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Vol. 10. Issue 4.
Pages 217-218 (October - December 2017)
Vol. 10. Issue 4.
Pages 217-218 (October - December 2017)
Letter to the Editor
DOI: 10.1016/j.rpsmen.2017.10.009
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Professional training in motivational interviewing as a strategy to overcome the therapeutic nihilism in smoking
Capacitación profesional en entrevista motivacional como estrategia para superar el nihilismo terapéutico en tabaquismo
Omar Walid Muquebil Ali Al Shaban Rodrígueza,
Corresponding author

Corresponding author.
, Enrique Álvarez de Morales Gómez-Morenob, Sergio Ocio Leónc, Mario Javier Hernández Gonzálezc, Manuel Gómez Simónc, María Aida Fernández Menéndezd
a Servicio de Psiquiatría, Hospital Universitario San Agustín, Avilés, Asturias, Spain
b Centro de Salud Mental El Coto, Gijón, Asturias, Spain
c Centro de Salud Mental de Mieres, Mieres, Asturias, Spain
d Monash University, Melbourne, Australia
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Dear Editor,

Only 58% of healthcare professionals in Spain consider nicotine addiction to be a chronic disease. In spite of this, in our country these professionals are generally becoming increasingly involved in controlling and preventing nicotinism.1 In our surgeries we see one of the population segments with the highest rates of prevalence and for whom smoking is, if possible, more harmful2 (smoking more cigarettes per day, with higher plasma levels of nicotine and greater dependency than the general population, among other factors). I carefully read and reflected on the recent editorial in this journal, “Smoking cessation programs for individuals with schizophrenia: an urgent and unmet need”.2 We are able to use the whole pharmacological therapeutic arsenal now that the European Medicine Agency (EMA) has withdrawn its warning about the possible risk of suicide with varenicline. This is due to the results of the EAGLES3 study (a fact that now has to consolidate among professionals, as the warning given by the highest authority in clinical safety may be foreseen to be hard to revert). Studies are now available which accredit the efficacy and feasibility of intervening, especially in this population.4 The authors raised the challenge of asking what more would have to be done to motivate managers and doctors to cease old habits (along the lines of the always correct ethical reflections of Lolas-Stepke in this journal5). Smoking cessation should be included as a care objective at the level it deserves in terms of health and ethics (and efficiency for managers). However, among the barriers cited in this relevant editorial, we missed one that may be of key importance in overcoming these prejudices in care: training in motivational interviews, an approach that has proven its usefulness in many areas to encourage healthy behavior. Empirically it is a highly effective way of giving medical advice and improving compliance with therapy.6 We know how effective advice or short interventions are, as well as cessation rates using nicotine replacement therapy, bupropion and varenicline7 (always in combination with psychological and social support). Thanks to initiatives such as the Socidrogalcohol “Autumn School”, which runs workshops for beginners and more advanced levels in this field, healthcare professionals in different fields are developing the motivational spirit. Working on nicotine abuse means working on an addiction, and therefore involves working on a chronic condition. It is necessary to increase training in the field of addiction from university onwards, to overcome the stigma of care. It is also necessary to give professionals the tools they need to overcome the frustration of dealing with patients who have often been smoking for years and have never attempted cessation. They often seem (and in fact, are) impermeable or completely unreceptive to cessation advice,8 and there is an urgent need for the system to accept the need to attain the care goals proposed.

Regarding the cost of pharmaceutical therapies, we would like to add that there should be public and ideally universal coverage, although in these times of necessary spending controls it would seem to be common sense to concentrate on those patients for whom smoking is especially harmful; those with serious mental disorders, but without forgetting those at high cardiovascular risk (diabetics, those with ischemic cardiopathy or metabolic syndrome).

S. Solano, C.A. Jiménez, E. de Higes, M. García, F.J. Callejas, J.I. de Granda, et al.
Prevalencia, conocimiento y actitudes acerca del consumo de tabaco en los miembros de SEPAR.
Arch Bronconeumol, 52 (2016), pp. 605-610
M.P. García-Portilla, J. Bobes.
Programas de cesación tabáquica para personas con esquizofrenia: una necesidad urgente no cubierta.
Rev Psiquiatr Salud Ment (Barc.), 9 (2016), pp. 181-184
R.M. Anthenelli, N.L. Benowitz, R. West, L. St Aubin, T. McRae, D. Lawrence, et al.
Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial.
Lancet, 387 (2016), pp. 2507-2520
M.P. García-Portilla, L. García-Alvarez, F. Sarramea, G. Galván, E. Díaz-Mesa, T. Bobes-Bascarán, et al.
It is feasible and effective to help patients with severe mental disorders to quit smoking: an ecological pragmatic clinical trial with transdermal nicotine patches and varenicline.
Schizophr Res, 176 (2016), pp. 272-280
F. Lolas-Stepke.
Tendencias y necesidad clínica de los principios éticos.
Rev Psiquiatr Salud Ment (Barc.), 8 (2015), pp. 1-2
Grupo Español de Trabajo en Entrevista Motivacional (GETEM). ¿Qué es la entrevista motivacional? Available from: http://getem.org [accessed 15.07.17].
T. Rüther, J. Bobes, M. de Hert, T.H. Svensson, K. Mann, A. Batra, et al.
EPA Guidance on tobacco dependence and strategies for smoking cessation in people with mental illness.
Eur Psychiatry, 29 (2014), pp. 65-82
J. Bommelé, T.M. Schoenmakers, M. Kleinjan, G.Y. Peters, A. Dijkstra, D. van de Mheen.
Targeting hardcore smokers: the effects of an online tailored intervention, based on motivational interviewing techniques.
Br J Health Psychol, 22 (2017), pp. 644-660

Please cite this article as: Muquebil Ali Al Shaban Rodríguez OW, Álvarez de Morales Gómez-Moreno E, Ocio León S, Hernández González MJ, Gómez Simón M, Fernández Menéndez MA. Capacitación profesional en entrevista motivacional como estrategia para superar el nihilismo terapéutico en tabaquismo. Rev Psiquiatr Salud Ment (Barc). 2017;10:217–218.

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