Brief Intervention for Tobacco Use 2: Guiding patients toward change Socorro Mental Health May 5, 2009 May 12, 2009

Agenda Review: 5 A’s of brief intervention for tobacco use How’s it going? Guiding patients toward change 5 R’s of brief intervention for patients not ready to quit

Review: 5 A’s of brief intervention for tobacco use

How’s it going?

Guiding patients toward change

5 R’s of brief intervention for patients not ready to quit

Opportunity for Clinicians 70% of tobacco users visit a health care provider each year Most tobacco users want to quit

70% of tobacco users visit a health care provider each year

Most tobacco users want to quit

Quitting Over 70% of smokers have made at least one quit attempt 46% attempt to quit each year Most smokers make several quit attempts before succeeding Evidence-based treatment for smoking cessation is highly cost-effective Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence (2008 Update) www.surgeongeneral.gov/tobacco

Over 70% of smokers have made at least one quit attempt

46% attempt to quit each year

Most smokers make several quit attempts before succeeding

Evidence-based treatment for smoking cessation is highly cost-effective

Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependence (2008 Update)

www.surgeongeneral.gov/tobacco

Brief Intervention: 5 A’s Ask every patient if he/she uses tobacco Advise all tobacco users to quit Assess willingness to make a quit attempt Assist with counseling and medication Arrange follow-up

Ask every patient if he/she uses tobacco

Advise all tobacco users to quit

Assess willingness to make a quit attempt

Assist with counseling and medication

Arrange follow-up

Ask: Systematically identify all tobacco users at every visit Ask every patient at every visit if he or she uses tobacco Expand vital signs to include tobacco use or implement other officewide system

Ask every patient at every visit if he or she uses tobacco

Expand vital signs to include tobacco use or implement other officewide system

Advise: Strongly urge all tobacco users to quit Advice should be Clear Strong Personalized

Advice should be

Clear

Strong

Personalized

Assess: Determine willingness to make a quit attempt Assess every tobacco user's willingness to make a quit attempt at the time. “ Are you willing to give quitting a try?”

Assess every tobacco user's willingness to make a quit attempt at the time.

“ Are you willing to give quitting a try?”

Assist: Aid the patient in quitting (provide counseling and medication) Help with a quit plan Recommend approved medication Provide practical counseling Provide social support Refer to quitlines, counseling services 1-800-QUIT NOW Socorro Mental Health: 575-835-2444

Help with a quit plan

Recommend approved medication

Provide practical counseling

Provide social support

Refer to quitlines, counseling services

1-800-QUIT NOW

Socorro Mental Health: 575-835-2444

Arrange: Ensure followup contact Either in person or over the phone Within one week of initial contact, with second follow-up within one month

Either in person or over the phone

Within one week of initial contact, with second follow-up within one month

The less-ready patient

3 Styles of Communication Following Listen empathically, make no suggestions Directing Listen enough to assess the situation Tell the person how to solve the problem Guiding Listen empathically to the person’s perspective Explore options for solving the problem Help the person move in the chosen direction

Following

Listen empathically, make no suggestions

Directing

Listen enough to assess the situation

Tell the person how to solve the problem

Guiding

Listen empathically to the person’s perspective

Explore options for solving the problem

Help the person move in the chosen direction

A Good Guide Will… ASK the person where he/she wants to go, and get to know him/her a bit LISTEN to and respect what the person wants to do and offer help accordingly INFORM the person about options and see what makes sense to them Rollnick, Miller, & Butler, 2007

ASK the person where he/she wants to go, and get to know him/her a bit

LISTEN to and respect what the person wants to do and offer help accordingly

INFORM the person about options and see what makes sense to them

Brief Intervention: 5 R’s Relevance Risks Rewards Roadblocks Repeat

Relevance

Risks

Rewards

Roadblocks

Repeat

Relevance Encourage the patient to indicate why quitting is personally relevant, being as specific as possible “ I’m sure you’ve heard some reasons to quit chewing tobacco. What have you heard that makes the most sense to you, personally?” “ Right now, what is the most important reason for you to think about quitting smoking?”

Encourage the patient to indicate why quitting is personally relevant, being as specific as possible

“ I’m sure you’ve heard some reasons to quit chewing tobacco. What have you heard that makes the most sense to you, personally?”

“ Right now, what is the most important reason for you to think about quitting smoking?”

Risks Ask the patient to identify potential negative consequences of tobacco use Ask permission to give more information, if needed “light” cigarettes aren’t safer Other forms of tobacco aren’t safer “What are you most concerned will happen if you continue smoking?”

Ask the patient to identify potential negative consequences of tobacco use

Ask permission to give more information, if needed

“light” cigarettes aren’t safer

Other forms of tobacco aren’t safer

“What are you most concerned will happen if you continue smoking?”

Rewards Ask the patient to identify potential benefits of stopping tobacco use “What do you think you’ll like most about being a non-smoker?” “What benefits did you notice last time you stopped using spit tobacco?”

Ask the patient to identify potential benefits of stopping tobacco use

“What do you think you’ll like most about being a non-smoker?”

“What benefits did you notice last time you stopped using spit tobacco?”

Roadblocks Ask the patient to identify barriers to quitting Identify aspects of treatment that can help solve those problems

Ask the patient to identify barriers to quitting

Identify aspects of treatment that can help solve those problems

Common Barriers Withdrawal symptoms. Fear of failure. Weight gain. Lack of support. Depression. Enjoyment of tobacco.

Withdrawal symptoms.

Fear of failure.

Weight gain.

Lack of support.

Depression.

Enjoyment of tobacco.

Repetition Repeat the motivational intervention every time the patient visits the clinic Remind patients that most tobacco users make several attempts before successful quitting

Repeat the motivational intervention every time the patient visits the clinic

Remind patients that most tobacco users make several attempts before successful quitting

A taste of Motivational Interviewing What do you think you will enjoy about making this change? What are the best reasons for you to do it? How might you go about it, in order to succeed? What concerns you most about what will happen if you don’t make a change? Where do you go from here?

What do you think you will enjoy about making this change?

What are the best reasons for you to do it?

How might you go about it, in order to succeed?

What concerns you most about what will happen if you don’t make a change?

Where do you go from here?

For more information www.surgeongeneral.gov/tobacco www.nmtupac.com www.vanhornconsulting.com – click on “resources” and look for your workshop date on the left side of the screen

www.surgeongeneral.gov/tobacco

www.nmtupac.com

www.vanhornconsulting.com – click on “resources” and look for your workshop date on the left side of the screen

Deborah H. A. Van Horn, Ph.D. 297 Westwood Drive, Suite 105 West Deptford, NJ 08096 (856) 905-5261 [email_address] www.vanhornconsulting.com