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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  2. 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. 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. 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. 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. 6. Partnership to Assist withCessation of 6
  7. 7. 7
  8. 8. Mayo Clinic: Your Path to SmokelessTobacco Freedom 8
  9. 9. Mayo Clinic: Your Path to SmokelessTobacco Freedom 9
  10. 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. 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. 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. 13
  14. 14.  After eating Working or finishing a job Driving Drinking alcohol Recreation Watching sport events Stress Seeing someone else using 14
  15. 15. 15
  16. 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. 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. 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. 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. 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. 21. Available in 2 mg and 4 mgUse 2 mg if also using patch 21
  22. 22. Available in 2 and 4 mg Use 2 mg if using patchProper instructions Essential! 22
  23. 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. 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. 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. 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 26
  27. 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. 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. 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. 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. 31.  Irritability Feeling tired Difficulty sleeping Constipation Depressed mood Headache Trouble concentrating Strong Urges 31
  32. 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. 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. 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. 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. 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). 36
  37. 37. Outstanding Guide: Order from ETR Associates. Offers bulk discounts.Enough Snuff: A Guide for Quitting Smokeless Tobacco, Severson &Gordon. 37
  38. 38.  (Quit Tobacco – Make Everyone Proud 38
  39. 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, tobaccospecialist@strongcommunities.org304-293-0926 304-320-9990 39