Tabakentwöhnung bei stationären Patienten mit einer Alkohol- abhängigkeit – Motivationsfaktoren und Erfolgsaussichten
Abstract
Einleitung: Die Raucherprävalenz ist bei alkoholkranken Personen überdurchschnittlich hoch. Die gesundheitliche Bedeutung der Tabakabstinenz, aber auch potentielle synergistische Effekte auf die Alkoholabstinenz legen nahe, während einer stationären Alkoholbehandlung auch eine Tabakentwöhnung anzubieten. Ziel: Untersucht wurden die Aufhörbereitschaft und der Abstinenzerfolg nach einer Raucherentwöhnung während einer sechswöchigen stationären Alkoholismustherapie bei alkoholkranken Personen mit zusätzlicher psychiatrischer Komorbidität. Methodik: 90 von 94 Personen eines Behandlungsjahrgangs nahmen an der Untersuchung teil. Sie durchliefen eine Psychoedukation zur Tabakabhängigkeit und hatten nachfolgend die Gelegenheit, eine Raucherentwöhnungsgruppe zu besuchen. Erfasst wurden soziodemographische Daten, Motivation sowie die Abstinenzquoten von Tabak und Alkohol am Ende und drei Monate nach der Therapie. Ergebnisse: Wichtige Motivationsgründe für eine Tabakabstinenz sind die Vorteile des Nichtrauchens. 40 % (n = 28) der rauchenden Patienten (n = 69) ließen sich zu einer Tabakentwöhnung motivieren, 25 % (n = 7) schlossen die Behandlung abstinent ab. Auch wenn keiner der Patienten über drei Monate tabakabstinent blieb, so war doch der Anteil alkoholrückfälliger Patienten in der Raucherentwöhnungsgruppe niedriger (21,4 %; n = 6/28) als bei den übrigen Patienten (29,3 %; n = 12/41)). Diskussion: Die Tabakentwöhnung im Rahmen einer stationären Alkoholismusbehandlung scheint nicht von Nachteil für die Patienten zu sein. Bei der Einführung eines Therapieangebotes sollten motivationale Faktoren, Bewältigungsfertigkeiten für rückfallgefährliche Situationen sowie Begleitsymptome komorbider Störungen stärker im Vordergrund stehen als bei anderen Rauchern.
Introduction: Smoking rates in alcohol dependent inpatients triple smoking prevalence in general population. Smoking related health consequences as well as therapy related synergistic effects support the idea of an inpatient smoking cessation therapy during alcoholism treatment. Methods: Inpatients admitted for alcoholism therapy during one year (n = 94) received information concerning tobacco dependence and had the opportunity to participate in a smoking cessation therapy (behavioural support in combination with medical management of withdrawal symptoms). N = 90 participated in this study. Sociodemographic data, motivational aspects and alcohol and tobacco related abstinence rates were collected at the end of the therapy and after three months. Results: 40 % (n = 28) of smoking inpatients (n = 69) could be motivated to undergo the smoking cessation therapy, 25 % (n = 7) became abstinent. Smoking cessation was motivated by positive aspects of non-smoking. Although all had relapsed within three months alcohol relapse rates were lower in patients participating in the smoking cessation group (21.4 % (n = 6/28) and 29.3 % (n = 12/41)). Discussion: Smoking cessation within an inpatient alcoholism treatment seems to be beneficial for alcohol related abstinence rates. Further efforts should focus on motivational factors and problem solving skills and address psychiatric co-morbidity in order to increase long-term smoking cessation results.
Literatur
1987). Social learning theory. In , Psychological Theories of Drinking and Alcoholism (S. 131 – 178). New York: Guilford Press.
(2009). Patient predictors of alcohol treatment outcome: A systematic review. Journal of Substance Abuse Treatment, 36, 75 – 86.
(2006). Treating smoking dependence in depressed alcoholics. Alcohol Research & Health, 29, 213 – 220.
