Basics of Tobacco Cessation

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Basics of Tobacco Cessation

• Intervening with tobacco users in a systematic
  way, consistently identifying tobacco users and
  delivering an appropriate intervention with every
  user will significantly increase the number of
  clients who quit using tobacco

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Tobacco use is the chief preventable cause of
illness and death in our society

• 14,000 Drugs
• 17,000 AIDS
• 19,000 Homicide
• 30,000 Suicide
• 41,000 Motor Vehicles
• 81,000 Alcohol
• 436,000 moking

Smoking-Attributable Morbidity Mortality and
Economic Costs, CDC, 2002
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Smoking Related Diseases

• In addition to being a strong factor in the
  development of lung cancer, cigarette smoking
  also increases the risk of a number of other
  cancers, including mouth and throat cancers,
  bladder, pancreatic, cervical and kidney cancer.
• Cancer is not the only disease caused by smoking.
  It also causes most cases of COPD (chronic
  obstructive pulmonary disease), and some 90
  percent of COPD-related deaths are caused by
  smoking. Heart disease and strokes are often
  linked to smoking, and a number of childhood
  diseases and conditions are linked to smoking
  during pregnancy and/or secondhand smoke.

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Why dont they just quit?

• Approximately 50 of current smokers reported
  making a serious attempt to quit during the last
  year
• Nearly 80 of all current smokers indicate that
  they want to quit smoking
• The causes of tobacco dependence are complex and
  vary somewhat from person to person
• Biological
• Cultural
• Psychological

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Biological Factors

• True drug dependence on nicotine
• Nicotine affects essential brain structures
  associated with feelings of award and arousal
• These changes persist long after use stops
• Learned behaviors that form tobacco use patterns
• Withdrawal symptoms and cravings

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Psychological Factors

• Reinforced, conditioned drug taking behavior
• Habit, automatic behavior
• A coping mechanism for stress, lonely, bored,
  happy, angry
• Self medicate for depression, anxiety

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Cultural Factors

• Group identity
• Social activity
• Cultural Practice
• National marketing by the tobacco industry versus
  having a primary care giver ask and advise

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Who Is Ready To Quit?

• Not everyone who uses tobacco is ready to quit
• Most have tried, some multiple times
• At any given time 20 are ready
• 40 are thinking
  about it
• 40 are not ready

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The Readiness to Change Model
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Readiness to Change Model

• Not Ready to Quit Has no intention to quit
  within the next 6 months
• Thinking About Quitting Intends to quit within
  the next 6 months
• Ready to Quit Is willing to set a Quit Date
  within the next 30 days
• Quitting Has remained tobacco free for less than
  6 months
• Staying Quit Has remained tobacco free for more
  than 6 months
• Relapse Is using tobacco again after a period of
  being tobacco free
• Because tobacco dependence is a chronic
  condition, tobacco users typically cycle through
  multiple periods of relapse

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The 5 A s

• Ask, Advise, Assess, Assist, Arrange
• A brief tobacco intervention
• Relevant to the person receiving it
• Should include both the risks of using tobacco
  and the rewards for quitting
• Should be repeated to encourage tobacco users to
  quit and allow for changes in their readiness to
  quit

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Ask

• Ask about tobacco use at every encounter with
  every person
• Displaying visible messages makes asking about
  tobacco use a normal and expected part of each
  patient encounter
• Include tobacco use as a vital sign
• Have you ever used tobacco?
• Do you use tobacco now?
• Does anybody else in your home use
  tobacco?
• I

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Advise

• In a clear, strong, and personalized manner,
  advise every tobacco user to quit
• One of the best things you can do to improve
  your health and the health of your family is to
  quit smoking. We can help.
• Personalize the message by tying tobacco use to
  the persons motivation
• 
  Health Status
• 
  Impact of their tobacco use on others
• Pregnancy
• Costs
  social and economic

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Assess

• Determine the tobacco users willingness to make
  a quit attempt at the present time
• Have you thought about quitting tobacco?
• When do you think you might be ready to
  quit?
• Are you willing to quit in the next 30 days?
• Provide information specific to that person

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Assist

• Tobacco users who are willing to make a quit
  attempt need help in developing a Quit Plan
• Setting a Quit Date
• Identifying social support
• Providing specific problem solving
  suggestions
• Giving information about medications
• Providing self-help materials
• Referring to intensive services if
  interested
• Assist the tobacco user who is not ready to quit

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It is not necessary or helpful to try to talk
someone into quitting

• People who are unwilling or unready to quit to
  make a quit attempt may be ready next time
• Avoid being judgmental or trying to pressure the
  tobacco user into quitting
• Offer written materials that emphasize the
  benefits of quitting
• Provide a brief motivational intervention using
  the 5 R s

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5 R s

• Relevant information
• Risks
• Rewards
• Roadblocks
• Repetition promotes effective outcomes

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Arrange

• Arrange for follow-up whenever possible
• Within a week for a tobacco user making a
  quit attempt
• Ask about tobacco status
• Congratulate people who are tobacco free and
  support them in staying Tabasco free
• Support people who have relapsed and assist them
  in making a new quit attempt

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2 A s and R

• Ask
• Advise
• Refer

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Motivational Interviewing

• A directive client-centered counseling style for
  eliciting behavior change by helping clients to
  explore and resolve ambivalence
• Motivation to change is elicited from the client
• It is the clients task to articulate and resolve
  their ambivalence
• Stages of Change Model Precomtemplation
• Contemplation
• Preparation
• Action
• Maintenance
• Relapse
• Eliciting change talk results in the client
  hearing themselves advocate for their own change

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Our job is to help facilitate clients moving to
the next stage

• Open-ended questions
• Affirm
• Reflect what has been said
• Summarize
• Desire
• Ability
• Reasons
• Need
• Steps taken
• Commitment
• Developing discrepancy and increase motivation
  for change
• This really works

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Psychiatric Nurse Counseling Points

• Breaking Barriers and Implementing Changes
• The Significance of Tobacco Dependence in
  Persons with Mental Illness July 2010, Vol
  1, No 1
• Delivering Effective Pharmacologic and
  Nonpharmacologic Interventions for Tobacco
  Dependence in Persons with Mental Illness
• September 2010, Vol 1, No 2
• Treating Tobacco Dependence in Persons with
  Mental Illness Identifying Challenges and
  Opportunities
• December 2010, Vol 1, No 3

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Resources

• Ohio Quit Line 1-800-QUIT-NOW
• 784-8669
• The Breathing Association 614-437-1511
• Laura Atkinson, Tom Houston, Gretchen Clark
  Hammond
• Association for the Treatment of Tobacco Use
  Dependence
• Center for Evidence Based Practices 216-398-3933
• Tobacco Recovery Across the Continuum
• And the usual suspects . . .