|Year : 2018 | Volume
| Issue : 4 | Page : 382-389
Effectiveness of two psychological intervention techniques for de-addiction among patients with addiction to tobacco and alcohol – A double-blind randomized control trial
Rahul Ganavadiya1, B R Chandra Shekar2, S Suma3, Pallavi Singh4, Ruchika Gupta5, Poonam Tomar Rana1, Shubham Jain6
1 Department of Public Health Dentistry, Index Institute of Dental Sciences, Indore, Madhya Pradesh, India
2 Department of Public Health Dentistry, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, JSS Medical Institutions Campus, SS Nagar, Mysore, Bangalore, Karnataka, India
3 Department of Orthodontics, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, JSS Medical Institutions Campus, SS Nagar, Mysore, Bangalore, Karnataka, India
4 Department of Periodontics, Index Institute of Dental Sciences, Indore, Madhya Pradesh, India
5 Department of Public Health Dentistry, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
6 Department of Public Health Dentistry, People's Dental Academy, Bhanpur, Bhopal, Madhya Pradesh, India
|Date of Web Publication||28-Feb-2019|
B R Chandra Shekar
Department of Public Health Dentistry, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, JSS Medical Institutions Campus, SS Nagar, Mysore, Bangalore, Karnataka
Source of Support: None, Conflict of Interest: None
Objective: The objective of this study was to evaluate effectiveness of two psychological intervention techniques (reading – writing therapy vs. games – narrative therapy) using motivational intervention alone as a control among tobacco addicts. Materials and Method: This randomized control trial was conducted over a period of 6 months from April to September 2013 at a de-addiction center in Madhya Pradesh, India. Patients with moderate-to-high levels of dependence as determined by Fagerstrom Test for Nicotine Dependence (FTND) admitted for treatment in a de-addiction center were recruited. A cluster randomization technique was used for allocation of participants to three different groups. Group allocation was concealed from investigator and done by coordinator. Three interventions were group A – motivational intervention alone, group B – games and story therapy along with motivational intervention, and group C – reading and writing therapy along with motivational intervention. Interventions were applied for 1 month. Two postintervention follow-ups (one at the time of discharge and one after 1 month following discharge) were done to assess level of dependence using FTND besides undertaking urine cotinine analysis among three randomly selected participants in each group. Results: A total of 82 participants (28 in group A, 27 each in groups B and C) completed the study. Eighty-one (98.8%) participants had complete abstinence at the end of 1 month with no significant difference in the success rate between different categories (P = 0.357). At the end of 1 month following discharge from center, only 7 participants (8.5%) had complete abstinence and 51 participants (62.2%) had partial reduction and remaining 24 participants (29.3%) were considered failures with no difference between three groups (P = 0.768). Conclusion: Although overall abstinence was low (8.5%), all intervention techniques were equally effective in at least reducing level of dependence with no significant difference in their efficacy.
Keywords: Addiction, games therapy, motivational intervention, nicotine dependence, psychological intervention, reading and writing therapy
|How to cite this article:|
Ganavadiya R, Shekar B R, Suma S, Singh P, Gupta R, Rana PT, Jain S. Effectiveness of two psychological intervention techniques for de-addiction among patients with addiction to tobacco and alcohol – A double-blind randomized control trial. Indian J Cancer 2018;55:382-9
|How to cite this URL:|
Ganavadiya R, Shekar B R, Suma S, Singh P, Gupta R, Rana PT, Jain S. Effectiveness of two psychological intervention techniques for de-addiction among patients with addiction to tobacco and alcohol – A double-blind randomized control trial. Indian J Cancer [serial online] 2018 [cited 2020 Jul 2];55:382-9. Available from: http://www.indianjcancer.com/text.asp?2018/55/4/382/253301
| » Introduction|| |
Tobacco use has emerged as a major public health issue in most regions of the world resulting in disability, disease, and death. With more than 5 million preventable deaths attributable to tobacco use occurring every year globally, menace of tobacco addiction has acquired the dimension of an epidemic. The number is expected to double by 2020, if death due to tobacco continues to occur at the same rate. Besides damage to personal health, tobacco use contributes to other societal costs like reduced productivity, environmental damage, and poverty of the families. Approximately 1 person dies in every 6 seconds (s) due to tobacco, accounting for 1 in 10 adult deaths. Nearly 80% of the more than 1 billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco caused 100 million deaths in the 20th century. India is the second largest producer and consumer of tobacco after China. More than one-third of adults in India use tobacco, accounting for 275 million. Nearly, 14.1% of children (13–15 years) consume tobacco in some or other form. Prevalence of tobacco use is around 48% among males and 20% in females in India. Two in five adults in rural areas and one in four adults in urban areas use tobacco. Beedi along with smokeless tobacco account for 81% of the Indian tobacco market. Nearly 30% of cancers in males in India and more than 80% of all oral cancers are related to tobacco use.
