integrating tobacco cessation treatment into practice statewide conference
TRANSCRIPT
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7/28/2019 Integrating tobacco cessation treatment into practice Statewide Conference
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IntegratingTobaccoCessationTreatmentintoPractice 4/22/2013
HeatherOsterbergAloi,MA,CTTSM 1
Heather Osterberg-Aloi, MS, CTTS-M
Senior Program Specialist
1. Participants will learn how to assess motivation to quittobacco use.
2. Participants will learn specific treatment strategies thatmatch the clients motivational level, including pre-contemplation, contemplation, preparation, action,
.
3. Participants will learn how to integrate motivationalinterviewing style and identify teachable momentsto provide personalized feedback with clients.
4. Participants will learn specific content that could beintegrated into patient education activities.
In collaboration with the client, identify specificand measurable treatment objectives.
Plan individualized treatments that account forpatient assessment factors identified during the
.
Collaboratively develop a treatment plan thatuses evidence-based strategies to assist the
client in moving toward a quit attempt, and/orcontinued abstinence from tobacco.
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Preparation Assessment
Tobacco Use History
Dependence Level
Motivation for change
Help them understand their tobacco use and the process ofquitting
e ei iv i
Action Teach specific strategies (i.e. medication, identifying trigger
situation and relapse prevention)
Success is Quitting and Staying Tobacco Free
Maintenance (Living As A Non-Smoker) Help client understand that maintenance of non tobacco use is
ultimate goal.
Learn to live as a non-smoker
Tobacco Use History History of Usage/ Time To First Cigarette Cigarettes Per Day Age at First Use/Regular Use Previous Quit Attempts (last 3)
Level of Dependence Fagerstrom Test for Nicotine Dependence Tobacco Use Self Assessment
Motivational Level Importance Confidence Scale Decisional Balance
1. Ask about tobacco use at each visit
2. Advise tobacco users to quit
.
4. Assist tobacco users to quit
5. Arrange for follow-up
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CO Score
Fagerstrom Score
Motivation Level
Money Spent
Medical Condition
Use of all Forms of Tobacco, NRT, etc.
Explore their first experience with tobacco use
Tell me about the first time you started smoking?
Why did they start?
Family Environment - Supportive vs. Discouraging
How did your parents react when they learned you were
smoking?
How does your significant other feel about your smoking?
A CO meter measures the amount ofcarbon monoxide in your body.
My CO reading is: __________
One of the most deadly chemicals found incigarettes smoke is carbon monoxide (CO).
When you smoke, you replace oxygen withcarbon monoxide in your blood. YOU
0-8: Normal to very low smoking orsecond hand smoking
8-12 Worryyou are affecting yourhealth
12-25 Cause for alarmyou areharming yourself
25-40 Dan er or hazard to ou health
ARE POISIONING YOURSELF!
The body needs oxygen to survive so theheart works harder to deliver oxygen. Thisputs smokers at greater risk for havingheart attacks.
CO is an odorless and colorless gas andeven though you cant see it, smell it, ortaste it, it can kill you. This is the reasonwe have C
O detectors in our homes.Environmental safety literature states thatCO readings above 36ppm pose seriousdangers to health and would evacuatebuildings at this level.
Over 40 Severe Dangertakeimmediate action
Great News: If you quit smoking, yourCO level will go back down to 0 and
you will begin to feel better. You willbe at the level of someone who neversmoked. Your heart and lungs willbenefit immediately and you will feelbetter.
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Give the client directions and reassure them that once youbegin you will remind them as they go along.
Sit up straight in the chair with both feet flat on the floor.
When I say go, you will take a deep breath and hold it for 15seconds. The machine will help you count down for 15seconds.
When it gets to zero, close your lips tightly around thecardboard tube and blow out (exhale) into the tube for aslong as you can.
Do not blow too hard or it can affect the reading by
disengaging the valve pin in the meter; just breathe outgently.
View output number and explain the reading to your client.
Actively smoking
Not thinking of making a change
In denial, maybe angry, defensive
I am not ready.I dont want to quit smoking.Im only here because my
Look to provide multiple interventions vs. single-episodetreatment
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Weighing the costs versus the benefits of smoking andidentify the ambivalence and move in the direction ofpositive change.
What are the good things about using cigarettes and whatare the not-so- ood thin s?
When you look at this list of pros and cons, what do youthink?
What do you enjoy most about smoking?
How might your life be better if you stopped?
Benefits of continuing to use tobacco Benefits of becoming tobacco free
Help Client Understand Their Own Reasonsfor Smoking or Not Smoking
Costs of continuing to use tobacco Costs of giving up tobacco
Still smoking- Ambivalent about stopping
Thinking of making a change
May look for the magic bullet cure
aug t etween es re to stop an ear o stopp ng
Feeling a sense of loss
Could become stuck in this stage
Assist them in finding alternative strategies
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Who in your life close to you uses tobaccoproducts and how will their use effect yourquitting?
How does others in your life feel about yourtobacco use?
