Christoph Kröger

Telephone booster sessions for optimizing smoking cessation for patients in rehabilitation centers.

Smokers with smoking-related diseases who are hospitalized in rehabilitation centers should be offered smoking cessation. This is the first study evaluating whether telephone booster sessions after intensive inpatient treatment are an effective strategy. The present study was conducted in 13 rehabilitation centers for somatic disorders as a prospective multicenter study with a randomized treatment-control group design. We compared abstinence rates after hospital discharge from treatment that included a group smoking cessation program with (treatment group) and without telephone booster sessions (control group). Data from 290 smokers were analyzed. After 6 and 12 months the treatment group achieved abstinence rates twice as high as those of the control group. Men profited more from telephone booster sessions than did women. Results indicated that telephone booster sessions were highly effective (even) after an inherently intensive group program during a hospital stay. Further research should focus on the special needs of women receiving telephone counseling.

Prediction of alcohol addicted patients’ smoking status through hospital tobacco control policy: A multi-level-analysis

Aims: The goal of the study was the exploration of the influence of tobacco control policies in German in-patient substance abuse treatment centres on the smoking status of alcohol-addicted patients at discharge. Method: A multi-centre field study with pre–post design was carried out in 40 in-patient treatment centres in Germany. The tobacco control policy questionnaire was answered by the director of each treatment centre (N = 40). Data from 774 alcohol addicted patients could be assessed at admission and discharge. A multi-level-analysis (HLM) was carried out to identify the predictive value of institutional tobacco control policy on smoking status post-rehabilitation. Findings: Findings uncovered that the strength of tobacco control policy lie in the areas of assessment of smokers, enforcement of smoking restrictions and restrictiveness of smoking policy. Comprehensiveness of smoking restrictions and intensity of smoking-related training of the employees are significant predictors for the variance in quit rates between the institutions. Significant individual predictors for quitting include gender, tobacco dependency and educational status. Conclusions: Results support findings from other areas like schools and public areas stating the effectiveness of restrictive smoking policies. However, this patient group is especially resistant to change, quit rates are low and effects of tobacco control policy small; the latter partly due to the distal character of policy variables for the individual.

Motivierende Gesprächsführung zur Aktivierung von Verhaltensänderungen

ZusammenfassungDas „Motivational Interviewing“ (MI) bietet Strategien und Techniken im Umgang mit Patienten, die sich schwertun, wichtige Verhaltensänderungen in ihrem Leben einzuleiten oder umzusetzen. Wichtiges Merkmal des MI ist der „Motivational Interviewing Spirit“ des Therapeuten, der die Ambivalenz seines Patienten als normale Erscheinung auf dem Weg zur Veränderung sieht, sich für dessen Änderungsmotive interessiert sowie auf seine Ressourcen fokussiert und beides nutzt, um ihn bei der Entwicklung einer Veränderungsmotivation oder konkreter Veränderungsschritte zu unterstützen.

Psycho- und Pharmakotherapie bei schädlichem Tabakgebrauch und -abhängigkeit

Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.

Influence of individual characteristics and tobacco control policy on smoking cessation in patients in German somatic and psychosomatic rehabilitation

Abstract Aims: The goal of this study was to analyse the influence of individual characteristics and tobacco control policies on smoking status and tobacco consumption amongst patients in (psycho-) somatic rehabilitation centres. Methods: A multicentre field study with pre-post-follow up design was carried out in 19 German rehabilitation centres. Each trainer of the cessation programme answered a tobacco control policy questionnaire (N = 19). Data from 367 patients were assessed at admission and discharge; data from 262 patients were collected at telephone follow-up six months after intervention. Multilevel analyses (HLM) were applied to identify the predictive value of individual and tobacco control policy characteristics on smoking behaviour directly after the intervention and six months later. Findings: Enforcement of smoking restrictions was a significant positive predictor for cessation rate at discharge and reduction rate at follow-up. Significant individual predictors for quitting include education, motivation and self-efficacy. Reduction rates were influenced by individual characteristics like motivation, self-efficacy, tobacco dependence and smoking rate at admission. Conclusions: Evidence-based measures should be applied to the individual to raise cessation and reduction. Additionally, implementing and enforcing smoking restrictions is another effective method to improve the health of the public.