Alcoholism has significant harmful impacts not only on individuals but also on global public health. About 5.9% of all deaths and 5.1% of the global burden of disease and injury in 2012, as measured in Disability Adjusted Life Years (DALYs), were attributable to alcohol. These figures translate into 3.3 million alcohol-attributable deaths. Beyond the population-level burden of diseases and injuries, it is significant to note that alcohol kills or disables people at a relatively young age, resulting in the loss of many years of life to death and disability.
Addiction is a term commonly applied to maladaptive drug-seeking behavior, often performed despite knowledge of negative health consequences. Nicotine and alcohol meet the established criteria for drugs that produce addiction. Withdrawal is a syndrome of symptoms that occur when a regular user abruptly stops use (e.g., following or during a quit attempt). Nicotine withdrawal and dependence are viewed as separate, albeit related, disorders, each with its own specific diagnostic criteria. Many intervention strategies such as counseling, behavioral intervention, psychotherapy, detoxification therapy, supportive pharmacotherapy, tobacco in tapering dose, nicotine replacement therapy, etc., are commonly applied while managing individuals with addiction to tobacco and alcohol.
Psychological interventions are based on the principle that any substance abuse is only due to psychological dependence of an individual toward them and no drug can substitute psychological dependence. This can be treated with proper psychological approach alone. Games therapy as a psychological intervention technique is expected to reduce craving and withdrawal symptoms by diverting participant's attention to some rigorous sports. Writing therapy was believed to make each participant express his feelings that he could not do either in group or individual counseling sessions and to make each participant analyze the emotional, financial, and social ordeals faced by his family members, friends, and relatives owing to his addiction.
Published literature comparing the effectiveness of different psychological intervention techniques is scanty. In this background, this study was an attempt to evaluate the effectiveness of two psychological intervention techniques (reading – writing therapy vs. games – narrative therapy) using psychological counseling (motivational intervention) alone as a control among patients admitted with addiction to tobacco and alcohol.
| » Materials and Method|| |
This was a randomized control trial with parallel design, conducted over a period of 6 months from April to September 2013 at a de-addiction center in Madhya Pradesh, India. Permission to conduct the study at the de-addiction center was obtained from the concerned authorities and informed consent was obtained from all eligible study participants after briefing them about the research protocol in a group discussion. Ethical clearance was obtained from Institutional Ethics Committee, People's Dental academy, Bhopal. The study was conducted in accordance with guidelines of Declaration of Helsinki. The trial was registered in Clinical Trial Registry of India (vide acknowledgement number Ref/2017/02/013304). All participants admitted to the center were initially interviewed by a trained and calibrated investigator to assess their level of dependence using Fagerstrom scale for nicotine dependence  for smoking and smokeless tobacco. A predesigned questionnaire was used for eliciting the patients' habits related to alcohol consumption. The questionnaire elicited information frequency and duration of alcohol consumption, quantity of alcohol consumed, and symptoms of hangover experienced. Sample size was estimated to be 28 per group for estimating difference between two proportions with a risk difference of 0.3 at 95% confidence level. On an average, the detox center will have 10–15 participants enrolled in a week. The required number of participants in each group was recruited based on following eligible criteria.
- Offering written informed consent
- With addiction to tobacco and alcohol
- Having a moderate-to-high level of dependence (dependence score of more than five) for smoking/smokeless tobacco/combinations as per Fagerstrom scale
- Who agreed to stay as inpatients in the de-addiction centers for the duration of 25–30 days to receive the assigned intervention.
- With addiction only to alcohol and/or other substances (drug addicts) without addiction to tobacco in any form
- Undergoing any other psychopharmacological interventions during the study period
- With known drug hypersensitivity, epilepsy, pregnancy, lactation, any serious or unstable cardiac, renal, hepatic, hypertensive, pulmonary, endocrine, or neurological disorder as these participants were not recruited into the de-addiction centers till their condition was medically stable.
