Basic Skills for Working with Smokers
1. Module one: The Tobacco Problem and Public Health Perspective
Overview: Addiction to nicotine, or nicotine dependence, is the leading cause of illness and death in the United States. This module will provide an overview of the tobacco problem, including a perspective on public health approaches to tobacco control. We will take a look at the Massachusetts Tobacco Cessation and Prevention Program, and the tobacco treatment system that has been developed to respond to the tobacco epidemic. Finally, we will review the Public Health Service Clinical Practice Guideline on Treating Tobacco Use and Dependence which offers a clinical roadmap on how best to address tobacco dependence within our healthcare system.
Learning Objectives: After completion of this module, participants will be able to:
1. Discuss the history of tobacco use and abuse in the United States.
2. Describe recent US smoking prevalence trends.
3. Describe the Public Health Model and how public health officials can use this model in planning tobacco control strategies.
4. List the components of a comprehensive tobacco control program.
5. Discuss the major recommendations of the Public Health Service Clinical Practice Guideline on Treating Tobacco Use and Dependence.
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2. Module Two: Exploring Barriers and Facilitators to Change
Overview: Why is it so difficult for a person to stop smoking? Why is it so hard for a provider to intervene with a client/patient who uses tobacco? This module will explore the complex interplay of biological, psychological and social factors that contribute to the initiation and maintenance of tobacco use and make it so hard to change. Social Learning theory and the Stages of Change model will be examined as they relate to tobacco use. Finally, you will be asked to apply this information by completing a brief exercise that assesses a client's stage of change.
Learning Objectives: After completion of this module, participants will be able to:
1. Describe the social learning model of smoking cessation.
2. Discuss the reasons that providers find it difficult to intervene with a person's tobacco use.
3. Define and describe the Stages of Change model.
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3. Module Three: Developing an Understanding of Addiction
Overview: Nicotine dependence is increasingly being recognized as a chronic, relapsing condition similar to that of other addictive substances. Most who use tobacco want to quit but find it difficult because of the addictive nature of tobacco. Clinical approaches to dealing with tobacco should be grounded in a general understanding of addictions and specific approaches to tobacco treatment. This module will provide an overview of nicotine dependence and treatment strategies. We will explore the definition and nature of nicotine dependence, and review the DSM-IV criteria for nicotine dependence. Finally, a brief overview of treatment approaches will be reviewed.
Learning Objectives: After completion of this module, participants will be able to:
1. Describe the effects of addiction on individuals.
2. Define the key features of nicotine dependence.
3. Outline the various approaches for treating nicotine dependence
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4. Module Four: Using Pharmacotherapy to Help Your Clients Quit Smoking
Overview: Correct and appropriate use of pharmacotherapy, such as nicotine replacement therapy (NRT) , bupropion (Zyban) or Varenicline (Chantix), can double a person's chances of successfully stopping tobacco use. It is important to understand the biological basis of addiction and how pharmacotherapy can help break the cycle of addiction. This module will provide a brief overview of the actions of nicotine on the brain and the rest of the body, including both physiological and psychological effects. The concepts of tolerance, nicotine regulation and withdrawal will be explored. We will then look at the various types of pharmacotherapy available and present guidelines for proper use. Finally, you will be asked to apply this information to 10 hypothetical clients.
Learning Objectives: After completion of this module, participants will be able to:
1. Describe the physiological & psychological effects of nicotine.
2. Describe the absorption & distribution of nicotine, including concepts of tolerance & nicotine regulation.
3. List nicotine withdrawal symptoms according to the DSM-IV.
4. Describe various types of nicotine replacement therapy available, how they work & general guidelines for use.
5. Explain what Zyban is and how it works and how it is to be taken.
6. Explain what Chantix is and how it works and how it is to be taken.
7. Apply knowledge of the use of pharmacotherapy to 10 hypothetical clients.
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5. Module Five: Talking with Clients about their Tobacco Use
Overview: As health professionals we know that tobacco use is the leading cause of preventable death in the US, and damages the health and quality of life of all smokers. But it can often be frustrating and discouraging to try to help people give up tobacco use. It seems sometimes that the harder we work, the more the smoker resists our efforts to help. This module will help you to address your clients' smoking in a way that minimizes defensiveness and facilitates movement toward change.
