Efficacy of smoking cessation strategies in a treatment program.

Efficacy of a total smoking ban on an inpatient drug and alcohol rehab program was assessed by urine cotinine levels and indicated a continued smoking rate of 70%. In spite of these results, however, some staff were concerned that removal of the smoking ban would lead to a dramatic increase in patients' smoking. However, other staff were concerned over the apparent dishonesty undermining the objectives of the program. Therefore, a change in policy was initiated. Under this new approach, where smoking was no longer punished, cotinine levels were 60% positive. Although this was not a statistically significant reduction, it was clinically significant. Patients were openly encouraged to discuss their smoking, and therapies were designed to match patients' level of motivation. A significant reduction in number of cigarettes smoked (mean = 26 pretreatment, mean = 17 posttreatment; p < 0.01), increased interest to stop smoking (on a linear scale from 1 to 5, mean = 1.86 pretreatment and mean = 2.61 posttreatment; p < 0.01), and increased patient satisfaction was noted in a subsequent sample. Nonprohibitive counseling approaches were just as effective as prohibition of smoking. Change in smoking behavior and motivation were demonstrable with programming that emphasized behavior change and motivational counseling. Relationships between nicotine dependence, depression and other substance use disorders are discussed.