Smokeless tobacco creating the quit plan 2012 catherine whitworth and donald reed
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Smokeless tobacco creating the quit plan 2012 catherine whitworth and donald reed

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  • 1. 1
  • 2. • Assessing dependence and motivation• Preparation • Setting a time frame • Reasons • Triggers • Environment• Support • Behavioral • Family & social• Specific strategies tailored to patient • Treating withdrawal • Tapering vs all at once• Avoiding relapse 2
  • 3. Smokeless products delivermuch more nicotine;dependence levels likely tobe high. Patient may use credit: Kevork Djansezian/Getty Imagesmore as it can be easilyconcealed 8 to 10 dips or chews a day is = smoking 30 to 40 cigarettes; holding an average dip or chew in the mouth for 30 minutes equivalent to 4 cigarettes 3
  • 4.  Habitual & cultural behaviors are deeply entrenched ◦ Strong sense of identity may be tied to smokeless use ◦ More activities linked to use ◦ Most initiate at a very young age, often introduced by family member 4
  • 5.  Tapering off seems to work better for smokeless users than for smokers Stronger need for oral substitutes ◦ Non-tobacco mimic products ◦ Sunflower seeds ◦ Cinnamon sticks ◦ Jerky 5
  • 6. Partnership to Assist withCessation of Tobacco.www.makeapact.ca 6
  • 7. Rxforchange.ucsf.edu 7
  • 8. Mayo Clinic: Your Path to SmokelessTobacco Freedom 8
  • 9. Mayo Clinic: Your Path to SmokelessTobacco Freedom 9
  • 10. Importance0 1 2 3 4 5 6 7 8 9 10 Confidence0 1 2 3 4 5 6 7 8 9 10 10
  • 11. Good things about Not so good things using chew about using chew Not so good things Good things aboutabout quitting chew quitting chew Mayo Clinic: Your Path to Smokeless Tobacco Freedom 11
  • 12.  Two to three weeks in advance. This time is needed to prepare. Midnight on a Thursday or Friday works well for most people. Avoid selecting a day that will be especially stressful. Schedule a doctor or dentist visit if this is an option, especially if using any medication. 12
  • 13. 13
  • 14.  After eating Working or finishing a job Driving Drinking alcohol Recreation Watching sport events Stress Seeing someone else using 14
  • 15. 15
  • 16.  Get active, take a walk, work out, ask the dog for help Use a short acting NRT Drink water Chew strong gum, toothpicks, cinnamon sticks, mints, a substitute product Call a friend - be with people who don’t dip Take your work break in a different place Take a different route to work 16
  • 17.  7 Approved Medicines for nicotine dependence, some by Rx, some OTC. Only the patient and clinician can decide what is most appropriate for the individual but try to dispel myths. Combination NRT therapy is safe and effective for smokeless users. 17
  • 18.  (NRT) can ease symptoms of nicotine withdrawal. A heavily addicted patient will benefit from more aggressive dose – combination therapy. Delivery systems: patches, lozenges, gum, nasal spray, puff inhaler. Provide instructions. Much more effective when used with a behavioral support. 18
  • 19. • Worn on the skin between the neck and the waist, and provide a steady delivery of nicotine to increase patient comfort• Can be started while tapering down when the patient notices withdrawal symptoms 19
  • 20.  24 hour nicotine patch: >3 cans or pouches/week = 42 mg/day 2-3 cans or pouches/week = 21 mg/day <2 cans or pouches/week = 14 mg/day Adjust based on withdrawal symptoms, urges, and comfort. After 4-6 weeks of abstinence, taper every 2-4 weeks in 7-14 mg steps as tolerated Combination Therapy: Patient may add 2 mg lozenge or gum as needed for acute cravings Mayo Clinic Guidelines 20
  • 21. Available in 2 mg and 4 mgUse 2 mg if also using patch 21
  • 22. Available in 2 and 4 mg Use 2 mg if using patchProper instructions Essential! 22
  • 23.  Bupropion (Zyban - Wellbutrin) ◦ Antidepressant that that has been helpful in treating nicotine addiction ◦ Can be used with NRT ◦ Helpful for those concerned with weight gain Chantix ◦ Pfizer medication used solely to treat nicotine addiction ◦ Blocks nicotines connection to dopamine receptors, making tobacco less desirable. ◦ Treats effects of cravings and withdrawal. ◦ Kidney Issues ◦ Mental Health Concerns 23