A sequential group randomization technique was used for allocation of participants to three different groups. All the eligible participants admitted in the first six weeks (one and a half months) were allotted to group A and were given only motivational interviewing. Eligible participants admitted in the next six weeks were allocated to group B and were subjected to motivational interviewing added to therapeutic games (games-narrative therapy). Then, eligible participants admitted in the last six weeks were allocated to group C and were offered motivational interviewing added to reading – writing therapy (Bibliotherapy). The group allocation was done by the research coordinator. This group allocation strategy facilitated easy application of the intervention besides eliminating possibility of contamination bias. Group code was entered on assessment form of participant and intervention offered to different groups was concealed from investigator involved in data collection to ensure blinding.
Baseline level of addiction was noted and urine samples were collected from three randomly selected study participants in each intervention group. Urine sample was collected before the initiation of detoxification procedure. The samples were collected in 50 ml bottles coded with participant ID within the first 24 h of participant's recruitment to the study and before group allocation.
After initial detoxification for 3 days to 1 week based on their level of dependence, participants were assigned to one of the three following intervention strategies:
Group A – Motivational intervention alone.
Group B – Games and story therapy along with motivational intervention.
Group C – Reading and writing therapy along with motivational intervention.
It mainly consisted of the following:
- Group counseling sessions were offered to all the inmates of the de-addiction center in a common hall, twice a day for 1 h in each session, by two trained counselors. Topics like importance of yoga in life, reasons for addiction, adverse medical and social consequences attributable to addiction, etc., were discussed in group counseling sessions where participants were encouraged to share their personal experiences
- Individual counseling sessions were given based on their behavior and involvement in group counseling sessions. Number of individual counseling sessions ranged from 10 to 15 during their stay in the de-addiction center where individual identity, anger, and stress management and planning of post-discharge lifestyles were discussed
- Anonymous meetings: These meetings were held once or twice in a month. Here, a person discharged from the de-addiction center following successful intervention was recalled and allowed to explain his own experiences before and after de-addiction. The participants were encouraged to actively participate in the discussion wherein their queries were clarified by the speaker citing his own example. The speaker was projected as a role model with the theme that “If he can do, why can't others?”. The anonymous meetings were believed to facilitate change in attitude and behavior among the study participants using a live example.
Games and story therapy along with motivational intervention
Participants in this group were offered games and story therapy for a minimum of 2 h in a day along with motivational intervention. Games therapy aimed at diverting participant's attention to some rigorous activity, which may mask the craving and withdrawal symptoms. It was carried out either on a individual or group basis under the monitoring of one of the trained counselors. Story therapy emphasized psychological dependence of the addicts through various stories, which were related to their personal life in such a way that each addict correlated circumstances that led him to addiction with the content in stories.
Reading and writing therapy along with motivational intervention
At any time, about half the participants in this group were offered reading therapy while other half during this time participated in writing therapy. These therapies were offered in such a way that each participant underwent almost equal sessions of reading and writing therapy. Each participant had one such session per day. Reading therapy was carried out on group basis wherein participants were given autobiographies of previously admitted patients who had successfully quit their abusive habits. These autobiographies were rotated among participants in such a way that each participant read biographies used in the group at least once. Reading therapy was expected to make the participants think that their problems are no different from the problems others faced and to make them realize that they too can find a solution to their problems, the way other successfully de-addicted persons did. The principle in writing therapy is that when a person expresses his real-life situations in writing, it will have a deeper impact in molding his attitude and behavior as he will assess each life circumstance thoroughly before writing. Diaries were distributed to each participant by the counselor and they were instructed to express their views in writing correlating the events in the autobiographies which they read, with their real-life situations. The headings under which participants wrote their feelings were specified. All participants enrolled for each intervention group were given the required number of sessions cited above and this was the protocol of the detox center which was adhered to.
