Tobacco Cessation Part 1


This episode was pre-recorded as part of
a live continuing education webinar. On demand CEUs are still available for this
presentation through ALLCEUs. Register at ALLCEUs.com/CounselorToolbox. Hey there everybody and welcome to
today’s presentation of management of tobacco use or nicotine dependence or
whatever you want to call it part 1 today we’re going to be talking about
really practical tips and tools this is a three part series the second part of
the series is really going to be focused on clinical interventions techniques
that counselors can use to enhance motivation yada-yada and the third
component is really going to focus on resources that are available as far as
workbooks and psychological interventions as an medication so you
know the actual interventions or the third part so just kind of so you know
how this is going to lay out over the next three sessions this is based in
part on the VA Department of Defense guidelines for treating tobacco use and
dependence in this presentation you’re going to gain information on the
assessment of tobacco use a little bit identify clinical interventions that we
can use for patients willing and unwilling to make a quit attempt at this
time remember I talked about we’re going to use some real practical tools today
we’ll examine systems interventions for healthcare administrators insurers and
purchasers we’re going to look at that more next week or in the next session
and then we’ll explore information relevant to specific populations so why
do we care well you know hopefully you just care because that’s the right thing
to do but clinicians mental health clinicians nurses social workers doctors
whatever can make a difference with even a minimal intervention less than three
minutes for some people you know if they’re sitting there on the fence and
they’re thinking you know what I might want to do something but I don’t even
know where to start all we have to do is go here here’s where to start and
they’re like oh okay thank you now they recognize that it’s going to be a
long process but if you can help get people kind of navigated in the right
direction and feel like they’ve got support that’s awesome a relation exists
between the intensity of intervention and the cessation outcome so if you’re
using really intense intervention where you’ve
got somebody checking in or touching base once a day that’s obviously going
to theoretically be more effective than somebody who is not using any nicotine
replacement not using any medications and only doing once a week counseling
even when patients are not willing to make a quit attempt at this time
clinician delivered brief interventions enhance motivation and increase the
likelihood of future quit attempts we’re going to talk a lot about that those
clinician delivered brief interventions on in the next presentation and tobacco
users are being primed to consider quitting by a right wide range of
societal and environmental factors so they’re primed if they’re ready to go if
they’re in that contemplation or even preparation stage of change that is
fabulous lets you know strike while the iron’s
hot and see if we can help them make that next step and be successful there’s
growing evidence that smokers who receive clinician advice and assistance
with their quitting report greater satisfaction with their health care than
those who don’t and sometimes we think you know these people have probably
heard over and over and over again that they shouldn’t smoke got it yada yada so
maybe I just won’t bring it up cuz they know it’s bad for them well yes they
know it’s bad for them but if you indicate that you care you know that’s
one of the things that you’re going to really be able to use in terms of
enhancing motivation tobacco use interventions are cost effective you
know using nicotine replacement therapy and medications and even counseling even
intensive counseling in the long run is far more cost-effective than dealing
with the side effects if you will of smoking I mean obviously buying
cigarettes or rum dip or whatever it is is not cheap but you also are preventing
or reducing the risk greatly of things like emphysema and cancer so those are
all wonderful things that will reduce the overall hell
of care costs in the long haul tobacco use has a high case but fatality rate up
to 50% of long-term smokers will die of a smoking caused disease and you would
be surprised or maybe you wouldn’t at all the different cancers and diseases
that smoking or using nicotine products can cause so just something that you can
explore three truths about tobacco use all tobacco products not just cigarettes
exact debit a devastating costs on a nation’s health and welfare okay we know
that for most users tobacco use results in true drug dependence so this is not
something somebody can wake up in the morning and easily say you know what I’m
not going to use anymore and never have another craving now does it happen
sometimes maybe the majority of people when they decide that they are going to
quit they are physiologically dependent on those substances so there is going to
be a withdrawal period and this dependence is comparable to the
dependence caused by opiates and fetta means and cocaine you know just kind of
let that set in for a second tobacco is not just some easy-peasy drug to quit is
one of the hardest drugs to quit actually both chronic tobacco use and
dependence warrant clinical intervention and as with other chronic disorders
these interventions may need to be repeated so basically that saying don’t
be surprised or disheartened if the person relapses once or slips once you
know then we want to look back at it and go okay what did we miss what triggers
