Increasing your odds for success...secondhand e‐cigarette emissions. •The long‐term health...
Transcript of Increasing your odds for success...secondhand e‐cigarette emissions. •The long‐term health...
10/24/2019
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Increasing your odds for success:
Rolling tobacco into your work
Introductions• Jamie Andycha, MPH
Wellness Services Manager
• Meghan Bown, LSW
Program Manager, Tobacco Treatment
• Sally Sales, MA
Mental Health Resources– Health & Wellness Manager
Learning Objectives:
• Identify myths and facts related to tobacco and other addictions
• Understand resources available to integrate tobacco into your existing SUD program
• Apply existing skills to treat tobacco addiction
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Game Plan:
• Tobacco Connection
• Myths & Facts
• Tips from the Field
• Bringing it home
Tobacco Defined
Sacred Medicinal Tobacco Commercial Tobacco, including e‐cigarettes
We have an opportunity
Substance Abuse and Mental Health Services Administration. (2011). Tobacco Use Cessation During Substance Abuse Treatment Counseling. HHS Publication No. (SMA) 11‐4636Clin
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Behavioral Causes of Death in the U.S.
U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014.4; 291:1238-1245
The Impact: Big Tobacco Target Marketing
More Connections:
Guydish, J., Passalacqua, E., Pagano, A., Martinez, C., Le, T., Chun, J., & Tajima, B. (2015). An International Systematic Review of Smoking Prevalence in Addiction Treatment. Society for the Study of Addiction.
85%OF PATIENTS IN TREATMENT FOR
OPIOD ADDICTION
SMOKE
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The Untreated Drug Tobacco Use Disorder
DSM‐5 305.1 (Z72.0) (F17.200)
• Three Criterion
• With 15 sub features,
• And four specifiers to diagnose Tobacco Use disorder.
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Criterion 1: Larger quantities of tobacco over a longer period then intended are consumed.
• Unsuccessful efforts to quit or reduce intake of tobacco
• Inordinate amount of time acquiring or using tobacco products
• Cravings for tobacco
• Failure to attend to responsibilities and obligations due to tobacco use
• Continued use despite adverse social or interpersonal consequences
• Forfeiture of social, occupational or recreational activities in favor of tobacco use
• Tobacco use in hazardous situations
• Continued use despite awareness of physical or psychological problems directly attributed to tobacco use
Criterion 2: Tolerance for nicotine, as indicated by:
• Need for increasingly larger doses of nicotine in order to obtain the desired effect
• A noticeably diminished effect from using the same amounts of nicotine
Criterion 3: Withdrawal symptoms upon cessation of use as indicated by• The onset of typical nicotine associated withdrawal symptoms is present
• More nicotine or a substituted drug is taken to alleviate withdrawal symptoms
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Tobacco = Nicotine = Central Nervous System Stimulant
2 ‐hour half life
Cycle of addiction
SUD Treatment can be more successful for all patients
Baca, C.T., & Yahne, C.E. (2009). Smoking cessation during substance abuse treatment: What you need to know. Journal of Substance Abuse Treatment, 36(2), 205‐209
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Quick Break: Stand up and find someone in the room that has a similar hobby as you.
“ If someone is struggling with substance use disorders, isn’t quitting tobacco the least of their worries?”
What about those we serve?
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Facts
• 89% of people seeking services who smoke said they want staff to ask them about quitting.
• 92% of people felt that avoiding tobacco was very important for them to be healthy.
• Most do want to quit; you can provide them the resources they need to be successful in treating their tobacco addiction.
* These surveys done in MN are consistent with surveys in other states.
“ Can people quit smoking on top of everything else?”
Facts
• Yes, they can!
• People can and do address smoking in addition to other treatment efforts.
• They may need more intensive support and a longer period of treatment.
• Quitting smoking can help participants remain abstinent from other substances and improve mental health.
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A survey from the CDC shows:55% of all smokers have made a quit attempt this past year
“ Should we just encourage people to use electronic cigarettes, vaping, or
Juuling?”
Facts• E‐cigarettes are unregulated tobacco products and almost all e‐cigarettes include nicotine, as well as harmful chemicals and carcinogens.
• Both the U.S. Surgeon General and the National Academies of Science, Engineering and Medicine have warned about the risks of inhaling secondhand e‐cigarette emissions.
• The long‐term health consequences of e‐cigarettes are just becoming known.