  • 24.  Herb based non-tobacco chew products processed to mimic taste and texture of smokeless tobacco Can be effective in gradually reducing level of nicotine while allowing user to continue habit 24
  • 25.  Substitute product is blended with tobacco user is accustomed to and kept in tobacco can 10% product with 90% tobacco first week Increase ratio by 10% each week Some programs endorse partner managing the system NRT is optional. Safe to initiate when withdrawal symptoms begin. Patient can adjust for comfort 25
  • 26. GOLDEN EAGLE Herbal ChewFlavors: Straight, Wintergreen, Cinnamon, Hibiscus-Ginger, and Licorice Mint1-800-736-8749www.goldeneaglechew.comSMOKEY MOUNTAIN Herbal ChewFlavors: Cherry, Classic, Cinnamon Ice, Arctic Mint, Arctic Mint Pouches,Wintergreen, and Wintergreen Pouches1-800-762-2439www.smokeymountainsnuff.comYOUNGS Herbal ChewFlavors: Classic, Wintergreen, Licorice, and Ginger Red928-632-7272www.youngschew.comBACC OFFFlavors: Straight, Wintergreen, Extra Wintergreen, Mint, Mint Pouches,Straight Pouches, and Wintergreen Pouches1-800-866-2439www.dipstop.com 26
  • 27.  From others ◦ Tell people about your quit date ◦ Ask them to support you ◦ Tell them how Get coaching from a quit line, support group, web networking or other program ◦ Tobacco Quit line 1-800-QUIT-NOW Most cessation product companies offer a support program 27
  • 28.  Physical Activity is not only is a natural stress reliever but can help prevent the weight gain some people experience Help the patient reframe – what is perceived as stress is often physical withdrawal If I dip, will this stressor actually go away? 28
  • 29.  Choose one or more activities to do without tobacco Schedule tobacco use “on the clock” Use the same amount, but change the setting in which the product is used 29
  • 30.  Get rid of all smokeless tobacco and empty cans/pouches Remove any reminders Put together a survival kit Try to get relief from some responsibilities and stressors just for a few days 30
  • 31.  Irritability Feeling tired Difficulty sleeping Constipation Depressed mood Headache Trouble concentrating Strong Urges 31
  • 32.  Ask the patient how he will cope, and what others can do to help him. He knows himself best. Make suggestions only if necessary Encourage him to do whatever it takes ◦ Eat whatever he wants for 1st three days – weight control can wait ◦ Remember the gum, jerky, carrots, substitute products ◦ Sleep as much as much as he wants or stay busy! The withdrawal symptoms WILL lesson. Urges will come less often and will not last as long after the first week 32
  • 33.  Know potential triggers in advance and plan for them Drink plenty of water Get enough sleep. Changing behavior is easier when well rested Don’t try to fix everything at once However, watch out for alcohol Increase physical activity! 33
  • 34.  Put yourself first. Quitting is the best thing you can do for your family. Accept help Plan rewards for milestones Focus on the present ◦ Handle one urge at a time ◦ If you slip, it’s not over. Forgive yourself ◦ Ask what happened & why ◦ Get back on track with the next urge 34
  • 35.  Quitting and staying quit are two separate challenges Lapse (slip) vs relapse. Mistaken beliefs. Continue to use medicines until you have NO URGE TO USE. After short term coping skills, the key is lifestyle change. Replace the tobacco with something better. Forever. If I resume chewing, will it change the outcome of this life event? 35
  • 36. Free Quit Plan Guides available from National Institute of Dental and Cranial Research (NIDCR) Recommend crossing out “What About Medication” statement on page 13. (anti-NRT and outdated).http://www.nidcr.nih.gov/OralHealth/Topics/SmokelessTobacco/SmokelessTobaccoAGuideforQuitting.htm 36
  • 37. Outstanding Guide: Order from ETR Associates. Offers bulk discounts.Enough Snuff: A Guide for Quitting Smokeless Tobacco, Severson &Gordon.http://pub.etr.org/productdetails.aspx?id=100000132&itemno=A050 37
  • 38.  Mylastdip.com Killthecan.org Quitnet.com Quitsmokeless.org ucanquit2.org (Quit Tobacco – Make Everyone Proud 38
  • 39. Catherine Whitworth, M.P.A., CTTS Donald R. Reed Jr., M.A. CTTSWest Virginia School of Public Health Southern Coalfields Tobacco PreventionPrevention Research Center Coalition NetworkMorgantown, WV Princeton, WVcwhitworth@hsc.wvu.edu tobaccospecialist@strongcommunities.org304-293-0926 304-320-9990 39