did we miss where was the strain too much and you just gave into those old
habits so variables to consider when we’re
really talking to people about whether they’re ready to quit and these are
variables for people to consider to about whether they’re ready to start
making this change because it is hard and it is very very hard every person in
my family smoked my mom my dad my grandparents and you know I watched most
of them try to quit and it was you know really really difficult so you know I’ve
seen it I get it so the person has to have high motivation and motivation is
weird because it wanes it waxes and wanes some days you’ll be like gung-ho
and other days you’ll be just like no I’m not feeling it today and that’s okay
that’s expected the key in change planning is to prepare for those low
motivation days and figure out how to ramp up your motivation again so you can
say you can do it if you’re more ready to change you recognize it’s a problem
you recognize it’s not you know working to help you achieve your long-term goals
those are things that are gonna help you feel ready to change if you recognize
that there are interventions that can be helpful and that can be you know I don’t
want to say not painful but they can make the withdrawal process easier you
know that’s gonna increase readiness for change so we’re going to talk a lot
about that in a few minutes the person needs to have moderate to high
self-efficacy if they have a can-do attitude or at least a I think I can
attitude that’s wonderful you know let’s work from there if the
person says I think I can that’s awesome and then we can start asking what things
make you wonder you know keep you from going from I think – I know I can do
this and let’s address those and people who have a supportive social network are
also at higher likelihood of success if they’re not living in a household with
other people who smoke if their friends who may still smoke are willing to not
smoke around them if they have people who are willing to try quitting at the
same time you know there are all kinds of ways that you can in
Hance social motivation relapse rates are higher for people with high nicotine
dependence people who are more like three pack a day smoker x’ as opposed to
you know an occasional cigarette people who have psychiatric comorbidity and/or
substance use if they are currently experiencing neurotransmitter
disruptions for lack of a better word you know some people smoke when they’re
stressed some people smoke when they’re depressed some people smoke when they’re
anxious you know so we’re gonna talk about the reasons people smoke but if
they’re not addressing this underlying reason for use they’re gonna be at much
higher risk of relapse you can’t just stop smoking if that’s your coping skill
and not put something else in there you’ve got to have a behavior to replace
it people with high stress levels even if they don’t meet the criteria for a
mental health disorder or whatever if they are high-strung and tend to have
high stress levels they are at greater risk of relapse because a lot of times
people smoke to reduce stress and exposure to other smokers you know if
you work in a bar and people smoke either in the bar or you know right
outside the doors you know there are a lot of environmental factors that can
make somebody at higher risk for relapse now that doesn’t mean you know well I’ve
got all of these I might as well not even try no it just means we got a plan
for these so if somebody has high nicotine dependence we want to make sure
that they talk with their doctor about ways to handle that withdrawal to
minimize the unpleasantness of the withdrawal period psychiatric
comorbidity if they’ve got depression or anxiety we need to make sure they’ve got
resources to deal with that and they’re learning new skills to deal with that as
opposed to smoking so they’ve got something to put in its place
a good stress management plan should be in place before the person starts trying
to quit smoking ideally we want to make sure people have all of their resources
kind of shored up before they start to try quitting so we want to make
that got the stress management plan in place and we want to make sure that they
have figured out where their social support is and how to handle other
smokers and exposure to smoke you know this all goes in pre change planning I
want to make sure that they’re trying to consider the changes so motivational
enhancement and again some of the things we’re going to talk about in the next
section really focus on educating people about the impact of smoking most smokers
and people who use nicotine products are well aware of the impact of these things
on their health so you know really hammering them with it isn’t going to do
any good and it may actually be kind of off-putting so we want to ask the person
who comes in and indicates that they might be thinking about quitting why do
you want to quit what do you think the benefits are and encourage them to look
at the rewards like they’ll get their sense of smell back and maybe their
taste sense of taste will improve they won’t have the yellow fingers you know
whatever it is that works for them risk reduction you know encourage them to
look at you know if you quit you know are there health benefits physical
health benefits that you see is positive other rewards can also include financial
rewards because you’re not having to pay a higher premium for health insurance
and you know you’re also not buying cigarettes so think about how much extra
money you’re gonna have so just encourage them to brainstorm all the
different rewards that might come from quitting that are rewarding to them you
know I can just roll off a litany of things but they may be like yeah I don’t
really care about that so I want to know what’s rewarding to you why are you
deciding to change and why now you know why not six months from now why not six
months ago why now what’s changed that is prompted
you to go I’m ready to do this the other thing we can ask them about
is what I abbreviate is RML a rich and meaningful life in what ways does
stopping smoking help you the person get closer to your vision of a rich and
meaningful life maybe it means you know if you stop smoking you’ll be able to
start running marathons again or you know do cross-country hiking or whatever
it is you do because that sounds like a lot of fun but right now you just can’t
do it because you know your lungs are in too bad of shape
for whatever it is maybe you envision living to a ripe old age to see your
great grandkids in your rich and meaningful life well stopping smoking
increases the chance that you will be protected from a lot of the health
problems so there are a lot of ways to elicit the reasons you want to quit and
you know the person who’s getting ready to quit ideally would share this with a
support person you know whether it’s their spouse or their best friend or
their counselor so we can talk about why they want to quit and we can both get
excited about it the next step and a lot of people kind of miss this is why do I
use why do I use these products some people will say for mental reasons it
helps with concentration obsessive thoughts or cravings you know I think
about I need to have a cigarette or or whatever and they can’t get that out of
their head and some people use it mentally I put rationalizing here
because they have reasons why they have to use so we want to address all those
you know if it helps you concentrate in what way does it help you concentrate
and what else have you done besides smoking to help you concentrate
we’ll talk about techniques for handling obsessive thoughts and then you know a
lot of times I’ll have people write down all their rationalizations for
continuing to smoke and then they will go through for themselves and debunk
each one of those rationalizations emotionally some people use out of
boredom you know might as well have a cigarette I’m just sitting around doing
nothing some people use and we talked to
this earlier because of what I call dysphoria anger anxiety stress
depression any of those unpleasant emotions okay again what do you do other
than smoke in order to deal with these things or what have you done in the past
or could you do do you think to deal with these things so encourage people to
start brainstorming what can I do when I start feeling bad besides using nicotine
products environmentally you know you want to remove as much access as
possible because some people use just because it’s there you know you know
your friends smoking you might as well smoke too and environmental triggers and
these can be seeing people on TV smoking these can be seeing other people in your
office smoking walking past the smoking patio sitting around the dinner table
after dinner there’s a lot of environmental triggers smells if you
smell smoke that can be a trigger it can be a trigger if you usually smoke when
you’re drinking alcohol a lot of different things so you want to be aware
or encourage people to be aware of their triggers that make them start wanting to smoke and
then we need to ask them you know to use mindfulness at this point to go okay you
know I’m having this thought that I want to smoke right now what can I do instead
or what am I really needing you know if you’re bored then what else could you do
some people use for physical reasons because they are nicotine dependent and
the withdrawals are really pretty miserable
okay well that’s addressable some people use because they think it helps with
their pain conditions and some people use for weight management they think it
works more as a appetite suppressant and some people continue to smoke because
they’re afraid of weight gain and then social reasons people use can include
things like peers that smoke you know they want to hang out with their friend
dying break time at work and their friend always smokes so they’re going to
smoke one of the keys here is to remember that you can add stopgaps
you know like if your friend smokes alright let’s not go hang out with that
friend during break time because that’s too triggering but eventually you need
to address the reasons that you used so figuring out other ways to deal with
your boredom your unpleasant moods help you concentrate those sorts of things so the next step is to develop a plan
remember we haven’t started doing anything yet you want to make sure in
order to set yourself up for success you want to make sure that you have tools in
your toolbox and you’re ready to go you know an electrician wouldn’t show up
drive in his personal car and show up without any tools to do a job hopefully
so we want to make sure that this person or you if you’re the person has a plan
in mind so what are you some your obstacles to
quitting and we’ve already talked about some of them if your obstacles are
mental like your thoughts you get stuck with those thoughts of I’ve got to have
a cigarette right now you can unhook which instead of saying I must have a
cigarette you can say I’m having the thought that I need a cigarette right
now thoughts come and go you know I forget things by the time I walk into
the kitchen half the time so we know that thoughts come and go if you’re
saying I need it it’s semantics but it makes a difference and it’s a powerful
difference if you really repeat it to yourself and believe it I’m having the
thought that I need a cigarette okay well what’s another thought you
could have urge surfing is something else that you can do recognizing that
most urges cresst within you know 10 or 15 minutes and then start to diminish so
if you’re having this urge to use nicotine products that’s okay recognize
it acknowledge it and then ride the wave out now a lot of people find is very
helpful when urge surfing to do something else because if they sit there
and they think about where they’re at on the wave you know it seems like it’s
going to delay the process and they keep thinking about what they want to do so
urge surfing the way I teach my clients is to recognize the intensity of their
urge when they’re having it are they at the beginning
are they cresting you know it’s just I really need it right now or is it
starting to diminish and a lot of times it’ll be somewhere between growing and
you know I really need it right now the good news
is that means it’s almost completely Crested and you just have to get through
the washout so if you can find something else to do for 15 minutes you’re
probably going to forget about that urge radical acceptance of thoughts is
another thing if you’re thinking to yourself I’m having this thought that I
have to have a cigarette right now except it is what it is don’t get angry
as yourself don’t get frustrated just be like okay well I’m having this thought
whatever and it is what it is what can you do to improve the next moment you
don’t want to dwell on this thought you don’t want to give it energy you want to
move forward other thoughts that you may have to radically accept a lot of people
when they quit are giving up something that they truly enjoy so you know there
are days maybe more often than not especially at the beginning where you
may get frustrated and grouchy because you’re giving up something that you
truly like you’re giving up something that you truly enjoy so you can be
frustrated and that’s okay radical acceptance means accepting the good and
the bad recognizing that yes I can’t do this one thing anymore that I’m choosing
not to do this one thing anymore that I really like however by choosing not to
do it I’m having these benefits so you can recognize that yeah there’s some
drawbacks to it but there are some benefits and hopefully meet in the
middle where it’s still worthwhile decisional balance exercises you really
want to look at the reasons for quitting and the reasons for continuing to smoke
because the reasons for continuing to smoke are those reasons that are going
to set you up for relapse you need to find alternate things to do besides
smoking to address those issues and mentally what I call efficacious
self-talk that means repeating to yourself you know I can do this you know
when you’re starting to have that urge just repeating to yourself I’ve come
this far I can’t
I can make it or I can deal with it for 15 minutes and then it’ll go away
efficacious or self efficacy means having that belief that you can do it
that can-do attitude emotional triggers to quitting um you know we all have bad
days and some people especially people who are nicotine dependent often cope
with their unpleasant moods by using okay that’s fine so we recognize that
that’s what you’ve done until now you do the best you can with the tools you have
at any point in time what else can you start learning to do now so again I
encourage people to look back over past times when they have had unpleasant
moods and what they have done to deal with it and what’s worked even if it’s
only worked a little bit we can build on that and then we start talking about new
skills that are out there distress tolerance exercises are great ones DBT
dialectical behavior therapy they have two acronyms accepts and improves and
they stand for different activities you can do in order to help you tolerate
distress cuz sometimes life just sucks and there’s nothing you can do about it
sometimes you know quitting smoking just sucks and there’s nothing you can do
about it so dwelling in that is just gonna feed it and keep you stuck there
like in quicksand distress tolerance encourages you to do
something else and I use this analogy a lot and I’m gonna use it again distress
tolerance is like if you’ve got a B and we’re assuming you’re not like deathly
allergic to bees B lands on your arm well your initial urge is probably to
wipe it off you know get off because it tickles or you don’t want to get stung
or whatever but if you do that you’re likely gonna get stung which I think
also kills the bee which is really sad so distress tolerance means tolerating
that bee being on your arm until it’s ready to fly away and then letting it
fly away on its own the same thing is true for our emotion
you know you don’t pay a lot of attention to it and sit there and go all
right mr. beer when are you gonna leave if you just kind of do whatever because
if you’re moving around too much mr. B’s could probably gonna fly off so distress
tolerance exercises help us deal with something that may be unpleasant instead
of acting on our initial urge we do something else in order to get through
that period stress management a stress management plan is crucial well for
everybody but especially for people who are in recovery or trying to recover
from depression anxiety use of nicotine products drug addiction whatever so work
don’t have enough time to go into how to develop a stress management plan but
know that you have to have one in early recovery it is hard enough to deal with
the neurochemical changes that are going on in your brain you don’t need to add
to it burning the candle at both ends working 16 17 hours a day you know
having all these other obligations and feeling like you’ve got way too much to
do and not enough time to do it so you need to figure out how to set boundaries
how to set limits and how to manage your anxiety about everything that may be
going on deep breathe you you all right well we had a little crash
there so let’s see if we can pick up where we left off so we were talking
about obstacles to quitting and we want to encourage people to use deep
breathing practices because deep breathing is going to slow your heart
rate when you’re anxious when you’re angry it’s going to cause the
fight-or-flight reaction which is going to cause the release of norepinephrine
and glutamate and all those excitatory neurons which is great when you need to
fight or flee but if you’re just stressed out not so much so by deep
breathing you slow down your heart rate which causes the release of gaba and
sometimes serotonin you’re more calming chemicals work toward acceptance of the
loss remember I said a lot of times people are upset about the fact that
they’ve got to give up something that kind of enjoyed and it’s unpleasant so
encouraging people to go through the grieving process
accepting the good with the bad and keep active a lot of times when we’re bored
those thoughts creep into our head a lot louder than when we’re not bored so try
to focus on not you know keeping yourself active but also like I said
with the stress tolerance action activities
if you’re feeling unpleasant emotions I use the phrase distract don’t react when
you’re feeling angry instead of you know lighting up go on a walk do something to
distract yourself for 10 minutes or so while that urge passes and you can get
into what we call your wise mind you can let the adrenaline go and you can get
into this place where you’re not thinking with emotions you’re thinking
with your head and make a better decision other triggers include environmental
triggers such as times of day and activities my mother for example when
she would roll out of bed in the morning she would light up you know then she’d
get come out and she’d make her breakfast and whatever she’d eat and
she’d go back into the bathroom and start getting ready for work and she
would light up and then she’d get into the car and drive to work and she would
be smoking the entire way there so there were a lot of time of day triggers and
environmental triggers for her when she started trying to quit so for a lot of
people the morning routine is can be really stressful because you know
they’re getting ready to approach their day which some people approach with a
sense of dread apprehension anxiety well you got a deal with that in order to be
successful at quitting we need to try to have some a paradigm shift so you’re not
going oh I need something to help me get through this you want to approach your
day with some level of optimism but you also want to change some of those
activities that you do that you normally would smoke during so for example when
you’re driving in the car obviously if you’re changing you know
stopping smoking you won’t have nicotine products there well that changes that
behavior pretty easily first thing in the morning when you roll out of bed
what can you do instead besides smoking how can you distract
yourself you know maybe get up and go to the gym and you’re like yeah right
it’s bad enough stopping smoking I really don’t want to be at the gym at
4:00 a.m. okay but find things that you can do that
differ and you know some people do really well with nicotine replacement
therapy during those times of day that there’s not a lot of wiggle room to
change stuff in the morning they got to get up and get ready for work
so if their first instinct is to smoke then a nicotine replacement gum or
something could be helpful some people you know smoke like when they’re sitting
there watching a football game so if that is something that triggers you to
want to use when you’re you know doing particular activities find something
else to do with your hands during that period of time that that can be helpful
you know I hate to say avoid those activities because a lot of times their
activities we really like so for example when I watch television I have a bad
habit of snacking when I eat but if I am crocheting then I’m doing something else
with my hands and I’m not quite as antsy and bored so if you can find something
else to do with your hands play on you know checkers or something on your
mobile device or pet your dog or whatever avoid things linked to smoking
when you can when it’s not something that’s gonna be really devastating if
you typically smoke when you drink you may want to consider not drinking for a
while that’s a personal choice you just got to figure out how you’re gonna
handle it if you are going to drink and you know you usually smoke when you
drink make sure you don’t have nicotine products available because then you’re
gonna break that association your brain will stop thinking well when I do this I
have to do this because it’s once you’ve drank a few enough times without smoking
that pairing is broken remove sensory triggers like sounds you
know if you sit in your chair and listen to Willie Nelson and smoke you know
maybe Willie Nelson is what not what you need to be listening to right now or
Pink Floyd or whatever it is that does it for you so consider what things that
you might hear that might trigger you to you know think about
using smells obviously the smell of nicotine is can be a trigger the smell
of smoke can be a trigger but there may be other smells that trigger it for you
and I remember when I was little my uncle Jack used to smoke a pipe
and I loved the smell of pipe tobacco you know not crazy about the smell of
cigarette smoke but I loved the smell of pipe tobacco