These psychological intervention techniques were applied for 1-month duration. Two postintervention follow-ups were carried out to assess the outcome. First follow-up was done at the time of discharge of study participants, whereas second follow-up was done 1 month following discharge from the center. In each follow-up, level of dependence was assessed using Fagerstrom scale for nicotine dependence by means of face-to-face interview by the same investigator who recorded baseline information. The information on the substance abuse and level of dependence in the second follow-up, which was collected from study participants, was cross-verified with the information sought from their respective family members. In case of inconsistency, information given by family member was considered final. Besides, urine sample was collected from each randomly selected participant (whose baseline samples were collected) in different intervention groups in both first and second follow-ups. Subsequently, urine analysis was done to assess the presence or absence of cotinine. Urine analysis was considered as an objective measure of substance addiction. Substance addiction based on objective parameter was also compared among the various intervention groups at baseline, first, and second follow-up. Finally, a correlation between subjective and objective assessments was done to assess degree of correlation between two assessment methods.
Dependence scores at baseline were compared with follow-up scores in each category separately. Outcome was assessed by assigning each participant to one of the following categories based on their current practices (level of dependence):
- Complete abstinence/total success (dependence score 0):
- Partial reduction/partial success (dependence scores ranging from 1 to 5)
- Failure (dependence score of more than 5).
Complete abstinence in other words meant abstinence from tobacco-related habits for 1 month following discharge from de-addiction center. These comparisons were made separately in each intervention groups. A debriefing meeting was organized following completion of study wherein cooperation by all concerned was acknowledged and information related to compliance and adverse events, if any, encountered by the participants during the study period was collected. Intervention procedures used were conveyed and all participants were rewarded with a memento for their cooperation.
Statistical analysis was done using SPSS version 20 (IBM, Chicago, USA). Comparison in dependence scores at baseline, first, and second follow-up between different intervention groups was done using Pearson's Chi-square test. Mean Fagerstrom Test for Nicotine Dependence (FTND) score between different categories at three different time intervals was compared using one-way analysis of variance. Mean FTND between baseline and other time intervals in each category was compared using repeated measures analysis of variance with Bonferroni post-hoc test. Statistical significance was fixed at 0.05.
| » Results|| |
A total of 83 participants were offered psychological intervention techniques. Among them, 28 were offered motivational intervention, 28 were offered games and narrative therapy, and the remaining 27 were offered reading and writing therapy. There was no statistically significant difference in the age distribution of the study participants in these three intervention groups [P = 0.282, [Table 1]. All were males and the mean age of the study population was 32.3 years with a standard deviation of 9.12. The age range of the study population was 14–65 years. Distribution of the study participants in relation to socioeconomic status in different intervention groups is denoted in [Table 1]. We used modified Kuppuswamy scale to assess socioeconomic status of the study participants, which takes into consideration education, occupation, and per-capita income. There was no significant difference in distribution of participants in relation to SES between different groups [P = 0.693, [Table 1]. All participants had at least primary education and were able to read and write Hindi. Distribution of study participants based on type of substance addiction and duration of substance addiction in different intervention groups is denoted in [Table 1]. There was no statistically significant difference in the distribution of participants in relation to type of substance addiction [P = 0.156, [Table 1] and duration of addiction [P = 0.917, [Table 1] in different intervention groups. All these participants had made attempts to quit in the past and they were not successful. They were motivated by family members to get enrolled in the de-addiction center. One participant in group B was dropped from the analysis as he left de-addiction center before completion of his assigned therapy. CONSORT flow diagram is presented as [Figure 1]. Eighty-one (98.8%) participants at the end of 1 month had complete abstinence with one participant (1.2%) in group C having partial reduction with no significant difference in the success rate between different categories [P = 0.357, [Table 2]. At the end of 1 month following discharge from center, only 7 participants (8.5%) had complete abstinence and 51 participants (62.2%) had partial reduction and remaining 24 participants (29.3%) had FTND score of more than 5 indicating failure with no significant difference between different psychological intervention techniques [P = 0.768, [Table 2]. Mean FTND score for the study participants at baseline was 7.08 ± 1.21. There was no significant difference in the mean FTND score at baseline between different intervention groups [P = 0.678, [Table 3]. This became zero at the time of discharge from the center which subsequently increased to 4.35 ± 1.93 at the end of 1 month following their discharge with no significant difference between different intervention groups at all three time intervals (P > 0.05). However, mean FTND score significantly decreased in all three groups post intervention compared to their baseline scores suggesting that the de-addiction program was at least successful in reducing the level of addiction if not achieving complete abstinence [P < 0.001, [Table 3]. Among nine participants randomly assessed for urine cotinine, none of them demonstrated its presence at the time of discharge. However, 1 month following discharge from center, seven participants (77.8%) demonstrated the presence of cotinine in their urine samples with no significant difference between different groups [P = 0.526, [Table 4]. We found a perfect correlation between subjective assessment based on Fagerstrom scale and objective assessment based on urine cotinine [Kappa = 1.00, P = 0.001, [Table 5] among nine randomly selected participants in whom urine samples were also assessed besides FTND. This was done to assess the degree of reliability with subjective assessment by corroborating with objective assessment.