Who can be supportive to you in your quittingprocess? (Not every non-smoker is supportive)
Whom do you know may potentially sabotageyour plans to quit?
How important is it for you right now tochange your use of tobacco?
On a scale of 0 to 10, what number would you give yourself?
.....not at all extremelyimportant important
A. Why are you at ___ and not at 0?
B. What would need to happen for you to get from _ to __?
How confident are you right now to changeyour use of tobacco?
On a scale of 0 to 10, what number would you give yourself?
0 ....10not at all extremelyconfident confident
A. Why are you at ___ and not at 0?
B. What would need to happen for you to get from _ to __?
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Relevance: How relevant to the tobacco user is quitting?
Risks: What are potentials risks from tobacco use?
Roadblocks: What are their personal obstacles to quitting
Repetition: Needed to facilitate change
Still smoking
Wanting to make a change
Has significantly resolved ambivalence
Motivated to stop
Ma tr to make smaller chan es reducincpd, a day tobacco free)
Willing to set a quit date
Preparing behaviorally, emotionally, and
physically to stop smoking Assist with disarming triggers and cues
Restricting smoking no longer smoking in thecar, or in your home only going outside maybe even for a walk
Substituting NRT for a cigarette -could useNRT gum or lozenge
Could also try going to Nic-A
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Setting a Quit Date
Talk to family and friends let them know you a re quittingtobacco products
Anticipate for setbacks
Remove all paraphernalia from the home, cars, etc.
Talk to your doctor about NRT
Stopped smoking
Smoker who is not smoking
Experiences desire to return to use
Follows concrete Stop Smoking Plan
Uses resources (Nic-A, 12 Steps, Group)
Use of NRT and/or Zyban
Practice the 4-Ds:
Delay
eep rea e
Drink water
Do something different
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Can identify relapse triggers and specificmeasures to cope with those triggers
Having made the change in behavior
And has incor orated into self
Im an ex-smoker. It was tough, but it was worth it.
Smoking is not an option
I cant have just one
Can occur anywhere along the recovery continuum,even after a period of abstinence
Is marked by a return to pattern of thoughts &behaviors associated with a previous stage
Return to ambivalence & conflicts
Loss of interest, commitment, motivation
A return to a previous stages thoughts or behaviors
You know, I thought I was ready but
Make an appointment to talk aboutquitting, including treatment options
Support the development of supportgroups here and in the community
LAHL, Quitters group, Nic-A
Become aware of other resources at cityand state level
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Tailor treatment to the individual
Different recovery for different clients
Evaluate current motivation
Match treatment to stage of motivation
Consider phases of treatment
Express Empathy
Develop a Discrepancy
vo rgumen a on
Roll with Resistance
Support Self-Efficacy
Use your OARS
Open-ended questioning
Affirmation
Reflective listening
Summarizing
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Desire: I want to change.
Ability: I think I can do it.
eason: can n s sc oo o
Need: I cant go on this way
Commitment: I will do whatever it takes
Link with other recoveries and behaviors
Impact on medical conditions
Effects on socialization
Financial costs of tobacco use
Carbon Monoxide reading and feedback Very impactful on clients Reality of daily impact of the behavior
Overall goal: gain knowledge and live a healthier lifestyle
Group facilitation, educational and motivational based
Role-plays, examples, assessment questions
,
Developed to help smokers at any motivational level to quit
Group I: LAHL for lower motivated
Group II: Quit Smoking for more motivated
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Can be used in a variety of clinical settings
Inpatient or outpatient
Clients can advance from Group to Group
Learn about related issues:
, ,
Sessions:
Individually or collectively
Risks associated with smoking, cigarette contents,
benefits of quitting, ways to quit smoking, CO testing etc.
Learn about related issues: Nutrition, physical activity, and stress management
Available for download:http://rwjms.umdnj.edu/addiction/documents/2012lahl.pdf
Steinberg, M.L., Ziedonis, D.M., Krejci, J.A., and Brandon, T.H. MotivationalInterviewing With Personalized Feedback: A Brief Intervention for Motivating Smokerswith Schizophrenia To Seek Treatment for Tobacco Dependence. Journal of Consultingand Clinical Psychology 72(4):723-728, 2004.
Ziedonis, D.M., Williams, J.M., Steinberg, M., Foulds, J. Addressing tobacco addiction inoffice-based management of psychiatric disorders: practical considerations. PrimaryPsychiatry13(2):51-63, 2006.
Boudreaux E.D., Baumann, B.M., Firedman, K., Ziedonis, D.M. Smoking stage of- .
Emergency Medicine 12(3): 211-218, 2005
Sobell, L.K. and Sobell, M.B. Group Therapy for Substance Use Disorders: AMotivational Cognitive-Behavioral Approach. New York ,NY: Guilford, 2011.
Toolkits for clinicians from The Alliance for the Prevention and Treatment of NicotineAddiction (APTNA): www.aptna.org/APTNA_Prov_Toolkits.html
Treating Tobacco Use and Dependence - Public Health Service Clinical PracticeGuideline (2008) Update:http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf