treatment of nicotine dependence ron alexander 7-22-05
TRANSCRIPT
Treatment of Nicotine Dependence
Ron Alexander7-22-05
The Public Health Field has led the fight for tobacco control
Health hazards associated with using tobacco products
Cessation efforts Clean indoor air
The Addiction field has lagged behind, almost protecting the use of nicotine, as the lesser of 2 evils.
Cooperation between tobacco control and addiction treatment is coming
Marathon County – 5 years of collaboration
Health Department and Premiere Recovery Services (NCHC)
“Quit Smoking Now” Program Support Group “Thinking About Quitting” Clean Indoor Efforts (Marathon
County Tobacco Free Coalition)
Why should Wisconsin AODA Treatment Providers be concerned about Nicotine Dependence Treatment?
78% of the drinking and drugging population is dependent on Nicotine compared to less than 25% in the general population
Recovering alcoholics and addicts continuing to use nicotine are dying from smoking related causes 12-20 years sooner than those nicotine free
Tobacco related disease is the leading cause of death in the recovering and actively addicted community
Research shows that recovering addicts who also quit nicotine are not at risk to relapse to their other substance at a higher rate, in fact there is some evidence that shows there is less relapse.
70% of tobacco users have a desire to quit, for those who also have an alcohol addiction 50% indicated they would like to
prioritize alcohol first and then take on cigarettes
70% of tobacco users have a desire to quit, for those who also have an alcohol addiction 50% indicated they would like to
prioritize alcohol first and then take on cigarettes
but 20% were interested in dealing with both
70% of tobacco users have a desire to quit, for those who also have an alcohol addiction 50% indicated they would like to
prioritize alcohol first and then take on cigarettes
but 20% were interested in dealing with both
this is a significant number and cannot be ignored.
There is a treatment protocol Medicine – primarily Zyban NRT – patch, gum, inhaler, spray,
lozenge Group therapy - responds well Individual therapy – responds
equally well Cognitive therapy Behavioral therapy
Barriers to Treating Nicotine Addiction Concurrently can’t quit
everything at once (myth)
the anxiety produced will cause relapse to other substance
clients will resist will detract from
serious addictions
lesser of 2 evils. don’t know how to
treat (cop out) no funding any
how some counselors
and administrators continue to smoke
Mainstream Addiction treatment will include nicotine dependence
The national association of addiction counselors (NAADC) 12,000 members, recently endorsed a policy to include nicotine dependence on the same priority as other drugs
New Jersey – all addiction treatment programs must include nicotine dependence treatment in order to be licensed
Certification as a specialist in Nicotine dependence available at the University of Florida and at Mayo Clinic
Mayo Clinic, Hazelden, the University of Minnesota Public Health Department and in Wisconsin (CTRI) are offering nicotine dependence education and training for best clinical practices.
A task force has been formed in the Department of Health and Family Services Tobacco Control Program on treating tobacco addiction. Maybe a directive or policy change is forth coming???
Addiction Journal Coverage January 2005 Article - National
Institute on Drug Abuse (NIDA) awards $2.1 million contract to learn more about genetic influences on nicotine addiction and treatment responses
July 2005 Advertisment for Hazelden Cessation Residential Program “WE HEARD YOU WANTED SOME HELP QUITTING SMOKING” 877-685-1414 www.hazelden.org/quitsmoking
Premiere Recovery Services
North Central Health Care
Day Treatment Program AODA Education Group Genesis Treatment Program Individual Counseling
Day Treatment Program 3 week duration Most intensive primary treatment
program Nicotine dependence gets 15 minutes per
week of attention (up from 10 minutes) Focus is on readiness Based on experiences at the Henley
Hazelden Center in West Palm Beach, FL “Smoke” break is still valued in our
program – Some clients even start to smoke when
they enter AODA treatment
AODA Education Group
10 week program 1 hour each cycle devoted to
Nicotine dependence/cessation
Genesis Treatment Program
14 sessions 7 weeks 1 hour presentation on nicotine
dependence/cessation
Individual Counseling
Attention given is minimal and inconsistent and often depends upon the counselor.
