Many alcoholics who go into hospital to detox face a massive challenge - they're also not allowed to smoke on DHB grounds.
But letting them smoke e-cigarettes in the ward could be a solution, a new study from Capital & Coast District Health Board and Massey University has found.
The research, published todayin the New Zealand Medical Journal,
was led by Dr Penelope Truman from Massey University's School of Health Sciences, with community specialist detox nurse Moira Gilmour and physician Dr Geoffrey Robinson from the Capital and Coast District Health Board.
More than 40 patients were surveyed at Kenepuru Hospital in Porirua, in two cohorts between 2013 and 2016.
All were alcohol-dependent, drinking an average of 20 standard drinks a day, and were mostly heavy smokers. They had been admitted for five to six days for medically-supported alcohol withdrawal.
One group was offered nicotine replacement therapies like patches and gum, while the other was also given the option of smoking vaporless e-cigarettes inside the ward.
Both groups had very similar, and significant, drops in smoking cigarettes while in detox. But the real difference was in how they felt about the therapies.
Patients in the control group were "politely positive" about patches and gum, the researchers said.
But those who used e-cigarettes were enthusiastic - saying "they really helped me to cut down", "liked not going outside to smoke" and "much better than patches and gum". Several also seemed more confident about quitting smoking in the future.
Smoking is banned on the grounds of some DHBs including Capital and Coast. But quitting smoking while detoxing is too stressful for most alcoholics, Gilmour said.
"The health effects they garner from not smoking are huge - it's an essential part of their long-term health. But the opposite side of the coin is in the first part of their treatment it can be one step too far."
Smokers resort to nicotine patches, gum, or heading out to the street with a nurse to have a puff. But this presents its own dangers.
"It actually makes them very vulnerable," Gilmour said. "These are people who are unwell enough to require medically-managed withdrawal. That puts the onus on nurses or the hospital to make sure they are safe."
On their first day of detox people may turn up drunk and immediately want a cigarette, and other patients are on medication.
Both risk falls or other dangers when they go outside, and nurses must leave their other patients to accompany the smokers, adding to the stress of their job.
Nurses worried at first about the effect on other patients but were "pleasantly surprised" by the results, Gilmour said.
The authors said the small trial showed e-cigarettes could help manage patients who smoke and should be explored, both in detox and at mental health units to avoid at-risk psychiatric patients having to leave hospital grounds.
E-cigarette use is not illegal but they are banned on the grounds of some DHBs.