Das Smita, Hickman Norval J, Prochaska Judith J
Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford (SD); Social and Behavioral Sciences, Tobacco-Related Disease Research Program, University of California, Office of the President, Oakland (NJH); Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA (JJP).
J Addict Med. 2017 Jul/Aug;11(4):273-279. doi: 10.1097/ADM.0000000000000320.
Tobacco use is undertreated in individuals with psychiatric and substance use disorders (SUDs), with concerns that quitting smoking may compromise recovery. We evaluated outcomes of a tobacco intervention among psychiatric patients with co-occurring SUDs.
Data from 2 randomized tobacco treatment trials conducted in inpatient psychiatry were combined; analyses focused on the subsample with co-occurring SUDs (n = 216). Usual care provided brief advice to quit and nicotine replacement therapy during the smoke-free hospitalization. The intervention, initiated during hospitalization and continued 6 months after hospitalization, was tailored to readiness to quit smoking, and added a computer-assisted intervention at baseline, and 3 and 6 months; brief counseling; and 10 weeks of nicotine replacement therapy after hospitalization. Outcomes were 7-day point prevalence abstinence from 3 to 12 months and past 30-day reports of alcohol and illicit drug use.
The sample consisted of 34% women, among which 36% were Caucasian, averaging 19 cigarettes/d prehospitalization; the groups were comparable at baseline. At 12 months, 22% of the intervention versus 11% of usual care participants were tobacco-abstinent (risk ratio 2.01, P = 0.03). Past 30-day abstinence from alcohol/drugs did not differ by group (22%); however, successful quitters were less likely than continued smokers to report past 30-day cannabis (18% vs 42%) and alcohol (22% vs 58%) use (P < 0.05), with no difference in other drug use.
Tobacco treatment in psychiatric patients with co-occurring SUDs was effective and did not adversely impact recovery. Quitting smoking was associated with abstinence from alcohol and cannabis at follow-up. The findings support addressing tobacco in conjunction with alcohol and other drugs in psychiatric treatment.
在患有精神疾病和物质使用障碍（SUDs）的个体中，烟草使用的治疗不足，人们担心戒烟可能会影响康复。我们评估了同时患有SUDs的精神科患者烟草干预的效果。
将在住院精神科进行的2项随机烟草治疗试验的数据合并；分析集中在同时患有SUDs的子样本（n = 216）。常规护理在无烟住院期间提供简短的戒烟建议和尼古丁替代疗法。干预措施在住院期间开始，并在住院后持续6个月，根据戒烟意愿进行调整，在基线、3个月和6个月时增加计算机辅助干预；简短咨询；以及住院后10周的尼古丁替代疗法。结果指标为3至12个月的7天点患病率戒烟率以及过去30天的酒精和非法药物使用报告。
样本中34%为女性，其中36%为白种人，住院前平均每天吸19支香烟；两组在基线时具有可比性。在12个月时，干预组中有22%的人戒烟，而常规护理组中这一比例为11%（风险比2.01，P = 0.03）。两组在过去30天的酒精/药物戒断率方面没有差异（22%）；然而，成功戒烟者比继续吸烟者报告过去30天使用大麻（18%对42%）和酒精（22%对58%）的可能性更小（P < 0.05），在其他药物使用方面没有差异。
同时患有SUDs的精神科患者的烟草治疗是有效的，且不会对康复产生不利影响。随访时戒烟与戒酒和大麻有关。这些发现支持在精神科治疗中同时解决烟草、酒精和其他药物问题。
