Cooperman Nina A, Lu Shou-En, Richter Kimber P, Bernstein Steven L, Williams Jill M
a Rutgers Robert Wood Johnson Medical School , New Brunswick , New Jersey , USA.
b Rutgers School of Public Health , Piscataway , New Jersey , USA.
J Dual Diagn. 2016 Apr-Jun;12(2):118-28. doi: 10.1080/15504263.2016.1172896. Epub 2016 Apr 11.
We aimed to evaluate how psychiatric and personality disorders influence smoking cessation goals and attempts among people with opiate dependence who smoke. This information could aid the development of more effective cessation interventions for these individuals.
Participants (N = 116) were recruited from two methadone clinics, completed the Millon Clinical Multiaxial Inventory-III, and were asked about their smoking behavior and quitting goals. We used the Least Absolute Shrinkage and Selection Operator (LASSO) method, a technique commonly used for studies with small sample sizes and large number of predictors, to develop models predicting having a smoking cessation goal, among those currently smoking daily, and ever making a quit attempt, among those who ever smoked.
Almost all participants reported ever smoking (n = 115, 99%); 70% (n = 80) had made a serious quit attempt in the past; 89% (n = 103) reported current daily smoking; and 59% (n = 61) had a goal of quitting smoking and staying off cigarettes. Almost all (n = 112, 97%) had clinically significant characteristics of a psychiatric or personality disorder. White race, anxiety, and a negativistic personality facet (expressively resentful) were negative predictors of having a cessation goal. Overall, narcissistic personality pattern and a dependent personality facet (interpersonally submissive) were positive predictors of having a cessation goal. Somatoform disorder, overall borderline personality pattern, and a depressive personality facet (cognitively fatalistic) were negative predictors of ever making a quit attempt. Individual histrionic (gregarious self-image), antisocial (acting out mechanism), paranoid (expressively defensive), and sadistic (pernicious representations) personality disorder facets were positive predictors of ever making a quit attempt. Each model provided good discrimination for having a smoking cessation goal or not (C-statistic of .76, 95% CI [0.66, 0.85]) and ever making a quit attempt or not (C-statistic of .79, 95% CI [0.70, 0.88]).
Compared to existing treatments, smoking cessation treatments that can be tailored to address the individual needs of people with specific psychiatric disorders or personality disorder traits may better help those in opiate dependence treatment to set a cessation goal, attempt to quit, and eventually quit smoking.
我们旨在评估精神疾病和人格障碍如何影响吸烟的阿片类药物依赖者的戒烟目标和尝试。这些信息有助于为这些个体开发更有效的戒烟干预措施。
从两家美沙酮诊所招募参与者（N = 116），完成米隆临床多轴问卷第三版，并询问他们的吸烟行为和戒烟目标。我们使用最小绝对收缩和选择算子（LASSO）方法，一种常用于小样本量和大量预测变量研究的技术，来建立预测当前每日吸烟人群中具有戒烟目标以及曾经吸烟人群中曾经尝试戒烟的模型。
几乎所有参与者都报告曾经吸烟（n = 115，99%）；70%（n = 80）过去曾有过认真的戒烟尝试；89%（n = 103）报告目前每日吸烟；59%（n = 61）有戒烟并保持不吸烟的目标。几乎所有（n = 112，97%）都有精神疾病或人格障碍的临床显著特征。白人种族、焦虑和消极人格方面（表现出怨恨）是有戒烟目标的负向预测因素。总体而言，自恋人格模式和依赖人格方面（人际顺从）是有戒烟目标的正向预测因素。躯体形式障碍、总体边缘人格模式和抑郁人格方面（认知宿命论）是曾经尝试戒烟的负向预测因素。个体表演型（爱交际的自我形象）、反社会型（行为外化机制）、偏执型（表现出防御性）和虐待狂型（有害表征）人格障碍方面是曾经尝试戒烟的正向预测因素。每个模型对是否有戒烟目标（C统计量为0.76，95%置信区间[0.66，0.85]）以及是否曾经尝试戒烟（C统计量为0.79，95%置信区间[0.70，0.88]）都有良好的区分度。
与现有治疗方法相比，能够针对特定精神疾病或人格障碍特征个体的需求进行定制的戒烟治疗，可能会更好地帮助接受阿片类药物依赖治疗的患者设定戒烟目标、尝试戒烟并最终戒烟。
