2009, Number 1
Evaluación de un programa de intervención breve motivacional para fumadores: resultados de un estudio piloto
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ABSTRACTTobacco consumption is a world-wide public health problem that has been associated with different types of cancer, cardiovascular and respiratory diseases, alterations in the reproductive system, dental problems and some eye diseases. In Mexico the National Survey of Addictions (2002) reported that 26.4% of the urban population between 12 and 65 years and 14.3% of the rural population are smokers. The Secretary of Health indicated that more than 53000 people died from diseases related to tobacco consumption. The consumption of tobacco stands among the ten first causes of morbidity and mortality in Mexico. In this sense, smoking is considered as one of the main public health problems in Mexico. Several organisms and institutions have undertaken actions in an attempt to solve it, such as the development of educative programs directed to the general population and programs to help smokers to quit this habit. Some of the main strategies to reduce cigarette consumption include nicotine replacement therapy, therapy not based on nicotine (antidepressants, some opiate antagonists and anxiolytic drugs), psychological programs, and the combination of some of them. Regarding psychological treatments, behavioral and cognitive behavioral techniques for smoking cessation hold empirical evidence about their efficacy for reducing the abuse of substances. In Mexico, psychological, nicotinic and non-nicotinic treatments to stop smoking are used. Nevertheless, the methodological and theoretical grounds of the psychological interventions are not wellestablished and there are no specific data about the changes in the consumption pattern after the application of the interventions and whether the effects of the treatment stay through the time. Specifically, the information about the efficacy of the brief interventions on smokers in the Mexican population is scarce. Although different studies have demonstrated that the brief motivational interventions are more effective to reduce the abuse of different substances than intensive interven ions or no interventions at all, the techniques are not widely used in the treatment of tobacco consumption in Mexican population. With this evidence, the National Autonomous University of Mexico (UNAM) developed the Brief Motivational Intervention Program to treat smokers. The Brief Motivational Intervention is based in the Social Cognitive Theory, the Prevention of Relapses Model, in techniques of motivational interview and self-control techniques. Therefore, the goal of the present research is to evaluate a brief motivational intervention program for smokers. In order to achieve this aim, 10 individuals between 19 and 55 years old participated in the program; five individuals showed low nicotine dependence and five severe nicotine dependence according to the Questionnaire of Fagerström Tolerance. There was a public invitation and the participants consent to participate voluntarily in the «Center of Psychological Services» belonging to the Psychology Department, UNAM. The motivational brief intervention program for smokers consists of six sessions: an admission session, an evaluation session and four treatment sessions of one hour each. All of them were carried out individually based on the following theoretical and methodological components: social cognitive theory, techniques of motivational interview, techniques of self cont rol and prevention of relapses model. The program was evaluated doing a comparison of the consumption pattern during and after the application of the brief intervention, and contrasting the level of self-efficacy before and after the application of the brief intervention. An analysis of variance (ANOVA) of repeated measures showed significant changes in the pattern of consumption (F [2, 18] =53.10,p‹0.001), a Bonferroni post hoc test for binary comparisons indicated that the differences were between the baseline and treatment (p‹0.001) and baseline and follow-up (p= 0.001). In relation to significant differences in the self-efficacy level, a Wilcoxon test showed differences in the following situations: disagreeable emotions (Z= 2.203, p‹0.05), physical discomfort (Z=2.492, p‹0.05), conflict with others (Z= 2.556, p‹ 0.05) and pleasant moments with others (Z=2.670, p‹0.05). In all the cases, the level of self-efficacy reported in the second application increased as compared to the first. Results found in this research agree with those collected in other countries using brief intervention therapy, but specifically with the ones employed in Mexico with drinkers, users of cocaine and adolescents initiating drug consumption. This program makes special emphasis in the strengthening of self-efficacy and in the prevention of relapses model that maintains the change of the consumption behavior of the user during and after the intervention. However, users learn mainly to conceptualize a relapse as a part of the process to quit smoking and not as a failure or an addictive behavior that they will never be able to change. Carroll indicates that the essential principles of the cognitive behavioral programs for the treatment of addictive behaviors are that they allow for individualized programs and that the goals of the treatment reflect a collaborative process between the user and the therapist. These principles allow the user to stay in the program and motivate him/her to maintain a change in the addictive behavior. The brief intervention for smokers in this study has not only shown excellent effects in users with low dependency, but also with users with severe dependency to nicotine (according to the Questionnaire of Fagerström Tolerance). Even though they did not stop smoking completely, they diminished the consumption pattern and increased the number of days of abstinence. The previous finding is congruent with the assumptions of the harm reduction, which is considered as an alternative associated to a decrement on the real and the potential damage with the use of the drug, more than to trying to stop it. It is important to do a follow-up that shows a long-term maintenance of the behavior for at least 12 months after the treatment. Some biological markers (carbon monoxide in the expired air, levels of cotinine in tinkles or shapes) are also needed that will represent an objective measure that helps to increase the motivation with respect to the initial consumption during and after the intervention and also to verify the pattern of consumption reported by the users. This treatment for smokers it is an effective alternative for its adoption in institutions of health and must be a part of the preventive policies for the treatment of smokers in a national scope because it has an impact in the pattern of cigarette consumption and the associated organic damages.
USDHHS. The Health Consequences of Smoking. Report of the surgeon general. Atlanta, GA: Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office an Smoking and Health. Consultado en http://www.surgeongeneral.gov/library el 20 de julio del 2004.
Tapia-Conyer R, Kuri MP, Cravioto QP, Galván F et al. Tabaco. En: Encuesta Nacional de Adicciones. Consejo Nacional Contra las Adicciones. México: CONADIC, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Dirección General de Epidemiología (DGE), Instituto Nacional de Estadística, Geografía e Informática (INEGI); 2002.