Embed Size (px)
Citation preview
Kicking the Habit(s):
Tobacco & Opiate Addiction
Tobacco Interventions Tailored to Individuals with Substance Use Disorders
Mental Health and Substance Abuse Treatment Facilities Webinar
March 25, 2015
Tony Klein, MPA, NCACII [email protected]
Introductions/Panelist
Stan Martin
Project Director of
CAI, Tobacco
Control Training
Project.
Sarah Wylie
Community Tobacco
Specialist, VDH
Tony Klein
MPA
CASAC,NCACII
Has over 25
years of clinical,
administrative
and training
experience
Credentialing & Evaluation • Vermont Alcohol and Drug Addiction
Certification Board has approved 1.0 hr of
education specific to the substance abuse use
disorder/co-occurring disorders category for
certification and recertification for the ADC and
AAP credentials.
• Gotowebinar automatically will send
attendees an evaluation
• Certificate of attendance
IMPORTANT NOTICE
• This GotoWebinar/GotoMeeting service
includes a feature that allows audio and any
documents and other materials exchanged or
viewed during the session to be recorded.
• By joining this session, you automatically
consent to such recordings.
• Please note that any such recordings may be
subject to discovery in the event of litigation.
Housekeeping & Logistics • Check Audio PIN
• Polling questions
• Typed questions
• Tech Difficulties
1-888-259-8414
Polling Question
Who do we have on this webinar?
Counselor / Therapist – Behavioral Health Treatment Provider Clinical Supervisor Clinic Director or Manager Senior Administrator Other Health Care Professional
Vision: Healthy Vermonters living in healthy communities.
Mission: To protect and promote optimal health for all Vermonters.
The Vermont Tobacco Control program provides comprehensive training and technical assistance for tobacco prevention and cessation.
www.healthvermont.gov
National Context: Tobacco &
Substance Abuse
Current Non-Smokers Current Smokers
Illicit Drug Use (ages 12+, 2013 NSDUH)
5.4% 24.1%
Youth Illicit Drug Use (ages 12-17, 2013 NSDUH)
6.1% 53.9%
Alcohol Use (ages 12+, 2013 NSDUH)
48.7% 65.2%
Binge Alcohol Use (ages 12+, 2013 NSDUH)
17.5% 42.9%
Source: National Survey on Drug Use and Health.
http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.htm#4.9
AIDS Obesity Alcohol Motor Homicide Drug Suicide Tobacco
Vehicle Induced
Num
ber
of
Death
s (
thousands)
Individuals
with
mental
illness or
substance
use
disorders
Tobacco use was the cause of death in 51% of alcoholics who completed inpatient treatment examined over a 20-year period
post treatment. Hurt et al. 1996
Among males with heroin addiction, tobacco use was responsible for more deaths than accidental drug poisoning/overdose,
suicide/homicide/accidents, and chronic liver disease examined over a 33-year period.
Hser et al. 2001
Centers For Disease Control and Prevention: Comparative Causes of Deaths in the United States, 2002
Tobacco Use is the Primary Cause of
Death Among Individuals With SUD
Vermont Context: Tobacco &
Substance Abuse
Vermont U.S.
Adult smoking prevalence (ages 18+, age-adjusted, 2013 BRFSS)
18% 18%
Alcohol or Illicit Drug Dependence or Abuse (ages 12+, 2012/2013 NSDUH)
9% 8%
Non-medical use of pain relievers (ages 12+, 2012/2013 NSDUH)
4% 4%
Source: Behavioral Risk Factor Surveillance System, National Survey of Drug Use and Health
Vermont Context: Tobacco and
Substance Abuse
• Prevalence of non-medical
use of pain relievers
decreased significantly in
Vermont across all age
categories from 2011/2012
to 2012/2013.
• There is no trend in overall
opioid deaths in the past 10
years in Vermont.
• Heroin-related fatalities rose
sharply starting in 2013,
reflecting national trends.
• Tobacco kills approximately
1,000 Vermonters per year.
36
46
56 55
49 52
39
61
54
72
67
31
44
55 52
47 47
39
52
46
53 43
6
1 2 4
2 5
1
9 9
21 35
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Total Opioid Rx Opioid Heroin
Figure 1. Total number of Vermont drug-
related fatalities involving an opioid
January 1, 2004 through December 31, 2014
Source: Vermont Office of the Chief Medical Examiner; Campaign for
Tobacco-Free Kids
Tobacco-Free Treatment Centers
in Vermont • July 1, 2015, Vermont’s treatment facilities will be
required to:
– Integrate tobacco use interventions into client
treatment plans
– Create and maintain a tobacco-free environment in
buildings, vehicles, and grounds
• Residential facilities may have an extended timeline
for tobacco-free campuses.
