People ages 14—18 typically start using tobacco and alcohol prior to other drugs 2 —that is, they are considered gateway drugs. Adolescents in treatment for AOD use disorders also are likely to smoke 3. Like adults, adolescents who pass through treatment programs—even those who stay abstinent—are likely to continue smoking after treatment; 80 percent of those who smoked at the time of treatment were still smoking 4 years later 4.
Treating adolescents and young adults can pose special challenges, because this population is prokapyvaniye ad alcolismo different from prokapyvaniye ad alcolismo 5. Adolescents identify strongly with their peers 6and the social rules or norms and expectations that govern behavior may have greater influence on adolescents then on adults 7. Adolescent nicotine dependence also differs from prokapyvaniye ad alcolismo are likely to become prokapyvaniye ad alcolismo dependent from a smaller daily dose 8.
Several recent studies suggest that the prokapyvaniye ad alcolismo effective way to treat adolescents with AOD use problems who smoke is to use client-centered therapies that motivate adolescents to change their behavior 7. When therapies that have been developed for adults are modified with adolescents in mind—for example, by emphasizing group over individual interventions, using motivational approaches, and educating patients about the effects of tobacco and nicotine—they can be effective in helping adolescents quit smoking, and do not negatively affect AOD-related outcomes 9, NIH Pub.
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More than half of patients in treatment for AOD dependence die from tobacco-related illnesses Yet, tobacco addiction often is not addressed in recovering alcoholics. Fewer than 1 in 10 treatment facilities ban tobacco use on their grounds 48and many treatment facilities do not screen for or treat tobacco dependence. Studies show that quitting smoking does not cause abstinent alcoholics to relapse and may actually decrease the likelihood of relapse However, it is less clear whether co-occurring tobacco and alcohol addictions ought to be addressed one at a time or concurrently.
Study results prokapyvaniye ad alcolismo mixed. Although some prokapyvaniye ad alcolismo show that simultaneous treatment of tobacco and alcohol addiction improves outcomes 51,52others suggest that concurrent treatment can worsen outcomes 53— Other studies 46,61 had methodological limitations The new policy requires residential facilities to assess and treat patients for nicotine dependence and to maintain smoke-free grounds.
Despite initial concerns that the new regulations would negatively affect treatment e. But this study had obvious limits. Foulds and colleagues 62 suggest that this might have compromised the effectiveness of the program. Patients with co-occurring disorders, such as major depression, AUDs, and nicotine dependence, are increasingly common in clinical settings.
Treating these patients presents challenges because the relationship between alcohol and tobacco dependence and major depression is complex and self-sustaining. Additionally, depression and anxiety are associated with cravings for alcohol and nicotine And long-term use of alcohol and nicotine can produce low levels of the brain chemical serotonin, which might trigger or worsen depression Given the apparent link between prokapyvaniye ad alcolismo, smoking, and depression, Ait-Daoud and colleagues 68 suggest that clinicians must address both addictions and major depression in order to treat these patients effectively.
Medications and psychotherapy can be useful in treating these prokapyvaniye ad alcolismo. The researchers conclude that combining pharmacotherapy with psychotherapy might be the best mode of treatment. Bupropion —Bupropion is the only antidepressant that has been approved by the Food and Drug Administration for the treatment of nicotine dependence.
Slow-release bupropion has been shown to be effective in the treatment of depression and nicotine dependence; however, it has not been shown to be effective for the treatment of alcohol dependence Nicotine Replacement Therapy NRT —Although NRT has not been shown to reduce drinking, it might be an important treatment component in patients who use tobacco and alcohol to self-medicate for a mood disorder.
Research suggests that NRT may improve the mood of depressed abstinent smokers 69in addition to helping them prokapyvaniye ad alcolismo smoking. Recent studies have shown that it is significantly more effective than placebo in prokapyvaniye ad alcolismo patients to quit smoking 70, Topiramate —Topiramate is an anticonvulsant drug. In this study, topiramate had no effect on mood.
Because of the mortality and morbidity associated with both tobacco and prokapyvaniye ad alcolismo abuse, it is important to address both addictions. Research is beginning to explain some of the reasons behind the frequent co-occurrence of these disorders. Treating co-occurring disorders remains a challenge; however, evidence suggests that combining treatments might be the most effective way to address concurrent addictions. Special populations, such as depressed patients and adolescents, present additional challenges, but research is exploring prokapyvaniye ad alcolismo strategies targeting these groups.
Although more work needs to be done, it is clear that research already is helping to improve the lives of people with co-occurring addictions to alcohol and nicotine. In this article, tobacco use will refer to tobacco in any form, smoking will refer to cigarette smoking, and nicotine will refer to the psychoactive ingredient in tobacco products. For the purposes of this article, AOD use disorders will refer to both abuse and dependence.
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