Tobacco Recovery amp Wellness Initiative Tony Klein MPA NCACII TonyKleinrochesterregionalorg Behavioral Interventions Tobacco Recovery Discussion Practical Counseling Methods amp Clinical ID: 1033913
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1. Community Behavioral HealthTobacco Recovery & Wellness Initiative Tony Klein, MPA, NCACII Tony.Klein@rochesterregional.orgBehavioral Interventions:Tobacco Recovery
2. Discussion Practical Counseling Methods & Clinical Objectives Recovery Oriented, Client Centered Strategy
3. Learning ObjectivesParticipants will: Be able to cite 2 fundamental components of evidence-based tobacco dependence treatmentIdentify counseling strategy to verify and bolster client motivationDescribe at least 6 coping techniques to assist with the development of a personalized tobacco recovery plan
4. Reframe LanguageUse language consistent to recovery culture, 12-Step teachings and therapeutic community principles Smoking Quit Date Cessation Tobacco Use, Hit, Fix Recovery Start Date Tobacco Treatment, RecoveryThe language we use is fundamental in creating environments conducive to a recovery process. – William WhitePublic Health/Medical Terms Preferred Terminology
5. Self-Determination TheoryThree Psychological Needs: Autonomy – freedom to choose Self-Efficacy – an inner sense of competence Relatedness – a connectedness to otherswww.psych.rochester.edu/SDT/theory.html Deci & Ryan, 1985“… when self-determined, people experience a sense of freedom to do what is interesting, personally important, and vitalizing.”
6. Readiness to Change BehaviorImportanceConfidence readiness(Knowledge) (Skills)
7. Tobacco InterventionsTwo Levels of Behavioral Counseling to Match Intervention to Client Stage-Readiness:Cognitive) Engagement Develop Interest Highlight Importance Advance Stage-Readiness Tobacco AwarenessTobacco RecoveryBehavioral Learn Coping Skills Elevate Confidence Embrace Lifestyle Change Always with Pharmacotherapy
8. Tobacco Counseling MethodsWhen to Use MI When to Use CBT(Tobacco Recovery Counseling)
9. Tobacco Recovery Counseling Identify and thoroughly process motivation Determine severity of physical dependence; pharmacotherapy plan Develop a strategy for replacement behavior/ coping skills / relapse prevention Goals Methods Cognitive Behavioral Therapy Person-Centered Approach Relapse Prevention Counseling Pharmacotherapy
10. Components of CBT ProgramGottlieb, J. Harvard Medical School, 2007 (Modified) Psychoeducation Tracking and Understanding Tobacco Use Behavior Learning about and Coping with Triggers Reasons to Use Tobacco and Reasons for Tobacco Recovery Using NRT/Learning about Medication Coping with Physical Cravings and Withdrawal Assertiveness Training Setting Goals and Self-Reward Relapse Prevention Strategies “Recovering” Identity
11. Stages of Readiness to ChangeProchaska & DiClemente Transtheoretical Model, 1983
12. Tobacco Recovery Counseling1) Verify and Bolster Autonomous Motivation (intra-treatment social support) Always start by asking the client to express his/her personal reasons for tobacco abstinence: “How is your life going to be better tobacco-free?” Use reflective listening to process client disclosure Suggest development of a “personal slogan” to symbolize and reinforce motivationEmotionally prepare to “end relationship”
13. Tobacco Recovery Counseling2) Define Tobacco Recovery / Develop a Personalized Treatment Plan to Address 3 Aspects of Tobacco Dependence Physical – severity of nicotine dependence Behavioral – habit / environmental factors Emotional – mood-regulating factors;“relationship”
14. Tobacco Recovery Counseling3) Teach Recovery Tools (problem-solving skills training) Physical Reasons for and proper use of pharmacotherapy Diet recommendations Relaxation techniques Physical exercise Cognitive behavioral craving management interventions
15. Reducing Caffeine Helps Caffeine is 99% metabolized by CYP1A2 Clearance is increased by 56% in smokers Median caffeine concentrations are 2-3x higher in non- smokers When a patient quits smoking, their caffeine intake should be reduced by ½ to avoid excessive caffeine levels Symptoms of caffeine toxicity can mimic those of nicotine withdrawalClinical Pharmacokinet 1999; 36:425-38
