Experience of Smokers and Recent Quitters With Smokefree Regulations and Quitting.

Experience of smokers and recent quitters with smokefree regulations and quitting.

Filed under: Addiction Rehab

Am J Prev Med. 2012 Nov; 43(5 Suppl 3): S163-70
Betzner AE, Boyle RG, Luxenberg MG, Schillo BA, Keller PA, Rainey J, Capesius T, Saul JE

Bans on smoking in public areas have increased as knowledge of secondhand smoke dangers has grown. Restrictions on smoking in public areas may lead to less smoking and increased quitting.This study examines the experiences of smokers and recent quitters with local smokefree regulations to better understand the possible mechanisms by which smokefree regulations affect individual tobacco users’ patterns of tobacco consumption and quitting.Fifteen in-depth interviews and thirteen focus groups were conducted with tobacco users and recent quitters formerly enrolled in cessation programs provided by ClearWay Minnesota(SM). Data were collected 3 months after smokefree legislation was adopted in the Minneapolis/St. Paul metropolitan area in 2006, and were stratified by tobacco use status and strength of regulation. Essential themes were extracted using NVivo 8 software in 2011.Study participants reported that smokefree legislation forced them to confront their addiction. They experienced apprehension, frustration, and panic anticipating smoking restrictions. This motivated some to attempt to quit, whereas others felt punished by and angry at government intrusion. Both current and former tobacco users felt smokefree regulations contributed to stigmatizing smokers. They also reported smokefree legislation reduced the temptation to smoke. The physical absence of cigarette smoke in bars and restaurants appeared to support quit attempts. The inconvenience of smoking outside was reported to have a similar effect.Essential mechanisms by which bans influenced patterns of tobacco use and quitting include confronting addiction, temptation, inconvenience, and social norms. These findings highlight the success of tobacco control advocates in denormalizing tobacco use, and suggest that some tobacco users may be internalizing negative messages about tobacco.
HubMed – addiction


The neurobiology of reward and cognitive control systems and their role in incentivizing health behavior.

Filed under: Addiction Rehab

Prev Med. 2012 Nov; 55 Suppl: S17-23
Garavan H, Weierstall K

This article reviews the neurobiology of cognitive control and reward processes and addresses their role in the treatment of addiction. We propose that the neurobiological mechanisms involved in treatment may differ from those involved in the etiology of addiction and consequently are worthy of increased investigation.We review the literature on reward and control processes and evidence of differences in these systems in drug addicted individuals. We also review the relatively small literature on neurobiological predictors of abstinence.We conclude that prefrontal control systems may be central to a successful recovery from addiction. The frontal lobes have been shown to regulate striatal reward-related processes, to be among the regions that predict treatment outcome, and to show elevated functioning in those who have succeeded in maintaining abstinence.The evidence of the involvement of the frontal lobes in recovery is consistent with the hypothesis that recovery is a distinct process that is more than the undoing of those processes involved in becoming addicted and a return to the pre-addiction state of the individual. The extent to which these frontal systems are engaged by treatment interventions may contribute to their efficacy.
HubMed – addiction


Maintenance of reinforcement to address the chronic nature of drug addiction.

Filed under: Addiction Rehab

Prev Med. 2012 Nov; 55 Suppl: S46-53
Silverman K, Defulio A, Sigurdsson SO

Drug addiction can be a chronic problem. Abstinence reinforcement can initiate drug abstinence, but as with other treatments many patients relapse after the intervention ends. Abstinence reinforcement can be maintained to promote long-term drug abstinence, but practical means of implementing long-term abstinence reinforcement are needed.We reviewed 8 clinical trials conducted in Baltimore, MD from 1996 through 2010 that evaluated the therapeutic workplace as a vehicle for maintaining reinforcement for the treatment of drug addiction. The therapeutic workplace uses employment-based reinforcement in which employees must provide objective evidence of drug abstinence or medication adherence to work and earn wages.Employment-based reinforcement can initiate (3 of 4 studies) and maintain (2 studies) cocaine abstinence in methadone patients, although relapse can occur even after long-term exposure to abstinence reinforcement (1 study). Employment-based reinforcement can also promote abstinence from alcohol in homeless alcohol dependent adults (1 study), and maintain adherence to extended-release naltrexone in opioid dependent adults (2 studies).Treatments should seek to promote life-long effects in patients. Therapeutic reinforcement may need to be maintained indefinitely to prevent relapse. Workplaces could be effective vehicles for the maintenance of therapeutic reinforcement contingencies for drug abstinence and adherence to addiction medications.
HubMed – addiction


Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness.

Filed under: Addiction Rehab

Prev Med. 2012 Nov; 55 Suppl: S54-60
Tidey JW

Serious mental illness (SMI) is associated with high rates of tobacco and other drug dependence, poor treatment compliance, obesity and low levels of physical activity, which have severe medical and psychosocial consequences. Interventions that effectively reduce these health risk behaviors among people with SMI are urgently needed.Published reports from studies evaluating incentive-based treatments for promoting tobacco and other drug abstinence, treatment attendance, medication use and increased physical activity are reviewed.Results of this review indicate the efficacy of incentive-based treatments for reducing tobacco and other drug use among people with SMI. Few studies have examined whether incentive-based treatments improve treatment attendance, medication use and physical activity levels in people with SMI; however, initial evidence is positive and indicates that further research in these areas is warranted.Given the medical and psychosocial costs of tobacco and other drug use, treatment non-compliance and physical inactivity, and the efficacy of incentive-based treatments for improving these behaviors, such interventions should be further developed and integrated into behavioral health treatment programs for people with SMI.
HubMed – addiction



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