• For best chance of success at stopping smoking cigarettes, people should use FDA‐approved products such as the patch, gum and lozenge, or prescription medicine under guidance of their health care provider, along with counseling.
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What about me?
“ What if I smoke and it helps me cope with
stressful work situations?”
Facts
• It’s part of our job to model appropriate coping skills in our work environment and using tobacco is not a healthy coping skill.
• Positive coping mechanisms can include a walk break, meditation, talking to a co‐worker.
• Mental health improves after quitting smoking and anxiety, depression, and stress significantly decrease in those who stop using tobacco.
What about my organization?
“ Will we be the first organization to talk about tobacco treatment?”
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Facts
• People Incorporated, Mental Health Resources, Avivo, and Vail Place went tobacco‐free in 2018. Other organizations have joined in 2019.
• One in four mental health treatment centers nationally offers tobacco treatment services.
• The American Lung Association, MN Department of Health, MN Department of Human Services, Twin Cities Medical Society, and National Alliance on Mental Illness are able to provide staff training and resources on tobacco dependence.
Who is doing it!Of 369 substance abuse treatment facilities, 2016
• 58.3% reported screening patients for tobacco use.
• 31.2% offered tobacco cessation counseling.
• 24.1% offered nicotine replacement therapy.
• 16.5% offered non‐nicotine cessation medications.
• 15.2% had a smoke‐free campus policy.
CDC MMWR: Tobacco Cessation Interventions and Smoke‐Free Policies in Mental Health and Substance Abuse Treatment Facilities — United States, 2016.
“ If we are among the first ones to go tobacco‐free, won’t staff and clients go elsewhere?”
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Facts
• There is a growing movement within mental health and substance use disorder (SUD) treatment programs to address the whole health of staff and clients by making their facilities tobacco‐free.
• Data does not show that staff leave
• Or, that census numbers drop when a site goes tobacco‐free.
“ Are tobacco‐free grounds policies enforceable?”
Facts
• With adequate • time leading up to implementation,
• staff training around changing social norms,
• And signage,
tobacco‐free policies are mostly self‐enforcing.
• Many organizations, including those who provide housing, college campuses, and other behavioral health organizations, have found tobacco‐free grounds to be easier to enforce than having designated smoking areas.
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Quick Break: BreatheTake 10‐15 deep breaths.
focus on blowing out all your stress & anxiety and taking in peace and grace
with yourself and others
A call to action & resources to help!
Culture
What role does tobacco play in your organization’s culture?
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You have options. There are many ways to address tobacco use in your work.
Tobacco Treatment
Referral to External Services Providing individual and/or group counseling
Providing and/or prescribing quit medications
Screening
Does your organization currently ask about tobacco use?
Support Tools
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Assessment
Fagerstom Test for Nicotine Dependence
Establishing readiness for change:
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Stages of Change
Stages of Change for Tobacco Use Disorder
Counseling Styles proven to support tobacco treatment
Motivational Interviewing
Cognitive Behavioral Therapy
Acceptance Commitment Therapy
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Best Practice
Medication Assisted Treatment
• Nicotine Replacement Therapies over the counter• Patch
• Gum
• Lozenge
• Quit Medications & Therapies by prescription• Inhaler
• Nasal Spray
• Varenicline (brand name Chantix) –prescription only
• Buproprion (brand name Zyban or Wellbutrin)
Treatment Planning
Thinking: Goal, Objective, Intervention
Write a possible treatment plan for someone currently in your stage of change.
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Billing & Documentation
Where are they now?
Journey Home, Family Unity, Recovery Plus
To support an environment for healing,
November 4, 2014 all our treatment facilities will be tobacco free.
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Count down & Education Center
Recovery Plus Lobby Journey Home Circle
People Incorporated
Mental Health Resources
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Contact Information• Jamie Andycha, MPH
People Incorporated– Wellness Services ManagerPhone: 651‐395‐1985Email: [email protected]
• Meghan Bown, LSWCentraCare Health –Program Manager, Tobacco TreatmentPhone: 320‐351‐2700 x 57936Email: [email protected]
• Sally Sales, MAMental Health Resources– Health & Wellness ManagerPhone: 651‐999‐4651Email: [email protected]
How to Address Tobacco Use in Minnesota's Mental Health and Substance Use Disorder Services: TIPS FROM THE FIELD
• https://www.lung.org/tips‐from‐the‐field• www.lung.org/behavioralhealth‐minnesota
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