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NRNP 6645 Assignment: Psychotherapy for Clients With Addictive Disorders

NRNP 6645 Assignment: Psychotherapy for Clients With Addictive Disorders

Introduction

¡Addiction is a complex disorder

¡ Uncontrolled use of a substance

¡Rx- pharmacotherapy & psychotherapy

¡The presentation will analyze an article on addiction treatment

¡Target population & intervention

¡Study findings & limitations

Addiction is a complex disorder characterized by uncontrolled use of a substance in spite of harmful consequences.

NRNP 6645 Assignment Psychotherapy for Clients With Addictive Disorders
NRNP 6645 Assignment Psychotherapy for Clients With Addictive Disorders

Various treatment approaches are available to treat addiction disorders, including Detoxification, Therapeutic communities, Outpatient medication management and psychotherapy, Intensive outpatient programs, Residential treatment, Mutual-aid group, and Self-help groups that have family members (Kalin, 2020).

This presentation will analyze an article that discusses a therapeutic approach for treating patients with an addictive disorder, including target population, intervention used, study findings, and limitations.

Article Overview

¡E-cigarettes vs. NRT in nicotine addiction

¡The study examined 1-year efficacy

¡Limited evidence on the effectiveness of e-cigarettes vs.NRT

¡Two-group, pragmatic, multicentre RCT

NRNP 6645 Assignment Psychotherapy for Clients With Addictive Disorders
NRNP 6645 Assignment Psychotherapy for Clients With Addictive Disorders

¡Randomization of 886 participants

¡Primary outcome- sustained abstinence for 1-year

¡E-cigarettes vs. NRT in nicotine addiction

¡The study examined 1-year efficacy

¡Limited evidence on the effectiveness of e-cigarettes vs.NRT

¡Two-group, pragmatic, multicentre RCT

¡Randomization of 886 participants

¡Primary outcome- sustained abstinence for 1-year

Hajek et al. (2019) examined the 1-year efficacy of refillable e-cigarettes compared with nicotine replacement therapy (NRT) when given to adults seeking help on smoking cessation and combined with face-to-face behavioral support. The study was informed by the limited evidence regarding the effectiveness of e-cigarettes compared with that of nicotine products approved for the treatment of smoking cessation. The researchers conducted a two-group, pragmatic, multicenter, individually randomized, controlled trial (RCT). The study randomized 886 participants (Hajek et al., 2019). Randomization occurred on the cessation date to limit differential dropout. The primary outcome was sustained abstinence for one year, which was confirmed biochemically at the final visit.

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Population under Consideration

¡Target- Adults seeking help on smoking cessation

¡Adult smokers were invited to the study

¡Criteria: Not pregnant/lactating

¡No strong preference for e-cigarettes or NRT

¡Currently not using e-cigarettes or NRT

The study’s target population was adults seeking help on smoking cessation. The researchers invited adult smokers to participate in the study if they were not pregnant or lactating, had no strong preference to use or not to use nicotine replacement or e-cigarettes, and were currently not using either NRT or e-cigarettes (Hajek et al., 2019).

Specific Intervention Used

¡NRT group selected preferred product

¡Used patch+ short-acting oral product for 3 months

¡E-Cigarette Group- given a starter pack +30-ml e-liquid

¡Taught on using refillable e-cigarette products

¡Weekly behavioral support for both

¡Both interventions have previously been studied

Participants were randomly assigned to either a Nicotine-Replacement Group or an E-Cigarette Group. Participants in the Nicotine-Replacement Group were educated on nicotine-replacement products, such as patch, lozenge, gum, nasal spray, inhalator, mouth spray, mouth strip, and micro tabs, and chose their preferred product. Use of combined products was encouraged, mostly the patch and a short-acting oral product (Hajek et al., 2019). They were also free to switch products. The nicotine replacement supplies were provided for up to 3 months.

Participants in the E-Cigarette Group were provided a starter pack (One Kit) to encourage the initial use and teach them how to use refillable e-cigarette products. They were also given one 30-ml bottle of e-liquid containing nicotine at 18 mg per milliliter (Hajek et al., 2019).

Treatment entailed weekly behavioral support for at least four weeks for both groups.

The E-cigarette and Nicotine replacement interventions have previously been studied, but there is limited evidence comparing their effectiveness.

Author’s Claims

¡The study would show a stronger effect of e-cigarettes than previous trials

¡Previous trials provided limited or no face-to-face support

¡Previous trials used 1st generation cartridge products

¡Refillable devices are more efficient at nicotine delivery

The authors claimed that the RCT study would show a stronger effect of e-cigarettes than previous trials. This is because they included smokers seeking help in quitting, provided face-to-face support, and used refillable e-cigarettes with free choice of e-liquids (Hajek et al., 2019). They also asserted that previous trials provided limited or no face-to-face support and used first-generation cartridge products.

Besides, they argued that refillable devices are generally more efficient at nicotine delivery.

Study Findings/Outcomes

¡E-cigarettes were more effective

¡High rate of continuing e-cigarette

¡The E-cigarette group was more likely to decrease smoking

¡E-cigarettes- throat/mouth irritation; NRT- nausea

¡The study will translate in managing nicotine addiction patients

¡Recommend e-cigarettes for successful outcomes

E-cigarettes were more effective in promoting smoking cessation than NRT. The rate of continuing e-cigarette use was relatively high. Among participants in the trial in whom full abstinence was not met, those in the e-cigarette group were more likely to decrease their smoke intake than those in the NRT group (Hajek et al., 2019). E-cigarettes were associated with more throat and mouth irritation, while NRT caused more nausea. More subjects in the e-cigarette group than in the NRT group reported respiratory adverse events.

The study findings will translate into my practice when managing clients with nicotine addiction, aiming at quitting tobacco use. I can recommend e-cigarettes to these patients to promote more successful outcomes.

Impact of Limitations in Using the Findings

¡Product assignments could not be blinded

¡Lack of blinding could affect the results

¡CO validation detects only over the past 24 hours

¡Limitations will not affect the use of findings

¡NRT interventions were provided under expert guidance

Limitations in the study include: Product assignments could not be blinded, affecting the results. Positive expectations partially affect long-term abstinence, but if NRT was viewed as an inferior option, participants in the NRT group could have put less effort into their cessation attempt than those in the e-cigarette group (Hajek et al., 2019). Validation of carbon monoxide detects smoking only over the past 24 hours, and therefore there may have been some false-negative results. The study’s limitations will not affect my ability to use the findings because the NRT interventions were provided under expert guidance.

Conclusion

¡The article compared the effectiveness of E-cigarettes vs.NRT

¡E-cigarettes had better ratings than NRT

¡Primary outcome- smoking abstinence for 1 year

¡Participants were offered face-to-face support

¡Established that E-cigarettes are more effective

¡Intervention can be applied in patients with nicotine addiction

References

Hajek, P., Phillips-Waller, A., Przulj, D., Pesola, F., Myers Smith, K., Bisal, N., … & McRobbie, H. J. (2019). A randomized trial of e-cigarettes versus nicotine-replacement therapy. New England Journal of Medicine380(7), 629-637. https://doi.org/10.1056/NEJMoa1808779

Kalin, N. H. (2020). Substance Use Disorders and Addiction: Mechanisms, Trends, and Treatment Implications. American Journal of Psychiatry177(11), 1015-1018. https://doi.org/10.1176/appi.ajp.2020.20091382