Presenter’s Bio Tony Klein has over 25 years of clinical, administrative, and training experience.
He has a Masters of Public Administration degree with a concentration in Healthcare
Management and holds numerous state, national and international credentials in
substance abuse counseling and training. Known for his work as an advocate for
addressing tobacco dependence in addiction services, he designed a tobacco
treatment model that utilizes evidenced-based practice guidelines anchored in
12-Step teachings and therapeutic community principles.
Mr. Klein served as a member of the New York State Partnership for the Treatment
and Prevention of Tobacco Dependence, the workgroup that consulted New York
State Office of Alcoholism and Substance Abuse Services on drafting state regulation
requiring substance abuse providers to develop tobacco-free policy. He provides
ongoing training and technical assistance to community providers. In addition,
Mr. Klein serves as Manager of Outpatient Services, Rochester Regional Health
System, Unity Chemical Dependency, Brighton, NY.
Disclosure Statement
I have no real or perceived vested interests that
relate to this presentation nor do I have any
relationships with pharmaceutical companies,
and/or other corporations whose products or
services are related to pertinent therapeutic
areas.
Learning Objectives
Participants will…
be able to describe the behavioral association of tobacco use to opiates and other drugs of addiction.
cite at least 3 counseling strategies to enhance client willingness to engage in discussion on the topic and advance stage readiness for tobacco abstinence.
identify 2 fundamental aspects of evidence-based tobacco dependence treatment.
Research Findings
Considerable research indicates that tobacco dependence treatment does not interfere with patients’ recovery from the abuse of other substances.
Evidence indicates that tobacco use interventions, both counseling and medication, are effective in treating smokers who are receiving treatment for chemical dependency.
Fiore et al. (2008). Treating Tobacco Use and Dependence: 2008 Update.
Clinical Practice Guideline. Rockville, MD: USDHHS, PHS, May 2008.
Polling Question: True or False?
People with mental illness and addictions smoke half of all the cigarettes produced, and are only half as likely as other smokers to quit.
TRUE FALSE
Tobacco Interventions
Two Levels of Behavioral Counseling to Match Intervention
to Client Stage-Readiness
Tobacco Awareness
Cognitive) Engagement Develop Interest Highlight Importance Advance Stage-Readiness
Tobacco Recovery(
Behavioral Learn Coping Skills Elevate Confidence Embrace Lifestyle Change Always with Pharmacotherapy
Tobacco Awareness Facilitation
Goals
Promote insight into tobacco use behavior Identify correlation to AOD Express a recovery-oriented message Promote ambivalence Elicit change talk
Methods
Motivational Interviewing Narrative Therapy Psychoeducation (foster teachable moments)
What Does A Great Facilitator Do? avoids taking sides (neutral position) demonstrates confidence and honesty (authenticity) is aware of the group mood and behavior of individuals demonstrates active and reflective listening asks questions that encourages client self-disclosure promotes peer to peer dialogue has a sense of humor can tolerate conflict within the group can summarize the discussion simply
Reframe Language
Use Language Consistent to Recovery Culture,
12-Step Teachings and Therapeutic Community Principles
Public Health / Medical Terms
Smoking Quit Date Cessation
Preferred Terminology
Tobacco Use, Hit, Fix Recovery Start Date Tobacco Treatment, Recovery
The language we use is fundamental in creating environments
conducive to a recovery process. – William White
Setting The Stage ) Welcome members to the group and introduce yourself Provide a brief overview of the topic Request help for exploring the topic Stress to the group that their verbal contribution is valuable Ask for permission to continue Approach the topic from the clients perspective, personal experiences, and existing knowledge of addiction and recovery
Suggested Facilitator Tasks/Topics Recognize the traditional use of tobacco use in the recovering community, i.e. coffee and cigarettes at 12-Step Meetings Share information on how cigarettes have been “re-engineered” to make them more addicting Highlight and thoroughly explore the role that tobacco plays within alcohol and drug use rituals Acknowledge how tobacco use increases AOD relapse Conduct a group decisional balance exercise Elicit client experiences on emotional detachment
Reflective Listening
Content Reflection “You see a strong association between your drug of choice and tobacco use.” Feeling Reflection “You get anxious when you run out of cigarettes.” Meaning Reflection
Simple, Amplified and Double-Sided Reflection
“I always need to smoke a cigarette when I’m getting high. I go through a
whole pack when drinking or drugging and totally panic when I’m down to my
last cigarette or run out.”
“So it sounds like you’re powerless over tobacco.”
Sample Dialogue 1
Does anyone like smoking cigarettes while high on heroin?