Rauchfreie Psychiatrie: Eine Bestandsaufnahme

OBJECTIVE In order to protect non-smokers, the federal states of Germany have adopted a law that provides for extensive smoking bans. In many of these federal laws, acute psychiatric facilities are treated as an exception. Therefore, it is often up to the institutions themselves to develop and enforce regulations. The aim of this study was to evaluate the situation in acute psychiatric facilities. METHODS The survey was created on the basis of previously evaluated questionnaires and consisted of 53 questions. A total of 289 hospitals were contacted. Participants were invited to take part in the survey via e-mail. RESULTS 59 hospitals (20.4 %) participated in the survey. Binding regulations were in place in 48 (81.4 %) hospitals, in 26 (44.1 %), smoking was prohibited on open wards. Three hospitals (5.1 %) strictly prohibited smoking on locked wards. Stop-smoking medication was available in 31 (55.3 %) hospitals. 19 (32.2 %) offered smoking cessation interventions. 22 (37.3 %) hospitals have set up a working group on the subject. CONCLUSION Currently, the issue of smoking in psychiatric facilities does not receive enough attention. The physical and mental health of psychiatric patients would benefit from a smoke-free policy. In order to achieve this, psychiatric staff and patients need appropriate support.

Psycho- und Pharmakotherapie bei schädlichem Tabakgebrauch und -abhängigkeit@@@Psychotherapy and pharmacotherapy for harmful tobacco use and tobacco dependency

Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.

Psychotherapy and pharmacotherapy for harmful tobacco use and tobacco dependency

Tobacco consumption is one of the major preventable health risk factors. In Germany approximately 110,000 people prematurely die from tobacco-related diseases and approximately 50% of regular smokers are considered to be tobacco dependent. Nevertheless, motivation to quit smoking is low and the long-term abstinence rates after attempts to stop smoking without professional support are far below 10%. As part of the S3 treatment guidelines 78 recommendations for motivation and early interventions for smokers unwilling to quit as well as psychotherapeutic and pharmacological support for smokers willing to quit were formulated after an systematic search of the current literature. More than 50 professional associations adopted the recommendations and background information in a complex certification process. In this article the scientific evidence base regarding the psychotherapeutic and pharmacological treatment options as well as recommendations and further information about indications and treatment implementation are presented. By following these guidelines for treatment of heavy smokers who are willing to quit combined with individual and group therapies on the basis of behavioral treatment strategies and pharmacological support, long-term success rates of almost 30% can be achieved.

Behandlung von schädlichem und abhängigem Tabakkonsum

Kapitel 4 umfasst alle Leitlinienempfehlungen zur Behandlung von tabakbezogenen Storungen mit ihrem Hintergrundtext und Empfehlungen zur weiteren Forschung. Inhalt sind: die Forderung der Ausstiegsmotivation, die Indikation und Durchfuhrung niederschwelliger Interventionen, Masnahmen zur Harm Reduction, psychotherapeutische, pharmakologische und somatische Ansatze, Techniken und Methoden zur Unterstutzung der Tabakabstinenz und Ruckfallprophylaxe. Spezielle Empfehlungen werden fur allgemeine Indikationsfelder (Alter, Geschlecht, Schwangerschaft) sowie somatische und psychische Komorbiditaten auf evidenzbasierter Basis mit den zugehorigen Hintergrundempfehlungen formuliert. Den Abschluss bilden Empfehlungen zu Setting und Versorgungssituation. Drei klinische Behandlungsalgorithmen stellen den allgemeinen Therapieprozess sowie die psychotherapeutischen und pharmakologischen Prozesse von der ersten Problematisierung des Tabakkonsums bis zum Erreichen der Abstinenz dar. Zum Verstandnis der Empfehlungstabellen wird das vorherige Lesen der Methodenabschnitte der Zusammenfassung (Kap. 1) dringend empfohlen, zum Verstandnis der klinischen Algorithmen Abschn. 2.1.4.

Diagnostik und Dokumentation

Kapitel 3 enthalt Hintergrundwissen und Empfehlungen zur Diagnostik und Dokumentation des Tabakkonsums bei Rauchern. Neben der rein kategorialen Diagnostik bei Erwachsenen und Minderjahrigen werden auch ein dimensionales Konzept der Abhangigkeit und entsprechenden Diagnostik dargestellt. Ein Uberblick uber vorhandene Fragebogen bzw. Messinstrumente gestattet eine weiterfuhrende Einarbeitung in das Thema. Die verschiedenen Facetten der Dokumentation des Rauchverhaltens werden umfassend dargestellt. Zum Verstandnis der Empfehlungstabellen wird das vorherige Lesen der Methodenabschnitte der Zusammenfassung (Kapitel 1) dringend empfohlen.