|Table 1: Sociodemographic distribution of study participants in different intervention groups|
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|Table 2: Distribution of study participants based on nicotine dependence score at first and second follow-up (at the time of discharge from de-addiction center and 1 month after)|
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|Table 3: Comparison of mean nicotine dependence score at baseline and postintervention among study participants|
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|Table 4: Comparison of urine cotinine scores between different intervention groups|
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|Table 5: Correlation between subjective and objective assessments for tobacco dependence at second follow-up for the study population|
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| » Discussion|| |
Smoking and use of smokeless tobacco can lead to addiction, which may be physical and psychological. A person with an addiction to tobacco often finds it too difficult to quit owing to various withdrawal symptoms such as dizziness, depression, feelings of frustration, anxiety, irritability, restlessness, dry mouth, chest tightness, slower heart rate, etc. These symptoms can make a smoker start smoking again to boost blood levels of nicotine until such symptoms go away. At this juncture, de-addiction centers play a vital role in facilitating an addict with supportive interventions which will enable them to overcome their withdrawal symptoms. De-addiction centers follow a variety of psychological, pharmacological, and combination of other methods to help the addicts overcome their addiction. The present study was undertaken to assess the efficacy of three psychological interventions followed in a de-addiction center in Madhya Pradesh, India. The study found no significant difference in the distribution of participants based on their addiction status between the six intervention groups at baseline. Level of addiction was one of the inclusion criteria while recruiting participants into study. Since participants with only moderate-to-high level of dependence to tobacco were recruited, there was no significant difference in the distribution of participants based on level of dependence between different intervention groups. This ensured that the participants in all intervention groups had almost same level of dependence at baseline.
Dependence at first follow-up was assessed using Fagerstrom scale and participants were assigned to one of the three categories (complete abstinence, partial reduction, and failure to quit the habit) based on their addiction scores. First, follow-up assessment was done at the time of discharge from de-addiction center as it helped us in assessing success rate at the time of discharge from the de-addiction center. This served as a measure to determine the relapse rate at the second follow-up assessment that was carried out 1 month after the discharge. 98.8% of participants had complete abstinence, whereas 1.2% had partial reduction with no significant difference between various subgroups.
The second follow-up assessment was made 1 month following discharge from the center. The second follow up was done at the end of one month in our study. Ideally, it should have been done at the end of either 3 or 6 months. However, the time constraints, and other logistic difficulties compelled us to complete the second follow-up at the end of 1 month. This second follow-up allowed us to assess at least the short-term success with regard to various de-addiction methods. Complete abstinence was found in 8.5% of participants and partial reduction in 62.2%. About 29.3% of participants were considered to be failures as they had dependence score of >5. Horn et al. in their study assessed the efficacy of a theory-based motivational tobacco intervention for smokers. Although the major findings of this study were not significant, the reductions in tobacco use suggested that motivational interviewing may be a clinically relevant counseling model for use in smoking interventions. In accordance to the findings of this study, the motivational intervention was effective to a certain extent in reducing the habit in our study, and its effectiveness did not differ significantly compared to other methods, which included additional psychological interventions such as games and narrative therapy, and reading and writing therapy along with motivational intervention. We found motivational intervention to be a key element in psychological methods of de-addiction. Ames et al. evaluated the efficacy of expressive writing as a treatment adjunct to a brief office smoking cessation intervention plus nicotine patch therapy in young adults. At the end of treatment (week 8), biochemically confirmed 7-day point-prevalence abstinence for the expressive writing plus brief office intervention condition was significantly greater than the brief office condition (33% vs. 20%, P = 0.043, OR = 2.0, 95% CI = 1.0–3.7, from a logistic regression adjusting for gender). However, we could not find a higher efficacy with reading and writing therapy compared to other two psychological interventions in the present study. Motivational intervention was included for all the participants in three psychological interventions in our study. The other therapies such as exclusive games and narrative therapy, and reading and writing therapy were given for only a limited period of time in a day (approximately 2 h). The lack of difference in dependence rates between the various psychological interventions may be attributed to the short duration of time in which the interventions differed. The short time interval that separated the three groups might not have been sufficient to produce a noticeable influence that could have changed the abstinence rates significantly. Khazaal et al. assessed feasibility and impact of a game called “Pick-Klop” among current smokers. The results revealed no effect on smoking cessation rates at posttest. However, there was an improvement in motivation and increased number of attempts to quit or reduce number of cigarettes among the participants. Authors cited games therapy to be an acceptable, feasible, and potentially helpful intervention to help smokers quit. Games stimulate curiosity and an intellectual and emotional investment. They do so in a nonjudging and decentered way that does not induce feelings of guilt, as players do not have to face or talk about their personal problems. Moreover, games facilitate interactions between players. Finally, games are very accessible and can be easily disseminated. Games have already been used in other fields of psychiatry. We also found games therapy to be a useful adjunct that can be effectively used along with motivational intervention.
