ABSTRACT
Substance use disorders (SUD) treatment centers are an optimal setting for delivering smoking cessation interventions (SCI). This study aimed to examine the adoption of SCI in SUD treatment centers in Catalonia (Spain) as well as to assess their managers' views on the appropriateness and feasibility of providing SCI. Managers directly in charge of SUD treatment centers (n = 57) answered a 30-item on-line questionnaire. Data was obtained of 50 centers (87.7% response rate). Forty-six per cent of the centers provided some kind of SCI, but only 4.8% of the new patients were treated for smoking cessation. Managers reported that 73.3% of mental health professionals working in SUD centers had not been trained in SCI. Sixty-four per cent of managers agreed that all health professionals should deliver SCI. Those centers offering SCI attended more patients and were more likely to have professionals trained in SCI than those not offering SCI. The implementation of SCI in SUD treatment centers in Catalonia was suboptimal. Continuing education and training should be provided for all health professionals working in SUD centers. Not systematically delivering SCI to patients in treatment for other SUD means missing opportunities to reduce health and economic costs while perpetuating a smoking culture.
Los centros de tratamiento de drogodependencias son un recurso óptimo para realizar intervenciones para la cesación tabáquica (ICT). El objetivo de este estudio fue examinar la implementación de ICT en la Red de centros de Atención a las Drogodependencias (CAS) de Cataluña, así como evaluar las opiniones sobre la adecuación y viabilidad de la provisión de ICT. Los responsables de los CAS (n = 57) contestaron un cuestionario on-line compuesto por 30 ítems. Se obtuvieron datos de 50 centros (87,7% tasa de respuesta). El 46% de los CAS ofrecía algún tipo de ICT, pero sólo un 4,8% de los nuevos pacientes eran tratados para dejar de fumar. Además, los responsables informaron que el 73,3% de los profesionales que trabajaban en los CAS no había recibido formación en ICT. El 64% de los responsables estaba de acuerdo que todos los profesionales deberían realizar ICT. Aquellos centros que ofrecían ICT visitaban más pacientes y era más probable que tuviesen profesionales formados en ICT, comparado con los centros que no ofrecían ICT. La implementación de ICT en los CAS de Cataluña era subóptima. Se debería facilitar formación continuada a los profesionales de los CAS. No intervenir sobre el consumo de tabaco en pacientes en tratamiento por otras drogodependencias significa perder oportunidades para reducir costes en salud y económicos mientras perpetuamos una cultura fumadora.
Subject(s)
Behavior, Addictive , Smoking Cessation , Substance-Related Disorders , Behavior Therapy , Humans , Spain , Substance-Related Disorders/therapyABSTRACT
Se analiza en una muestra de 142 centros, la mayoría de drogodependencias y algunos de alcoholismo, de 11 comunidades autónomas españolas, los programas que realizan para el tratamiento del tabaquismo. El 55.6% llevan a cabo tratamiento de fumadores. A lo largo del año 2004 en dichos centros hubo una demanda de tratamiento por parte de 3.771 personas. Fueron tratadas unas 3.000, finalizando el tratamiento la mitad de ellas. Los niveles de abstinencia indicados para el final del tratamiento como en los seguimientos a los 6 y 12 meses son buenos, en relación a los estudios clínicos publicados. El tratamiento más utilizado es el combinado (psicológico y farmacológico) seguido del psicológico. Suelen ser los distintos profesionales del equipo terapéutico los que llevan a cabo el tratamiento. Indican varias limitaciones para realizar este tratamiento, incluidos los presentes en cualquier adicción (ej., baja motivación de los fumadores), carencia de tiempo, poco personal, etc. Aprecian un claro incremento de la demanda, tanto de personas que acuden con solo dependencia de la nicotina como de sus usuarios clásicos que están a tratamiento por otras dependencias. Tienen clara su relevancia profesional en el tratamiento de esta adicción y la alta eficacia de los tratamientos que llevan a cabo con los fumadores. Ven necesario que se les aporten más medios para hacer frente al incremento continuo de demanda que están teniendo para el tratamiento de la dependencia de la nicotina en sus centros
