk of alcohol use relapse among adults in recovery from alcohol use disorders. Alcoholism, clinical and experimental research 2015; 39: 1989-1996
• 21 Batra A, Niethammer S, Mänz C. et al. Tabakentwöhnung bei stationären Patienten mit einer Alkoholabhängigkeit – Motivationsfaktoren und Erfolgsaussichten. SUCHT-Zeitschrift für Wissenschaft und Praxis/Journal of Addiction Research and Practice 2011; 57: 337-346
• 22 Mueller S, Petitjean S, Wiesbeck G. Cognitive behavioral smoking cessation during alcohol detoxification treatment: a randomized, controlled trial. Drug and alcohol dependence 2012; 126: 279-285
• 23 Olbrich R, Trager S, Nikitopoulos J. et al. Rauchreduktion bei Alkoholkranken im Rahmen einer stationären Alkohol-Entzugsbehandlung: Eine kontrollierte klinische Pilotstudie. Fortschritte der Neurologie-Psychiatrie 2008; 76: 272-277
• 24 Hughes JR, Kalman D. Do smokers with alcohol problems have more difficulty quitting?. Drug and alcohol dependence 2006; 82: 91-102
• 25 Kalman D, Kim S, DiGirolamo G. et al. Addressing tobacco use disorder in smokers in early remission from alcohol dependence: the case for integrating smoking cessation services in substance use disorder treatment programs. Clinical psychology review 2010; 30: 12-24
• 26 Baca CT, Yahne CE. Smoking cessation during substance abuse treatment: what you need to know. Journal of substance abuse treatment 2009; 36: 205-219
• 27 Joseph AM, Willenbring ML, Nugent SM. et al. A randomized trial of concurrent versus delayed smoking intervention for patients in alcohol dependence treatment. Journal of studies on alcohol 2004; 65: 681-691
• 28 Berner M, Gunzler C, Frick K. et al. Finding the ideal place for a psychotherapeutic intervention in a stepped care approach – a brief overview of the literature and preliminary results from the Project PREDICT. International journal of methods in psychiatric research 2008; 17 (Suppl. 01) S60-64
• 29 Czarnecki DM, Russell M, Cooper ML. et al. Five-year reliability of self-reported alcohol consumption. Journal of studies on alcohol 1990; 51: 68-76
• 30 Cahill K, Stevens S, Perera R. et al. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. The Cochrane database of systematic reviews 2013; DOI: 10.1002/14651858.CD009329.pub2. Cd009329
• 31 Piper ME, Smith SS, Schlam TR. et al. A randomized placebo-controlled clinical trial of 5 smoking cessation pharmacotherapies. Archives of general psychiatry 2009; 66: 1253-1262
• 32 Smith SS, McCarthy DE, Japuntich SJ. et al. Comparative effectiveness of 5 smoking cessation pharmacotherapies in primary care clinics. Archives of internal medicine 2009; 169: 2148-2155
• 33 Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). S3-Leitlinie „Screening, Diagnostik und Behandlung des schädlichen und abhängigen Tabakkonsums (Stand: 09.02. 2015)“. 2015;
• 34 Rüther T, Eberhardt K, Kiss A. et al. Reduziertes Rauchen: Was können Interventionen erreichen und wie sollten sie gestaltet sein?. Suchttherapie 2014; 15: 179-186
• 35 Stead LF, Lancaster T. Interventions to reduce harm from continued tobacco use. The Cochrane database of systematic reviews 2007; DOI: 10.1002/14651858.CD005231.pub2:. CD005231
• 36 Bjartveit K, Tverdal A. Health consequences of smoking 1–4 cigarettes per day. Tobacco control 2005; 14: 315-320
• 37 Lee PN. The effect of reducing the number of cigarettes smoked on risk of lung cancer, COPD, cardiovascular disease and FEV(1) – a review. Regulatory toxicology and pharmacology: RTP 2013; 67: 372-381
• 38 Polosa R, Morjaria J, Caponnetto P. et al. Effect of smoking abstinence and reduction in asthmatic smokers switching to electronic cigarettes: evidence for harm reversal. International journal of environmental research and public health 2014; 11: 4965-4977
• 39 Hughes JR, Carpenter MJ. Does smoking reduction increase future cessation and decrease disease risk? A qualitative review. Nicotine & tobacco research: official journal of the Society for Research on Nicotine and Tobacco 2006; 8: 739-749
• 40 Prochaska JJ, Delucchi K, Hall SM. A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. Journal of consulting and clinical psychology 2004; 72: 1144-1156
• 41 Kalman D, Hayes K, Colby SM. et al. Concurrent versus delayed smoking cessation treatment for persons in early alcohol recovery. A pilot study. Journal of substance abuse treatment 2001; 20: 233-238
• 42 Nieva G, Ortega LL, Mondon S. et al. Simultaneous versus delayed treatment of tobacco dependence in alcohol-dependent outpatients. European addiction research 2011; 17: 1-9