The mean dependence score as well as the participant's level of addiction decreased in the follow-up examinations compared to baseline scores. The least score was found at the first follow-up followed by the score at the second follow-up, whereas the highest score was observed at baseline. These results were encouraging as the intervention programs were successful in reducing the level of addiction among the participants if not complete abstinence. However, this finding needs to be assessed cautiously as these are only short-term rates taken at the end of 1 month following the discharge which may drastically change over a period of time. The partial success attributed increase in their knowledge, attitude, and practices related to tobacco habits., A study by Green et al. evaluated the efficacy of a 4-day residential smoking treatment program among smokers who had relapsed after participation in an outpatient smoking program. The smoking abstinence at the time of discharge was found to be 91.3%, which reduced to 26.1% at 6 months follow-up. The overall relapse rate for tobacco dependence considering complete abstinence in our study was 90.3% within 1 month following the discharge, which was likely to increase if the follow-up were to be carried out for longer duration. This finding highlights the need for a thorough assessment of causes for relapse in such individuals. Though we could not precisely estimate the causes for relapse, we presume that the higher relapse to tobacco dependence in our study compared to the study by Green et al. could be due to difference in the level of substance addiction at baseline, the interventions followed, the exposure to various stressor following discharge. We found a substantial and significant decrease in the mean dependence score, but our interventions failed to yield a high abstinence rate for tobacco-related habits. The study found a perfect positive linear correlation between subjective and objective assessments. Based on this, we can infer that the information obtained from the participant and their relatives in subjective evaluation by means of face-to-face interview is valid and reliable.
The study had some limitations: a sequential group randomization was followed in view of lack of feasibility to adopt other random allocation procedures. This procedure ensured that all participants in that period received the same care without scope for contamination bias. The second follow-up, though ideally should have been done at later periods, probably 3 and 6 months, the time constraints and other logistic difficulties compelled us to complete the second follow-up at 1 month following their discharge. The results may be considered a short-term outcome. We assessed dependence status with respect to alcohol and tobacco ignoring the other substance abuse among the participants such as addiction to brown sugar, ganja, etc., The de-addiction centers might have given a higher priority to these addictions with least priority on tobacco de-addiction. The assessment of other substance abuse and the level of addiction to these would have given more meaningful results. The generalizability (external validity) of the study is limited to the participants treated in de-addiction centers as majority of these participants were self-selected with a willingness to quit the habit. The objective assessment was done only on a small number of participants in view of the financial constraints. This was done with the intention of correlating the objective assessment with Fagerstrom scale for tobacco and smokeless tobacco assessed by means of face-to-face interview (subjective assessment). Although the participants had both tobacco and alcohol habits, our assessments were restricted to check abstinence for smoking using Fagerstrom scale for nicotine dependence and urine cotinine assessment. We could not use any scales for assessing alcohol dependence.
| » Conclusion|| |
Although the overall abstinence from tobacco habits in the present study was low (8.5%), the intervention techniques were successful in reducing the level of addiction. However, these results may be regarded as short-term success rates. All the interventions were equally effective and there was no significant difference in their efficacy with regard to tobacco addiction.
We express our sincere thanks to all center authorities, participants, and counselors for their kind support in completing this project.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]