We analyzed in a sample of 142 Centers of Drug Abuse and Alcoholism, in 11 regions of Spain, the programs that they carry out for smoking cessation. The 55.6% of centers carries out treatment of smokers. Along the year 2004 in this centers had a treatment demand of 3,771 smokers, 3,000 were treated, concluding the treatment half of them. The levels of abstinence for the end of the treatment and in the 6- and 12-months followup are good, in relation to the published clinical studies. The most utilized treatment are the combined (psychological and pharmacological) followed by the psychological treatment. They are usually apply by diferent professionals as therapits. They indicate several limitations to carry out this treatment, included usual in any addiction (e.g., the smokers low motivation), lack of time, limited personal, etc. They appreciates a clear increment of the demand, so much of people that they go with single nicotine dependence like of its classic users that are to treatment for other dependences. This data indicated the professional relevance of Centers of Drug Dependence in the treatment of nicotine dependence and the high effectiveness of the treatments that carry out with the smokers. They consider necessary that they have more means to make in front of the continuous increment of demand that they are having for the treatment of the nicotine dependence in their centers
Subject(s)
Male , Female , Adult , Adolescent , Humans , Tobacco Use Disorder/therapy , Substance Abuse Treatment Centers/methods , Substance Abuse Treatment Centers/organization & administration , Substance Abuse Treatment Centers , Tobacco Use Disorder/therapy , Tobacco Use Disorder/diagnosis , Surveys and Questionnaires , Epidemiology, Descriptive , Community Mental Health Centers , Spain/epidemiology , Substance Withdrawal Syndrome/therapyABSTRACT
OBJECTIVE: To compare the serum levels of beta2-microglobulin (beta2M), neopterin (NP), TNF-alpha and soluble receptors of TNF-alpha (sTNF-R55 and sTNF-R75) and interleukin-2 (sIL-2R) in a population of intravenous drug abusers according to whether or not they had HIV-1 infection and to the stage of the HIV-1 infection. METHODS: A cross-sectional study was performed at four drug detoxification centers in Barcelona, and the HIV outpatient clinic at Hospital Clínic in Barcelona. Three cohorts of intravenous drug abusers (IVDAs)-105 HIV-1-uninfected patients (cohort A), 174 with asymptomatic HIV-1 infection (cohort B) and 39 with AIDS (cohort C)-were enrolled. On the first visit, the following laboratory tests were performed: hemogram and platelet count, hepatitis B surface antigen (HBsAg), anti-hepatitis C antibodies, B2M, NP, sIL-2R, TNF-alpha, and TNF receptors (sTNF-R55 and sTNF-R75). RESULTS: The three cohorts were homogeneous according to sex, type of drug, average number of intravenous doses of drug in 1 day, and hepatitis B infection. Patients with AIDS were older than those of cohort A and B (p<0.0001). HIV-negative IVDAs were co-infected with hepatitis C virus less frequently than were HIV-positive IVDAs (80% versus 91%, p<0.03). Among HIV-1-negative IVDAs (cohort A), almost all (from 86% to 95%, depending on the marker) individual values were within the normal boundaries of our laboratory. With a single exception (level of sTNF-R55 in cohort B compared with cohort A, p=0.15), levels of all markers were significantly higher in asymptomatic HIV-1-infected (cohort B) when compared with uninfected patients (cohort A), and in AIDS patients (cohort C) when compared with both cohorts A and B. There was a significant positive correlation between levels of ss2M and NP (r=0.56; p<0.01), ss2M and TNF (r=0.65, p<0.01) and NP and TNF (r=0.76, p<0.01). There was no correlation between levels of sIL-2R and levels of ss2M, NP or TNF and its receptors. CONCLUSIONS: Intravenous drug abuse does not modify serum levels of ss2M, NP, sIL-2R, TNF-alpha, and TNF receptors (sTNF-R55 and sTNF-R75). Levels of these markers increase significantly when an HIV-1 infection occurs and when there is progression to AIDS.