16. Tobacco Recovery Counseling3) Teach Recovery Tools (problem-solving skills training) Behavioral Structured “a day at a time” recovery plan Menu of replacement activity / coping skills Identify and address barriers Plan for challenging events/environments PA Free Quitline 1-800-QUIT-NOW 1-800-DEJELO-YA
17. HALTHungryAngryLonelyTired Modify Behavioral Patterns Daily Ritual – Add Recovery Supports Home – Rearrange Furniture Strategy for High Risk SituationsReplacement Activities High Energy Low Energy Alternate Plan
18. Enhance Confidence/Self-Efficacy Clean Interior / Tobacco Free Setting Commit to abstain “while in vehicle” Keep cigarettes out of reachHave replacement “hand to mouth” aids – water bottle, dental pic, sugar-free lozengesConsider alternate routeAcknowledge process of reinforcement Learn to Drive a Vehicle Tobacco-Free As we reinforce new behavioral patterns, old patterns fade
19. Enhance Confidence/Self-Efficacy Attend a Sober Support Meeting Tobacco-Free Go with a non-smoking friend Arrive late, leave early Affirm commitment to abstain prior to meeting Have replacement “hand to mouth” aids – water bottle, dental pic, sugar-free lozenges Share tobacco-free goal with sober support network Gradually extend activity time As we reinforce new behavioral patterns, old patterns fade
20. Craving ManagementStartEndPeakTime Line
21. Craving ManagementStartEndPeakTime Line End
22. Craving ManagementStartEndPeakTime Line “This too shall pass”
23. Craving ManagementStartEndPeakTime Line “This too shall pass” Change Setting Shift Focus Call a Friend Music / Arts & Crafts Cold Shower Physical Exercise Relaxation Breathing Meditation/Prayer Fresh Fruit NRT As we reinforce new behavioral patterns, old patterns fade
24. Tobacco Recovery Counseling3) Teach Recovery Tools (problem-solving skills training)Emotional Highlight the benefits of being tobacco free Journaling Grief counseling Prayer, meditation Recovery support network, community support social media, Nicotine Anonymous, etc. (extra-treatment social support)
25. Relapse Prevention CounselingManaging Relapse (return to tobacco use) Relapse is a common tobacco use disorder symptom - no need to be ashamed or embarrassed A return to use indicates a need to modify a tobacco recovery plan (“If Plan A doesn’t meet your needs, let’s develop Plan B!”) Provide a behavioral analysis to identify internal and external warning signs Plan B to enhance an individualized strategy to manage the early warning signs (solution-focused) Miller, W.R.; Harris, R.J. Simple scale of Gorski's warning signs for relapse Journal of Studies on Alcohol, 61(5):759-765, Sept 2000
26. Tobacco Recovery Counseling
27. Tobacco Withdrawal Symptoms SymptomCauseDurationReliefChest tightnessSore muscles fromcoughingA few daysRelaxation techniques Deep breathing Constipation, stomach pain, gasIntestinal movement decreases1–2 weeksDrink plenty of fluidsAdd fruits, vegetables, and wholegrain cereals to dietCough, dry throat, nasal dripThe body is getting rid ofmucus from blockedairwaysA few daysDrink plenty of fluidsDifficulty concentratingThe body needs time to adjust to not having constantstimulation from nicotineA few weeksPlan workload accordingly Avoid additional stressDizzinessThe body is getting extraoxygen1–2 daysUse extra cautionChange positions slowlyFatigueNicotine is a stimulant2–4 weeksTake napsNRT may helpHungerCravings for a cigarette can be confused with hunger pangsUp to several weeksDrink water or low-calorie liquids and snacksInsomniaNicotine affects brain wavefunction and influences sleeppatterns; dreams about smoking are common1–2 weeksLimit caffeine intakeRelaxation techniquesIrritabilityCraving for nicotine2–4 weeksPhysical exerciseRelaxation techniquesAdapted from Materials from the National Cancer Institute
28. Final Thoughts Provide a client-centered, individualized tobacco recovery plan that focuses on skill development Maintain an objective, collaborative, non-judgmental therapeutic alliance Normalize post acute withdrawal symptoms “More” is better – frequency & duration of interventions Always reinforce the benefits of being alcohol, tobacco and drug-free