so that was a smell you know when I would walk past the tobacco counter at
the store and I actually worked at one for a while that was a smell that
brought back happy memories so thinking about smells that remind you to to use
sights obviously things that you see if you’re seeing nicotine right there could
be a trigger if you are you know maybe you associate nicotine with trying to
stay up all night to study or you know if you were a soldier when you were
deployed anything that reminds you of those things you want to figure out okay
how do I deal with those when I see those sights when I get triggered you
can’t plan for every possible trigger it’s just it’s not possible so what you
need to do is know again mindfulness be aware of when you’re triggered and
feeling like oh I really want to use and have a plan for dealing with the
cravings as opposed to trying to plan for every single trigger anything that
might trigger you that you can eliminate in the first three months you know to
make it easier on yourself well that’s certainly going to make life easier but
again focus more on how to handle the cravings that are triggered instead of
preventing all triggers and have an emergency exit plan other triggers can be physical like
withdrawal so if you experience withdrawal from nicotine which you
probably will talk with your doctor about medications that can help you
handle those cravings so you can step down gradually instead of going cold
turkey or mood issues and the research is kind of ambiguous about whether
people tend to feel better when they smoke or
experience higher depression and anxiety when they quit when I talk to people
most people I talk to say yeah my depression and my irritability and my
anxiety went through the roof when I tried to quit smoking well okay
you know if you know if you have a pre-existing mood issue and you know
that a lot of times you smoke to deal with unpleasant feelings talk to your
doctor about ways to deal with it maybe you need to have be on a combination
therapy like um bupropion and nicotine replacement therapy so talk with your
doctor also look at ways to develop other coping skills to deal with your
mood issues being aware that during the first three to six months of recovery if
you want to say that you are probably going to have more mood lability just be
aware of that and practice good sleep hygiene some people when they quit
smoking feel like they’ve got all the energy in the world and other people
can’t sleep you know they they wake up in the middle of the night they have
cravings yada yada whatever you want to make sure that you’re keeping your
circadian rhythms stable so you’re getting about eight hours of sleep a
night and it’s good quality sleep if you smoke because of pain you know when
you’ve got migraines or whatever it is pay attention to and learn about other
pain management techniques obviously you could go from a collage achill my
recommendation would be to talk with your doctor about alternatives such as
ice heat massage stretching physical therapy tends units there’s a lot of
stuff out there that can be used besides drugs oral fixation I couldn’t figure
out another nice way to put this some people when they are trying to quit
they’ve been smoking so long they’re used to having something in their mouth
and that’s just the way it is and when they don’t have something in their mouth
they feel you know antsy I mean think about a child that is just totally
attached to either sucking their thumb or their pacifier my
bless bless his little heart he always had a pacifier attached to his shirt he
had a pacifier in each hand and then he had three pacifiers above his head when
he slept at night until he was like three um his orthodontist loves me let
me tell you what but some people need some they have some need or some way of
comforting themselves or calming themselves orally okay well if this is
one of your things we call it harm reduction so instead of having a
cigarette in your mouth maybe you look at having something else in your mouth
like a toothpick or gum or even just a straw you know I know when when I study
and stuff often times I will chew on a pencil if I’ve got a pencil
I know it’s nasty but I do it and I bite my fingernails too which is not healthy
but those are all other things that you may pick up so if you don’t want to
start biting your nails when you quit smoking if you don’t want to be eating
all the time when you quit smoking you need to think what else am I going to do
to satisfy that oral need that I’ve got right now and it can be just calling a
friend and talking because you can’t have something in your mouth and talk at
the same time alrighty social triggers avoid being around
people when they’re smoking or vaping or dipping you know any of those things can
trigger your desire to use try not to sit next to people who smell like smoke
so if you ride the bus or when you go to a restaurant you know you may want to
try not to sit next to people who who smell like tobacco find alternative
activities to smoke breaks like going on a walk
and have something else to do with your hands I have actually I think I gave it
to my daughter nope it’s right here I have this worry stone and it’s just a
little quartz worry stone that’s in the shape of a heart but sometimes I’ll hold
it and you know and that’s they have the fidgets spinners and everything else now
to that you can get things to do with your hands
and I got this because I used to always fidget with my hands I had a USB Drive
on my on my keychain and I broke it because I would push it out and click it
back in and push it out and click it back in
yeah that’s not real helpful but if you’re one of those people like me who
