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بررسی پروتکل درمانی در ترکیه

Data reported in this study were collected in two phases.  During the first stage, we acquired a list of patients who had undergone auricular therapy using the R.I.S.E. protocol at IQS Centers in Istanbul.  Demographic and outcome data for patients who had undergone treatment over the past three years (2006 – ۲۰۰۸) were obtained. During the first phase, we reviewed data that clinicians at the treatment center had obtained including the following: patients’ age, gender, and educational level; number of treatments received; and smoking behavior (e.g., duration of smoking behavior and number of cigarettes smoked per day). During the 2nd phase, members of our research team contacted each patient (143 female and 172 male patients) and acquired additional outcome data including current smoking behavior (i.e., is the patient smoking cigarettes and, if he or she has resumed smoking, how many cigarettes is the patient smoking per day) as well as treatment satisfaction. Data analyses, using statistical software, were carried out to determine the effectiveness of the treatment as well as relation between specific variables of interest and outcome (e.g., the relationship between the number of treatments received and outcome, and the relation between the passage of time since the treatment was administered and current smoking behavior). Demographic and outcome data for 315 patients (143 female and 172 male) who had undergone auricular treatment (i.e., the RISE program) over the past three years (2006 – ۲۰۰۸) were analyzed.  The mean age of the patient group was 39.5 years and patients had attained a mean educational level of 14.6 years.  Note that male and female patients did not differ in age or educational level.  However, pre-treatment assessment revealed that male patients smoked more cigarettes per day (mean = 29.7, SD = 13.2) in comparison to female patients (mean = 25.9, SD = 10.8).  Gender groups did not differ, however, in the duration of the smoking habit (i.e., number of years they have been smoking cigarettes).  Moreover, there was no relation between the age of the patient and the daily smoking rate.  The majority of patients (56.8 %) received one treatment; however, a substantial number of patients participated in more that one treatment session (26.7 % received two treatments; 12.1 % received three treatments; 3.5 % received four treatments; and 1 % participated in five treatment sessions).  Note that male and female patients did not differ in the number of treatments received.  There was a relationship between educational level of the participant and the number of treatments required.  Patients with only a primary school education received more treatments.  There was no relation between the age of the patient and the number of treatments requested.  Moreover, there was no association between the number of treatments requested and the patient’s daily cigarette consumption rate.  Similarly, the duration of the addiction (i.e., number of years patient has smoked cigarettes) was not associated with the number of treatments requested.  A substantial number of patients (49.2%) reported that they were satisfied with the treatment received, while a small number of patients (4.8%) reported that they were satisfied with the treatment only during the therapy period.  A significant number of patients (46%) were not satisfied with the therapeutic intervention.  A noted above, a member of our research team contacted patients and obtained smoking behavior data.  We found that 138 patients (43.8%) reported that they were not currently smoking, while 177 patients (56.2%) reported that they were still smoking cigarettes.  Thus, auricular therapy (i.e., the RISE program) compares favorably to established therapeutic approaches.  Of course, a placebo-controlled research study must be carried out before we can conclude that auricular therapy is responsible for the aforementioned quit rate.  Also, note that patients were contacted a varying points in time (i.e., the amount of time between the treatment session and the contact point varied).   There was no relationship between smoking status (i.e., currently smoking or not smoking) at follow-up and the patient’s gender, age, educational level, duration of addiction, daily pre-treatment smoking rate.  Patients responding favorably to auricular therapy employing the RISE protocol and patients failing to respond did not differ on the following variables:  gender, age, educational level, pre-treatment smoking rate (i.e., number of cigarettes smoked per day), duration of addiction, and the number of treatment sessions.  Interestingly, there was an association between the passage of time and the recommencement of smoking behavior; however, a substantial number of patients reported that they were not smoking cigarettes smoking even after a significant amount of time had passed (i.e., the amount of time between the treatment session and the contact point). It is important to note that a member of our research team contacted patients who had undergone auricular therapy (i.e., the RISE protocol) after varying amounts of time had passed since the patient received treatment.  For example, one patient may have undergone treatment three months before the outcome interview took place, while a 2nd patient may have received treatment one year prior to the outcome interview.  Thus, outcome data were organized is the following manner:  a patient was assigned to one group based on the amount of time that had passed (i.e., between the final treatment and the outcome interview).  For example, all patients contacted three months after undergoing treatment were assigned to one group, while patients contacted six months after receiving auricular therapy were assigned to a separate group.   Hence, we were able to determine whether there was an association between the passage of time (since undergoing treatment) and the quit rate.  Analysis revealed that a substantial number of patients (77.3 %) were not smoking cigarettes when contacted at the 3-month point; however, the quit rate dropped to 36.4% after 27 months.  Moreover, we assigned patients to the following groups and carried out further analyses:  ۱) patients contacted one year after undergoing treatment; and 2) patients contacted two years after having received treatment.  Again, analysis revealed that a significant number of clients (61.1%) had stopped smoking at the one-year contact point, and a sizable minority of patients (34.2%) had stopped smoking at the two-year contact point.  As noted above, a member of our research team contacted different patients at varying points in time.  In addition, a clinic employee contacted patients at varying points of time (i.e., contacted the same patient and determined smoking status at varying points of time).  We reviewed the data acquired by clinic employees and carried out the following analysis.  First, we determined smoking status at specific contact points (e.g., one week after treatment or four months after treatment). Second, we identified 63 patients contacted on specific dates.  Third, we determined the smoking status of the 63 patients.  Analysis revealed that 51 of 63 patients (80.9%) reported that they had stopped smoking when contacted one week after undergoing auricular therapy.   A significant number of patients (47.6 %) reported that they were not smoking at the four-month contact point.  Clearly, abstinence rates dropped as the length of time between treatment and the outcome interview increased; however, abstinence rates were still quite robust.  Did patients reporting that they had not stopped smoking or had resumed smoking demonstrate a reduction in the number of cigarettes smoked per day?   To answer that question, we compared pre-treatment and post-treatment daily consumption rates.  Analysis revealed that the mean number of cigarettes smoked per day dropped from 29.9 (pre-treatment) to 22.2 per day (post-treatment).  Although, our analyses suggest that auricular therapy (RISE program) compares favorably to established intervention strategies, we cannot conclude that alterations in smoking behavior were due to the treatment received.   Methodologically sound, placebo-controlled research must be conducted before we can confidently state that auricular therapy (RISE protocol) is an effective approach.  Our research group, led by Associate Professor Ayse Aycicegi-Dinn (Chairperson of the Experimental Psychology Program at Istanbul University), is currently pursuing such research and the study is in the data collection phase.