Research shows that 20% of all clients who present with addiction to multiple substances including nicotine are ready for a concurrent quit attempt.
It is common in addiction treatment for a person to be at different readiness state for each substance – but at least priorities can be addressed in the treatment plan.
Funding and Payment for Cessation and Treatment
Tobacco settlement monies were re-allocated Major setback but efforts did not stop There is passion in this field volunteerism
Funding and Payment for Cessation and Treatment
Separate funding for nicotine treatment done concurrently with other drugs is not an issue. Funding available for both group or individual counseling
Funding and Payment for Cessation and Treatment
Separate nicotine dependence treatment is currently funded by Medicare, Medicaid with a master’s level clinician. Some health insurance or HMO coverage for replacement medication and counselor. Recent CTRI report 32% increase between 2002-2004.
Quit Smoking Now Educational focus Preparation to quit NRT/stress management/nutrition Joint venture between Health
Department and Premiere Recovery Since 2001 Currently being revised
4 times a year 8 sessions to 6 sessions - weekly Better coordination with support group
Why a Smoking Cessation Support Group?
We know that nicotine dependence is a chronic disorder
Why a Smoking Cessation Support Group?
We know that nicotine dependence is a chronic disorder
Requires ongoing rather than acute care
Why a Smoking Cessation Support Group?
We know that nicotine dependence is a chronic disorder
Requires ongoing rather than acute care
Staying involved in a support group for 1 year increases chances of staying quit
Smoking Cessation Support Group
Began at Premiere Recovery in June 2001 following the 1st Quit Smoking Now class.
Meets every Wednesday 6-7 pm For all community members
ReadinessYou can create movement towards a quit attempt. You do not have to tell
them to come back when they are really ready
Readiness levels Just finished Quit Smoking Now
Readiness levels Just finished Quit Smoking Now Seeking information – provide
packet of information
Readiness levels Just finished Quit Smoking Now Seeking information – provide
packet of information Ready for a quit attempt
Readiness levels Just finished Quit Smoking Now Seeking information – provide
packet of information Ready for a quit attempt Just relapsed
RelapseRemember relapse is a
component of the chronic nature of nicotine
dependence - not an indication of personal failure by clients or
clinician
During group interactions avoid argument and confrontation - focus on the positive benefits, not negative labels
For new group members use the 5 A’s
Ask about tobacco use
For new group members use the 5 A’s
Ask about tobacco use Advise them to quit
For new group members use the 5 A’s
Ask about tobacco use Advise them to quit Assess willingness to quit
For new group members use the 5 A’s
Ask about tobacco use Advise them to quit Assess willingness to quit Assist describe best clinical
practices
For new group members use the 5 A’s
Ask about tobacco use Advise them to quit Assess willingness to quit Assist describe best clinical
practices Arrange for follow-up
The 5 R’s Relevance – tailor advice to each
person
The 5 R’s Relevance – tailor advice to each
patient
Risks – of continual smoking
The 5 R’s Relevance – tailor advice to each
patient
Risks – of continual smoking
Rewards – benefits of quitting
The 5 R’s Relevance – tailor advice to each
patient
Risks – of continual smoking
Rewards – benefits of quitting
Roadblocks – individual barriers
The 5 R’s Relevance – tailor advice to each
patient
Risks – of continual smoking
Rewards – benefits of quitting
Roadblocks – individual barriers
Repetition – the “heart” of the support group
Quit attempt’s 4 D’s Delay
Quit attempt’s 4 D’s Delay Distract
Quit attempt’s 4 D’s Delay Distract Drink Water
Quit attempt’s 4 D’s Delay Distract Drink Water Deep Breathing
Address all areas in the process of recovery
Address all areas in the process of recovery
Address all areas in the process of recovery
Address all areas in the process of recovery
Address all areas in the process of recovery
Cessation Support Group for community support program
(NCHC)
Meets weekly For persons with dual diagnosis Very difficult population