has a lot of nervous energy that can be helpful so you’re not thinking about you
know smoking or doing something with your hands that’s not helpful okay I’ve
been talking about medications the use of approves the station medications can
be really helpful not everybody’s down with that and I’m I get it you know not
a problem but it can help you taper and one of the things that wasn’t
mentioned in the guideline that I’ll mention here before medications actually
is there are tobacco products that have lower levels of nicotine so if you go
down to like a light cigarette you can choose products that have lower
levels of nicotine to start helping you on your way before you make the leap to
going smoke-free some people find that that tapering is a little bit easier
other people prefer to just cut it and go you know what no more nicotine
products and then taper with a nicotine replacement therapy whatever it is that
you’re comfortable trying is a good thing to try so if you decide to go with
the medications to help you taper first-line medications include bupropion
SR which is extended-release and that helps a lot with cravings nicotine
replacement therapy or NRT s come in the forms of gums lozenges patches or enable
nasal sprays one thing to remember when you are used especially when you’re
using nicotine replacement therapy is that nicotine is not well absorbed in
the mouth when you are drinking things that are acidic like sodas and coffee
and citrus juices so you want to avoid those while you’re chewing your nicotine
gum if you want to get the full benefit from it second line medications include
clonidine and nortriptyline and you know those are all things that can be added
if the first-line medications aren’t working and people who have concurrent
depression especially have done really well with nortriptyline and nicotine
replacement therapy so it’s a matter of what works for you and communicating
with your doctor about what most effectively works if the first thing you
try doesn’t doesn’t do it or it’s just it’s still too too difficult
that’s okay you didn’t fail it just means the medication they chose
or you guys chose wasn’t the exact right level for you either dosage or the type
of medication because all of these medications act on different
neurotransmitters and have slightly different mechanisms of action so
bupropion doesn’t work try something else you also want to consider
medications for any underlying mood disorders especially in the short term
so if you’ve got clinical depression it’s definitely worth considering
addressing the clinical depression with medication in the short term the higher
dose preparations of nicotine gum the patches and lozenges have been shown to
be effective in highly dependent smokers so again like I said it may not be the
type of medication it may be the dose so talk with your doctor advocate for
yourself combination nicotine replacement therapy may be particularly
effective in suppressing tobacco withdrawal symptoms and increasing
long-term abstinence rates the nicotine patch over 14 weeks can be paired with
either nicotine gum or nasal spray the nicotine patch can also be paired with
the nicotine inhaler or bupropion so there are and there are other options
out there but these are their you know first-line combinations that might be
considered bupropion and nicotine replacement therapies in particular for
milligram nicotine gum and four milligram nicotine lozenges delay but do
not prevent weight gain okay I want I want you to have that sink
in weight gain is caused by eating too much so we need to figure out why are
you eating too much are you eating to self-soothe are you eating because you
have to have something to do with your hands
are you eating because so in order to manage weight gain you need to figure
out you know why are you eating and also maybe look at what are you eating cuz a
lot of times when people are trying to stop smoking the things they choose to
eat to tend to be higher in fat and sugar
why because fat and sugar caused the brain to release serotonin and dopamine
which makes you feel better so you’re basically substituting
addictions if you will in patients with depression bupropion and nortriptyline
appear to be effective especially in combination with nicotine replacement
therapy so getting ready to quit set a quit date usually within two weeks you
know you’ve got everything shored up you’re ready to go then you got to make
that quit date within two weeks tell family friends and co-workers about
you’re getting ready to quit and request understanding and support you know give
them a heads up so you know you don’t drop it on them on Monday morning
anticipate challenges to the upcoming quit attempt particularly doing during
the first few weeks and I say 12 weeks you know the first 12 weeks is really
critical remove tobacco from your environment tobacco products as well as
tobacco smell you know give your house a good scrub down so you’re not walking in
and smelling it and getting triggered prior to quitting avoid smoking in
places where you spend a lot of time such as work home or even the car so
prior to quitting completely you may stop start cutting back and saying okay
I am NOT gonna smoke when I’m in the car I am NOT gonna smoke in the house I’m
not going to smoke yadda yadda it doesn’t mean you’re stopping smoking
completely but you’re again unpair you will those places or and those
activities with smoking make your home smoke-free
make sure nobody else in the house is smoking if they are it’s gonna make it a
lot harder for you to quit individual group and telephone counseling are also
effective treatment formats particular types of counseling strategies are