Learning Objectives: After completion of this module, participants will be able to:
1. Identify biopsychosocial factors which impact the tobacco user.
2. Apply the Stages of Change model to clinical examples.
3. Describe the dynamics of ambivalence.
4. Articulate the underlying goals of counseling and the central principles of Motivational Interviewing.
5. Describe the six general principles of Patient-Centered Counseling.
6. Describe the concept of cultural competency and why it is a critical component of effective counseling.
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6. Module Six: Health Consequences of Smoking
Overview: Tobacco use is responsible for 440,000 deaths in the US every year, causing 1 out of every 2 smokers to die from a smoking-related disease. In addition, exposure to environmental tobacco smoke causes another 65,000 deaths due to coronary heart disease and lung cancer. This module will review how tobacco use affects the respiratory and cardiovascular systems and look at the major health consequences of smoking, including cancer, heart disease and lung disease. We will also explore the especially devastating health effects of smoking on women, infants, and persons who have diabetes or are pregnant. Finally, we will look at both short and long term benefits of quitting.
Learning Objectives: After completion of this module, participants will be able to:
1. Describe the anatomy of and ingredients in a cigarette.
2. Describe the health effects of second hand smoke
3. Discuss the effect of cigarette use on the respiratory and cardiovascular systems.
4. Discuss the effects of smoking on selected medical conditions.
5. Describe the leading health consequences of smoking.
6. List seven benefits of quitting smoking.
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7. Module Seven: Resources
Overview: This module will review key resources available to tobacco treatment counselors and provide information on the Massachusetts Tobacco Treatment Specialist Training and Certification program.
Learning Objectives: After completion of this module, participants will be able to:
1. List resources available to tobacco treatment specialists.
2. Identify key resources in tobacco control.
3. Describe the Tobacco Treatment Specialist certification process.
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8. Module Eight: Creating an Environment Supportive of Tobacco Treatment Services
Overview: Research has demonstrated that systems-level changes can be effective in increasing quit rates within health care agencies. The Public Health Service Clinical Practice Guideline recommends that every tobacco user be asked about their tobacco use status at every visit and offered assistance in quitting. This module will review the 5A model of brief intervention and look at those components that help institutionalize tobacco treatment. We will explore why something seemingly so simple to do can be so difficult to implement. Participants will develop their own tobacco treatment action plan to take back to their workplace.
Learning Objectives: After completion of this module, participants will be able to:
1. List the major guidelines available to guide efforts at institutionalizing tobacco treatment services within a healthcare agency.
2. Name and describe the 5As.
3. Describe 3 levels of cessation intervention.
4. List the components of a supportive environment for tobacco treatment services.
5. Complete an action plan to take back to your workplace that will help guide tobacco treatment planning efforts.
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9. Module Nine (Required for MassHealth Providers: Optional but Highly Recommended for All Other Providers): Conducting a thorough intake and assessment interview with a patient who smokes
Overview: Conducting a thorough intake and assessment interview with a patient who smokes is an important component of effective treatment planning. This module provides the basic foundation for the use of a 4 page Intake, Assessment and Treatment Planning tool that serves as a guide in working with the patient to assess the physiological, psychological and social aspects of an individual’s tobacco dependence. It is expected that each clinician will amend this tool and its use to best fit his/her practice.
Learning Objectives: After completion of this module, participants will be able to:
1. Describe how to assess a person’s smoking history in order to determine the level of nicotine dependence and appropriate recommendations for pharmacotherapy.
2. Identify the psychological, environmental and social factors that have maintained a person’s smoking or influenced their desire to quit.
3. Identify medical and psychiatric factors that influence the quitting process and treatment planning.
4. Determine the client’s level of readiness to quit smoking in order to customize counseling and potential quitting strategies.
5. Develop a treatment plan and/or referral based on the information gathered during an initial assessment which identifies the client’s level of nicotine dependence, stage of readiness to change, and strengths and barriers to quitting.
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© 2008 University of Massachusetts Medical School