(2003). Perceived barriers to quitting smoking among alcohol dependent patients in treatment. Journal of Substance Abuse Treatment, 24, 169 – 174.
(1992). AUDIT. The Alcohol Use Disorders Identification Test. Guidelines for Use in Primary Health Care. Geneva, Switzerland: World Health Organization.
(2001). A meta-analysis of alcohol drinking and cancer risk. British Journal of Cancer, 85, 1700 – 1705.
(2000). Tabakabhängigkeit und Raucherentwöhnung bei psychiatrischen Patienten. Fortschritte der Neurologie Psychiatrie, 68, 80 – 92.
(2001). Beziehung von Alkoholismus, Drogen- und Tabakkonsum. Deutsches ärzteblatt, 98, 2590 – 2593.
(2004). Tabakabhängigkeit – Ein Leitfaden für Therapeuten. Kohlhammer: Stuttgart.
(2008). Multidimensional smoker profiles and their prediction of smoking following a pharmacobehavioral intervention. Journal of Substance Abuse Treatment, 35, 41 – 52.
(2010). A cluster-randomised trial of smoking cessation tailored to multidimensional smoker profiles. Journal of Substance Abuse Treatment, 38, 128 – 140.
(2006). Tabakabhängigkeit. In , Evidenzbasierte Suchtmedizin. Behandlungsleitlinie substanzbezogene Störungen (S. 91 – 142). Köln: Deutscher ärzte-Verlag.
(2000). Sociocultural influences on smoking and drinking. Alcohol Research & Health, 24, 225 – 232.
(1991). Smoking cessation for substance abuse inpatients. Journal of Substance Abuse, 3, 269 – 276.
(2008). Anxiety and substance use: layers of complexity. Expert Review of Neurotherapeutics, 8, 493 – 501.
(1988). Tolerance and cross tolerance between ethanol and nicotine. Pharmacology Biochemistry and Behavior, 29, 365 – 373.
(2001). The relationship between tobacco use, substance-use disorders and metal health: results from the National Survey of Mental Health and Well-Being. Nicotine & Tobacco Research, 3, 225 – 234.
(2006). A tailored smoking, alcohol, and depression intervention for head and neck cancer patients. Cancer Epidemiology Biomarkers & Prevention, 15, 2203 – 2208.
(2006). An epidemiologic analysis of co-occurring alcohol and tobacco use and disorders. Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Research & Health, 29, 162 – 171.
(2008). Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville, MD: U. S. Department of Health and Human Services, Public Health Service.
(2004). Nicotine dependence and psychiatric disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 61, 1107 – 1115.
(2006). Smoking cessation and alcohol abstinence: what do the data tell us? Alcohol Research & Health, 29, 208 – 212.
(1994). Das Beck-Depressions-Inventar (BDI). Bern: Huber.
(1995). The addictive role of nicotine in tobacco use. Psychopharmacology (Berl.), 117, 11 – 13.
(2007). Long-term behavior in treated alcoholism: Evidence for beneficial carry-over effects of abstinence from smoking on alcohol use and vice versa. Addictive Behaviors, 32, 3093 – 3100.
(2003). Past alcohol problems do not predict worse smoking cessation outcomes. Drug & Alcohol Dependence, 71, 269 – 273.
(2003) Efficacy of nicotine patch in smokers with a history of alcoholism. Alcoholism: Clinical & Experimental Research, 27, 946 – 954.
(1996). Mortality following inpatient addictions treatment. Role of tobacco use in a community-based cohort. Journal of the American Medical Association, 275, 1097 – 1103.
(2003). Probabilities of alcohol high-risk drinking, abuse or dependence estimated on grounds of tobacco smoking and nicotine dependence, Addiction, 98, 805 – 814.
(2004). A randomized trial of concurrent versus delayed smoking intervention for patients in alcohol dependence treatment. Journal of Studies on Alcohol, 65, 681 – 691.