particularly effective you want to look at practical counseling so you know when
you’re talking to a therapist if you are somebody trying to quit talk with them
about what types of things will we talk about you know humanistic therapy is
great and it’s got a place but a lot of people when they’re trying to quit
smoking need practical interventions and problem-solving to say alright I feel
like I have stronger urges and triggers first thing in the morning or you know I
try I’m trying to quit and my irritability is through the roof I need
to develop some skills to you know tamp down those emotions a little bit and
look for social support a social support from people who’ve never smoked or
people who are start starting to try to quit themselves or people who’ve stopped
smoking those are really helpful because they’ve been there and they can tell you
what works for them they can tell you it gets better they can tell you the good
the bad and the ugly because quitting smoking is not just
good there is some bad and ugly in there too and you know forewarned is forearmed institutionally you know looking at
where you work but also in clinics where you know you may be receiving treatment
policies that can facilitate stopping smoking you want to have a tobacco-free
workplace have a tobacco user identification program as part of any
assessments in medical clinics ensure that everybody at your workplace or at
your medical clinic are adequately trained in assessing for and making
referrals for smoking cessation activities if you have a workplace
wellness program or you know again in clinics have a dedicated staff person
who at who is assigned to doing nothing but nicotine dependence interventions
and maybe they don’t do all the counseling right there but they can
facilitate the connections ensure that covered and or cost effective treatments
are available it’s important special populations when someone smokes when
they’re pregnant it increases their heart rate reduces their circulation
which can cause the baby to have a low birth weight and the baby might also
have some withdrawal symptoms substance dependent individuals remember I talked
about alcohol earlier a lot of times people who are substance dependent smoke
so nicotine products are associated with use so that’s a trigger for their use as
well as you know nicotine use but it’s also a if you want to call it a
substitute addiction if they can’t get to their crack or their methamphetamine
or whatever you know they may just be jonesing for a cigarette they need
something to help them feel better because their neurotransmitters are at a
wack from the detox or whatever it is so you know I worked in substance abuse
treatment in a residential facility for many many years and a lot of the people
that I worked with smoked and you know they found that quitting their substance
of choice was really hard but quitting their substance of choice and quitting
nicotine was you know even harder so we want to make sure to provide adequate
support to those people the elderly now this isn’t this is written in a
slightly different way the improvements the elderly see if they stop smoking
their circulation improves immediately well that’s true for everybody their
lungs begin to repair any damage that’s also true of just about anybody in one
year the added risk of heart disease is cut in almost half and their risk of
stroke lung disease and cancer also diminish
among smokers who quit at age 65 so it’s never too late to quit men gained an
average of one point four to two years of life and women gained on average two
point seven to three point four years I have no idea how they determined that
but that’s what the statistics say so if you want to live a few more years you
know think about cutting cutting back on the nicotine products people of low
socioeconomic status also have issues when it comes to smoking cessation
because they may have some environmental in mobility they’re stuck in an
environment that is pro smoking they may not have access to nicotine replacement
therapy that’s much less problematic now that the Affordable Care Act policies
are in place and there’s really most insurances cover at least some level of
nicotine replacement therapy and access to medical care identification and
intervention of tobacco use should be a priority in all settings even you know
whether you’re identifying yourself or you know a workplace you know you want
to identify workers who are smoking because they’re probably going to have
more absentee days they may have more health related problems which can
increase insurance rates for the whole group yada-yada so we want to have
somebody in HR we want to have somebody at the doctor’s office we want to have
somebody at the mental health clinic who all can screen and make referrals for
tobacco cessation activities effective interventions are dose dependent so the
more intense the intervention the more effective it often is especially in the
first twelve weeks a combination of nicotine replacement therapy options is
often helpful for heavy smokers and long-term abstinence is most strongly
related to a combination of practical counseling because remember I said you
have to address the reasons you were using in the first place and medication
assisted therapies in motivated patients so that’s three things you have to have
practical tools that you can replace the smoking with medication assisted therapy
to help with the withdrawal and motivation to actually follow it
through even when the going gets tough alright everybody thanks for being with
me today and I will see you on Wednesday counselor toolbox podcast is sponsored
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