Smoking Cessation Training in Rehabilitation Centres for Alcoholics

1
Smoking Cessation Training in Rehabilitation
Centres for Alcoholics
Comparing a Motivational (MT) and a
Cognitive-Behavioural Treatment (CBT)

• Karin Metz, Christoph Kröger, Anneke Bühler,
  Carolin Donath, Stephanie Flöter Daniela
  Piontek
• IFT Institute of Therapy Research, Munich
• EASAR 14.05.2005

2
WIRK-Project

• Funding Federal Ministry of Education and
  Research (BMBF)
• Duration Nov. 2001 Oct. 2004
• Realisation IFT Institute of Therapy Research
• Munich PI Christoph Kröger

3
Target Group

• Alcohol addicted patients in residential
  treatment
• in rehabilitation centres
• after detoxification
• duration of stay 8 weeks to 4 months

4
Background

• High prevalence rate of smokers in alcohol
  dependence treatment (80-95)

• High risk of smoking related diseases (Hurt et
  al., 1996)

• Positive effects on alcohol abstinence (Bobo,
  1989 Burling et al., 2001)

• Optimal time period (window of opportunity)

• Insurance companies demand smoking cessation

5
Aims of the Study

• Implementation or improvement of smoking
  cessation interventions in rehabilitation centres
  for patients with an alcohol addiction
• Reaching a population with a high risk for health
  problems who are resistent to change their
  smoking behaviour
• Evaluation of smoking cessation interventions
  (effectiveness)
• Matching patients to interventions (Allocation)

6
Setting of Smoking Cessation Interventions

• 1-2 staff members (medical doctors, alcohol
  therapists, psychologists) were trained to
  deliver both interventions
• Voluntary participation
• One information session
• Six group sessions once or twice a week (60-90
  minutes)
• 6 to 8 group members

7
Topics of the Sessions - CBT

• self observation of smoking behaviour (analysis
  of behaviour and situations learning self
  control strategies)
• changing smoking behaviour (reduction plan
  preparation of the stop day stop day)
• stabilisation of non smoking (relapse prevention)
  

8
Topics of the Sessions - MT

• Emotional involvment in the topic Environmental
  reactions about smoking and quitting
• Consciousness rising Quiz about objective facts
  of smoking and smoking cessation Feedback of
  personal smoking behaviour with results of FTND
• Increase ambivalence Collection of common
  reasons for and against quitting smoking
  Individualized decisional balance
• Support to change Personal obstacles of not
  quitting Realise the power of thoughts
  Cognitive restructuring of negative thoughts
  about smoking cessation Brain storming Creative
  solutions
• Preparing to changeMountain climber as metaphor
  of a smoker who is on his way of quitting

9
Design
Rehabilitation centres
Nov. 02 - April 03
May 03 - Oct. 03
CBT
MT
50 Rehabilitation centres
MT
50 Rehabilitation centres
CBT
10
Hypothesis
H1 Cognitive-behavioural treatment (CBT)
and motivational treatment (MT) have the same
overall success rates
11
Data Collection

• Questionaire pre treatment (T0)
• Questionaire post treatment (T1)
• Follow-up after 3 months (T2)
• Follow-up after 6 months (T3)
• Follow-up after 12 months (T4)
• ? Outcome variable smoking abstinence 7 day
  prevalence not smoking during the last 7 days
  self reported data

12
Sample

• 19 rehabilitation centres
• 88 smoking cessation courses
• (CBT n47MT n41)
• 663 alcoholic smokers
• (CBT n363 MT n300)
• N 29 trained staff members

13
Dropout Analysis
T0 pre-treament
N663 (100)
Dropout N 98 (15)
T1 post-treatment
N 565 (85)
Dropout N 269 (40,6)
T2 3 months Follow-Up
N 394 (59,4)
Dropout N 330 (50)
T3 6 months Follow-Up
N 333 (50)
Dropout N 339 (51)
T4 12 months Follow-Up
N324 (49)
14
Pretest Equivalence
15
Stages of Change
16
Results
17
Effectiveness
H1 CBT MT

18
Abstinence Rates with (ITT-Analysis) and without
Dropouts
19
Abstinence Rate CBT versus MT (ITT-Analysis)
20
Further Analyses
21
Hospital- specific Abstinence Rates (T1)
22
Interviews with staff members

• Smoking cessation (sc) is not effective when,
• there is no adequate importance of sc in the
  hospital
• therapist as lone fighter
• hospital follows only health political pressure
• there is no adequate support from staff
• colleagues are smoking
• lack of motivation of colleagues regarding sc
• the therapist himself is unconvinced of the
  efficacy of sc
• he is sceptical about the therapy success
• he himself is a current smoker

23
Discussion

• Very high interest of hospitals and patients
• The MT is as effective as the CBT. Maybe the
  interventions are more equal than they look like.
  
• The MT may be favoured as a larger target group
  can be reached. More alcohol addicted smokers may
  become engaged in reflecting their smoking
  behaviour.
• Skills training ist part of alcohol treatment
  where self control, stress management, relapse
  prevention techniques are tought. A transfer of
  these techniques may help smokers to become
  tobacco abstinent.
• Improving the outcome by improving the hospital
  tobacco policy

24
Recommendations (West et al., 2000)

• In order to send out a consistent message to
  smoking patients a clear tobacco policy should be
  self-evident
• Implementation of efficient systems for recording
  the smoking status
• Hospitals should be smoke-free and all patients
  should be advised of this at the earliest
  opportunity
• Current smokers attending hospital should receive
  opportunistic advice from a clinician (MI)
• Offering specialist support and NRT on
  prescription
• Clinicans and other staff who are involved in
  discussing smoking with patients should receive
  adequate training for effective interventions