(2001). Concurrent versus delayed smoking cessation treatment for persons in early alcohol recovery: A pilot study. Journal of Substance Abuse Treatment, 20, 233 – 238.
(2006) The relationship between nonstandard working and mental health in a representative sample of the South Korean population. Social Sciences & Medicine, 63, 566 – 574.
(2006). Tobacco cessation treatment for alcohol-dependent smokers: When Is the best time? Alcohol Research & Health, 29, 203 – 207.
(2001). Repräsentativerhebung zum Gebrauch psychoaktiver Substanzen bei Erwachsenen in Deutschland 2000. SUCHT, 47 (Sonderheft 1), 3 – 86.
(2005). Alcohol consumption and risk of laryngeal cancer. Oral Oncology, 41, 956 – 965.
(2006). Cancer risk associated with alcohol and tobacco use: focus on upper aero-digestive tract and liver. Alcohol Research & Health, 29, 193 – 198.
(1993): Die gemeindenahe Versorgung von Alkoholabhängigen. Psychiatrische Praxis, 20, 102 – 105.
(1997). Nicotine dependence and withdrawal in alcoholic and nonalcoholic ever- smokers. Journal of Substance Abuse Treatment, 14, 521 – 527.
(2003). Understanding the potential of teachable moments: the case of smoking cessation. Health Education Research, 18, 156 – 170.
(2002). To smoke or not to smoke: impact on disability, quality of life and illicit drug use in baseline polydrug users, Journal of Addictive Diseases, 21, 35 – 54.
(2001). A review of temporal effects and outcome predictors in substance abuse treatment studies with long-term follow-ups. Preliminary results and methodological issues. Evaluation Review, 25, 113 – 161.
(1983). Addictive behaviors and life problems before and after behavioral treatment of problem drinkers. Addictive Behaviors, 8, 403 – 412.
(2006). Cigarette smoking among adolescents with alcohol and other drug use problems. Alcohol Research & Health, 29, 221 – 227.
(1988). Separate and combined effects of smoking and alcohol abuse in middle-aged men. Acta Medica Scandinavica, 223, 111 – 118.
(2007). Cigarette smoking and long-term alcohol and drug treatment outcomes: a telephone follow-up at five years, American Journal of Addiction, 16, 32 – 37.
(2003). Smoking cessation treatment among dually diagnosed individuals: preliminary evaluation of different pharmacotherapies. Nicotine & Tobacco Research, 5, 589 – 596.
(2002). Deutsche Version des „Fagerström-Test for Nicotine Dependence (FTND) – (FTND-d)“. In A. Glöckner-Rist, F. Rist & H. Küfner (Hrsg.), Elektronisches Handbuch zu Erhebungsinstrumenten im Suchtbereich (EHES) Version 2.0. Mannheim: Zentrum für Umfragen, Methoden und Analysen. Zugriff am 30. 08. 2011. Verfügbar unter: www.psy.uni-muenster.de/institut1/ehes/startseite.htm
(2006). Leben in Deutschland. Haushalte, Familien und Gesundheit – Ergebnisse des Mikrozensus 2005. Wiesbaden: Statistisches Bundesamt.
(2004). Motivational interviewing with personalized feedback: A brief intervention for motivating smokers with schizophrenia to seek treatment for tobacco dependence. Journal of Consulting and Clinical Psychology, 72, 723 – 728.
(2005). Smoking cessation interventions in Australian drug treatment agencies: a national survey of attitudes and practices. Drug and Alcohol Review, 24, 235 – 244.
(2005). The integration of tobacco dependence treatment into residential addictions treatment in New Jersey. Journal of Substance Abuse Treatment, 28, 331 – 340.
(2006). Barriers and solutions to addressing tobacco dependence in addiction treatment programs. Alcohol Research & Health, 29, 228 – 235.
(2003). Acceptance of an intended smoking ban in an alcohol dependence clinic, European Psychiatry, 18, 255 – 257.
(