TOBACCO TRIGGER TAPE SYNOPSES - PSYCHIATRY Tape
Dialogue
Scenario
Problem
Solution
5
“I’ve quit at least a hundred times. I just don’t know that I can stay off cigarettes once I get home.”
Man is in a hospital bed, receiving bedside counseling.
Many individuals who have had multiple relapses convince themselves that they can never quit.
Instruct the patient to think of quitting smoking as a learning process similar to learning to ride a bicycle. Consider saying, “When you learned to ride a bike, you fell off, figured out what worked and what didn't, and then got back on. You did this until you were able to ride without falling. Some people even used training wheels.” Educate the patient about the quitting process and how he can learn from his past quit attempts. Consider saying, “Those past experiences were your ‘training wheels.’ What did you learn about yourself during those attempts? Apply those lessons now to make this quit successful. Don’t let those past ‘falls’ be the excuse to never try again.”
8
“Why do I need drugs to quit? I don’t like putting drugs in my body.”
Woman is sitting on a patient examination table, talking with her clinician.
Many smokers mistakenly view the cessation products negatively while not understanding the real negative consequences of the chemicals found in cigarettes.
Explain to the patient that she is putting lots of chemicals in her body every time she smokes. Each cigarette contains over 4,000 substances, many of which are known or suspected human carcinogens. Any smoking cessation medication contains only one drug that has been shown to be an effective way to help smokers quit for good. Ensure that the patient understands that although nicotine is the addictive drug found in cigarettes, it is not what causes the negative health consequences of smoking. These health consequences occur from ingesting carbon monoxide, acetone, and tar, for example, as well as a multitude of cancer-causing substances. Thousands of chemicals are found in each and every cigarette. Say to the patient, “You will only use a smoking cessation medication for a short period of time. These medications have been proven to be safe and effective through dozens of clinical trials. They help you slowly reduce your dependence on nicotine while immediately eliminating all the other toxic substances found in cigarettes.”
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Copyright © 1999-2011 The Regents of the University of California. All rights reserved.
TOBACCO TRIGGER TAPE SYNOPSES (CONT’D) Tape
Dialogue
Scenario
Problem
Solution
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.
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.
25
“What do you mean I can’t go outside and smoke?”
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.
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Copyright © 1999-2011 The Regents of the University of California. All rights reserved.
TOBACCO TRIGGER TAPE SYNOPSES (CONT’D) Tape
Dialogue
34
“Hey don’t hassle me about my smoking, doc! Everyone keeps asking me if I smoke – why can’t everyone just leave me alone?! Look…my life’s a mess right now, and I just need my cigarettes!”
Clinician’s office
Many patients believe they cannot function without smoking and are extremely fearful of quitting.
Consider saying, “I’m asking because I’m concerned about your health and I want you to be as healthy as possible. I’m not telling you that you have to quit.” Understand that many individuals who make these types of statements literally do believe that they “need” cigarettes to survive. 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. Ask the patient, “How is smoking making your life better?” or “What benefit do you think you are getting from your cigarettes?” Then point out the reality behind the myth of the positive impact they think the cigarette is providing them.
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.
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.
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Scenario
Problem
Solution
Copyright © 1999-2011 The Regents of the University of California. All rights reserved.
38
“Well, my doctor didn’t say anything about my smoking, so…it can’t be that bad, right?”
Page 4 of 3
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.
Copyright © 1999-2011 The Regents of the University of California. All rights reserved.
