Trudeau D L, Isenhart C, Silversmith D
Department of Psychiatry, Minneapolis V.A. Medical Center, MN 55417, USA.
J Addict Dis. 1995;14(1):109-16. doi: 10.1300/J069v14n01_10.
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.
通过尿液可替宁水平评估了全面禁烟对住院戒毒和戒酒康复项目的效果，结果显示持续吸烟率为70%。然而，尽管有这些结果，一些工作人员担心取消禁烟会导致患者吸烟量大幅增加。然而，其他工作人员则担心明显的不诚实行为会破坏该项目的目标。因此，启动了一项政策变革。在这种新方法下，吸烟不再受到惩罚，可替宁水平呈阳性的比例为60%。虽然这在统计学上没有显著降低，但在临床上具有重要意义。公开鼓励患者讨论他们的吸烟情况，并设计了与患者动机水平相匹配的治疗方法。在随后的样本中，观察到吸烟数量显著减少（治疗前平均为26支，治疗后平均为17支；p<0.01），戒烟兴趣增加（在1至5的线性量表上，治疗前平均为1.86，治疗后平均为2.61；p<0.01），患者满意度提高。非禁止性的咨询方法与禁止吸烟同样有效。通过强调行为改变和动机咨询的项目，可以证明吸烟行为和动机的改变。文中还讨论了尼古丁依赖、抑郁症和其他物质使用障碍之间的关系。