I LOVE smoking them on other drugs to boost the high and it works tremendously, such as Ecstasy, Weed, Alcohol, and Caffeine. I tried smoking one while nodding out on black tar heroin however, and I've never been so nauseous in my entire life. I threw up and still felt like throwing up so badly after that. I got SOO hot and sweaty and so dizzy. I couldn’t move without getting so sick. Ironically, this is actually the first time I’ve gotten nausea on an opiate. I felt sooo terrible...just laid there for about 20-30 minutes and then felt good again.
www.bluelight.org/vb/threads/648318-Smoking-a-cigarette-on-heroin
Sample Dialogue 2
I used to always smoke cigs after a fat shot of dope.
I’m on suboxone right now and I love to smoke cigs on suboxone, but they do occassionaly make me throw up or feel really nauseous, so I can relate to you. But most of the time, smoking cigs on suboxone feels amazing. When I was doing H everyday 6 months ago I would LOVE smoking cigs on dope.
www.bluelight.org/vb/threads/648318-Smoking-a-cigarette-on-heroin
Sample Dialogue 3
Why do cigarettes give SWIM the nods big time... SWIM has burnt many a hole in trousers/chairs etc when smoking a cigarette on H
Most junkies seem to smoke cigarettes! It must be the heroin that's making people nod off/ 'gouch' out. SWIM is very right to point out the dangers of burning whilst smoking and taking heroin
SWIM used to chain smoke on heroin, it seemed to enhance the buzz for her and she frequently nodded out while smoking too (only when she was lying down though). After a few hours though SWIM would be sick and she is pretty sure that was a result of too many cigarettes rather than too much heroin…
https://drugs-forum.com/forum/showthread.php?t=41005
Sample Dialogue 4
SWIM always craves a cigarette right after a shot, and if he doesn't
have any, he usually just keeps taking more shots, rather than
smoking more cigarettes like he would normally.
From SWIMs experiences, the first cigarette after doing dope does
strengthen the buzz and is great.
However when SWIM smokes a couple cigarettes after, he starts to
feel nauseous and usually vomits. He has been using for a while, so it
isn't just because he's a new user.
https://drugs-forum.com/forum/showthread.php?t=41005
Case Example
Therapeutic Community
Harlem NYC
45 – 50 Adult Males
Community Meeting
Tobacco Awareness Group
Odyssey House
Polling Question: True or False?
Tobacco Awareness Sessions designed for individuals with substance use disorders focuses on tobacco morbidity and mortality data.
TRUE FALSE
Tobacco Recovery Counseling
Goals
Identify and thoroughly process motivation Determine severity of physical dependence; pharmacotherapy plan Develop a strategy for replacement behavior/ coping skills / relapse prevention
Methods
Motivational Interviewing Cognitive Behavioral Therapy Person-Centered Approach Relapse Prevention Counseling Pharmacotherapy
Tobacco Recovery Counseling
(1) Verify and Bolster Autonomous Motivation
(intra-treatment social support)
Always start by asking the client to express his/her personal reasons for tobacco abstinence: “How is your life going to be better tobacco-free?” Use reflective listening to process client disclosure Suggest development of a “personal slogan” to symbolize and reinforce motivation
Tobacco Recovery Counseling
(2) Define Tobacco Recovery / Develop a
Personalized Treatment Plan to Address the 3
Aspects of Tobacco Dependence
Physical – severity of nicotine dependence Behavioral – habit / environmental factors Emotional – mood-regulating factors
Tobacco Recovery Counseling
(3) Teach Recovery Tools (problem solving skills training)
Physical Reasons for and proper use of pharmacotherapy Diet recommendations Relaxation techniques Physical exercise Cognitive behavioral craving management interventions
Tobacco Recovery Counseling
(3) Teach Recovery Tools (problem solving skills training)
Behavioral Structured “a day at a time” recovery plan Menu of replacement activity / coping skills Identify and address barriers Contingency planning for challenging environments
Tobacco Recovery Counseling
(3) Teach Recovery Tools (problem solving skills training)
Emotional Cognitive restructuring, prayer, meditation Journaling Grief counseling Recovery support network, community support, social media, 802Quits.org, 1-877-QUIT-NOW, Nicotine Anonymous (Internet Meetings), etc. (extra-treatment social support)
Polling Question: True or False?
Tobacco Recovery Counseling utilizes a personalized treatment plan to ensure the appropriate use of nicotine replacement medications, identify coping skills to establish tobacco abstinence, and relapse prevention planning to maintain tobacco abstinence.
TRUE FALSE
For More Information
Questions
Please type in your
questions using the
chat function.
Thanks for joining us today
Think Spring!
