TOBACCO TRIGGER TAPE SYNOPSES – PEER COUNSELOR MENTAL HEALTH Tape
Dialogue
Scenario
Problem
Solution Generally speaking you will approach patients with psychiatric illness in a slightly different manner than patients in the general population. Because smoking is viewed by the vast majority of these individuals as a central part of their life, quitting altogether on a specific day may be untenable and overwhelming. Therefore, it is possible that a tapering schedule, with an eventual quit day, may be more efficacious with some individuals within this population. However, thoroughly discuss the options with the patient before making a decision about methods for quitting. Individuals with psychiatric or substance abuse problems can quit smoking as well as the general population, as long as the quitting plan meets their specific needs. Because many psychiatric drugs interact with cigarette smoke, be aware of the need to monitor drug dosing with anyone in this population who is quitting. Consider discussing the situation with the patient’s physician prior to their quit date. Many individuals who say they cannot live without cigarettes literally do believe it. Therefore, be especially empathic and understanding, and do not push. However, make it clear that cigarettes cannot help anyone live a better life, and that the vast majority of the population lives just fine as nonsmokers. Point out that all of the cessation products cost between $3.50 - $5.00 day, generally the same as a pack of cigarettes. Do the math. Determine how much the smoker spends in a year on cigarettes and show them how much they will save if they quit. Remind the patient that although they perceive the products as being expensive, use is only for a short period of time, unlike continued smoking. Help the patient understand that smoking does not get rid of stress, it causes it. Because there is no drug in cigarettes that magically gets rid of stress, remind the patient that they have actually been the one to deal with their stress for their entire life. Advise the patient to give themselves credit, not the cigarette, for successful stress management. Refer patients to local stress management programs, advise them to begin to exercise, or suggest that they take a meditation class, all ways to effectively learn to deal with stress.
16
“I can’t live without cigarettes. I just can’t.”
Patient with psychiatric illness reacts to the notion of quitting.
Many patients with psychiatric illness believe they cannot function without smoking and are extremely fearful of quitting.
17
“All those smoking medications cost way too much.”
N/A
Many patients who smoke feel that they cannot afford cessation medications, so they continue to smoke.
20
“I just have too much stress in my life to even think about quitting.”
Patient examination room
The pervasive belief that smoking either gets rid of stress or helps the smoker deal with stress prevents many smokers from attempting to quit or prompts them to relapse back to smoking once they have quit.
Page 1 of 3
Copyright © 1999-2011 The Regents of the University of California. All rights reserved.
TOBACCO TRIGGER TAPE SYNOPSES – PEER COUNSELOR MENTAL HEALTH (CONT’D) Tape
Scenario
Problem
Solution
25
“What do you mean I can’t go outside and smoke?”
Dialogue
Patient with IV pole, in hospital hallway, attempting to go outside to smoke
Many hospitalized patients think that they have the “right” to smoke and that they can leave the hospital at any time to do so.
Calmly remind this patient that they are in the hospital to get well, not to continue to harm himself by smoking. Reframe the hospitalization as the ideal time to quit and review the options available at your institution to help them do so. Help this patient to understand how smoking has contributed to his hospitalization and that permitting him to smoke would be unethical.
33
“The last time I quit, my depression got worse. I’m just starting to feel good now…I don’t want to backslide.”
Clinician’s office
Patients often understand the link between smoking and depression and fear that quitting will impact their depression.
Inform the patient that the effects of nicotine on the brain mimic those of an antidepressant. As such, depression can be a very real withdrawal symptom. Therefore anyone with a history of depression should quit smoking under a doctor’s care or with help from a psychiatry pharmacist so that medication levels can be monitored. However, be sure to emphasize that they can quit successfully without a reoccurrence of their depression. From the start, coordinate your quitting program with the individual’s psychiatrist/psychologist. Pay special attention to the patient’s symptoms/mood the first week of the quit and at points where the patient is stepping down on nicotine replacement therapy as these are likely the times of the greatest metabolic shifts.
35
“But won’t the stress of quitting increase my chances of drinking again?”
Counselor’s office
Because smoking and drinking (alcohol) are closely associated for many patients, they commonly assume that quitting smoking will lead to an increase or return (for those who are abstinent) to drinking.
Inform the patient that there simply is no scientific evidence to show that people who quit smoking relapse back to drinking. In fact, research shows the exact opposite. Individuals with substance abuse problems who quit smoking are more likely to stay sober than those who continue to use. “In any case, we will certainly address your concerns as we create your quitting plan by focusing on stress management strategies.” Encourage this patient to maintain their attendance at (or return to) AA during the quitting process so that they have a ready forum to discuss any concerns as they arise.
Page 2 of 3
Copyright © 1999-2011 The Regents of the University of California. All rights reserved.
TOBACCO TRIGGER TAPE SYNOPSES – PEER COUNSELOR MENTAL HEALTH (CONT’D) Tape
Dialogue
36
“I have so many problems anyway another one’s not gonna make any difference. Besides how can I quit when everyone in my group home smokes?”
Clinician’s office
Most patients who live in group homes perceive it will be very difficult to quit when others are smoking around them.
Consider saying, “Hundreds of people who live with other smokers quit every day. I will work with you to create a plan so that you will be able to deal with this situation and be comfortable in your home.” Some suggestions for dealing with this situation: Have a meeting with the housemates to discuss where they will/will not smoke. Ask the housemates not to leave cigarettes or dirty ashtrays where the quitter can find them. Because this likely is a psychiatric setting, contact the health professional in charge of the home and discuss possible strategies to help the quitter cope while in this setting. Strongly encourage the entity in charge of the group home to make it smokefree.
38
“Well, my doctor didn’t say anything about my smoking, so…it can’t be that bad, right?”
Examination room
Failure to address tobacco use with a patient tacitly implies that continued smoking is acceptable.
“Unfortunately, many physicians do not address tobacco use for a variety of reasons. However, don’t take that as an endorsement to continue to smoke. The scientific evidence is very clear…smoking is the leading cause of disease and death.” Clearly link the presenting diagnosis with smoking. Remind the patient that smoking is causing their condition, exacerbating symptoms or interfering with healing.
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Scenario
Problem
Solution
Copyright © 1999-2011 The Regents of the University of California. All rights reserved.
