Tobacco Intervention Workbook

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1 Tobacco Intervention Workbook Name: Addiction Prevention & Treatment Services To be tobacco free!

2 TO BE TOBACCO FREE. TOBACCO INTERVENTION WORKBOOK.

3 Table of Contents Introduction Fagerstrom test for nicotine dependence* Getting started Benefits of stopping Myths about stopping Getting support Why do I want to stop Preparing to stop Cutting down Understanding my patterns Coping with cravings and triggers Stop-day countdown Preventing and coping with return to use Where to get support Medications to help you stop using tobacco Alternative therapies Acknowledgements Diary Inside back cover 1 CAPITAL HEALTH. ADDICTION PREVENTION AND TREATMENT SERVICES.

4 Introduction If you re reading this booklet, you ve probably been thinking about stopping or cutting down on your tobacco use. Perhaps you ve already started this process, or maybe you ve tried before but haven t yet accomplished your goals. The important thing is that you re still trying. Here s some good news, you can achieve your goal. Here s what it takes: The determination to stop or cut down on smoking Information about the process of stopping and its effects on your health Support from your family, friends and coworkers Enough time for you to make the physical, emotional and social adjustments to the changes that will happen to you This workbook is designed to help you stop using tobacco. It contains information and strategies to support your efforts. Tobacco Intervention Programming Capital Health Addiction Prevention & Treatment Services (902) TO BE TOBACCO FREE. TOBACCO INTERVENTION WORKBOOK.

5 Fagerstrom test for nicotine dependence* Answer the following questions. Based on your score, you ll be able to figure out how much you depend on nicotine. Points Total 1. How soon after you wake up do you smoke your first cigarette? Less than five minutes 3 Six to 30 minutes 2 31 to 60 minutes 1 After 1 hour 0 2. Do you find it difficult to not smoke? Yes 1 No 0 3. Which cigarettes would you hate most to give up? The first one in the morning 1 Any other 0 4. How many cigarettes do you smoke a day? 10 or less 0 11 to to or more 3 5. Do you smoke more frequently during the first hours after awakening than during the rest of the day? 6. Do you smoke if you are so sick that you are in bed most of the day? Yes 1 No 0 Yes 1 No 0 Total points: One to five: Dependent on nicotine Six or more: Heavy dependence on nicotine If you are dependent on nicotine you can best reach your goals by setting a firm stop date, calling the Smoker s Helpline and using this workbook. 3 If you are heavily dependent on nicotine you can best reach your goals by setting a firm stop date, calling the Smoker s Helpline and using this workbook. As well you may want to try nicotine replacement therapy to make the withdrawal from nicotine more comfortable. * Heatherton, TF, Kozlowski LT, Frecker RC,Fagerstrom KO The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addictions 86: CAPITAL HEALTH. ADDICTION PREVENTION AND TREATMENT SERVICES.

6 Getting started Benefits of stopping When you stop using tobacco, within 20 minutes your body begins the following series of changes. 20 minutes after stopping: blood pressure goes down pulse rate slows body temperature of hands and feet increases Eight hours after stopping: carbon monoxide level in blood drops to normal oxygen level in blood increases to normal 24 hours after stopping: chance of a heart attack lessens 48 hours after stopping: nerve endings start re-growing ability to smell and taste improves Two weeks to three months after stopping: One to nine months after stopping: One year after stopping: circulation improves walking becomes easier lung function increases coughing, sinus congestion, fatigue and shortness of breath decreases high risk of heart disease is cut down to half of that of a tobacco user Long-Term Benefits of Stopping 4 At five years: At 10 years: At 15 years: from five to 15 years after stopping, stroke risk is reduced to that of people who have never used tobacco risk of lung cancer drops to as little as one-half that of continuing tobacco users risk of cancer of the mouth, throat, esophagus, bladder, kidney and pancreas lessens risk of stomach ulcer lessens risk of coronary heart disease is now similar to that of people who have never used tobacco risk of early death returns to nearly the level of people who have never used tobacco Financial Benefits of Stopping One year: you will save more than $3,000 Lifestyle Benefits the freedom to go wherever you want and stay as long as you want TO BE TOBACCO FREE. TOBACCO INTERVENTION WORKBOOK.

7 Myths about stopping Myth #1: It takes several attempts to stop successfully. This may be true for some but not all people who want to stop using tobacco. Many people stop on their first try, while others may need to try a few times. The more support you have, the more successful you ll be (for more information about support, see pages 6 and 13). Myth #2: I can t stop tobacco use without nicotine replacement products such as the patch or gum. Medications may not be necessary for everyone who wants to stop smoking. Many light to moderate tobacco users may not need nicotine replacement to stop. Other methods such as support programs and self-help materials can be just as effective when you re trying to stop smoking. Nicotine replacement may be helpful if: you are motivated to stop and you have tried to stop before without success. you are a moderate to heavy tobacco user. Myth #3: If I use medications with nicotine, such as a patch or gum, they may be addictive and harmful to my health. The nicotine in the patch or gum helps reduce tobacco cravings and the withdrawal symptoms that some people experience when they stop smoking. This type of nicotine is completely safe for most people because it doesn t contain any of the harmful chemicals in cigarettes. The small amount of nicotine you receive also means that you won t become addicted to the patch or gum. Myth #4: I ll gain weight if I stop smoking. Not everyone gains weight after they stop using tobacco. Those who do usually gain only a few kilograms (five to seven pounds). If you do gain weight, you could try losing it by adopting healthy-eating habits and increasing your physical activity a few weeks after you have been tobacco free. The health benefits of stopping are far greater than those associated with putting on a few extra pounds. My strategies for maintaining my weight after I stop smoking: CAPITAL HEALTH. ADDICTION PREVENTION AND TREATMENT SERVICES.

8 Getting support The support you get from friends, family and coworkers is one of the most important factors to your success in stopping tobacco use and not starting again. The network of support you form will definitely improve your chances of success. Who can support you and how? Talk to your family, friends and coworkers. Tell them that you are planning to stop using tobacco and you need their help. Ask them not to smoke around you and not to leave cigarettes lying around. Talk to your family doctor about your plan to stop and ask for his/her help and advice. Ask close friends or family members if they are willing to be part of your special network of support. They can be your sounding board when you need to talk to someone about your good or bad day. Access telephone support such as the Smoker s Helpline at This kind of support can help you get through the difficult moments that are bound to arise when you try to stop smoking and help you understand your stopping process. Benefits of stopping my tobacco use The main reasons I have decided to stop are: TO BE TOBACCO FREE. TOBACCO INTERVENTION WORKBOOK.

9 Why do I want to stop? Check ( ) all of the benefits that would apply to you if you quit smoking: I would feel healthier Food would taste better I would be a better role model for my children My clothes and hair wouldn t smell I would be more physically fit I would cough less My risk of heart disease would decrease I wouldn t have to smoke outside I might live longer Other: Other: What are the three biggest barriers or difficulties I might encounter if I try to stop my tobacco use? What are the three biggest factors supporting me to stop using tobacco at this time? CAPITAL HEALTH. ADDICTION PREVENTION AND TREATMENT SERVICES.

10 Preparing to stop Cutting down If you want to reduce or cut down on your tobacco use, here are a few suggestions: Carry only the number of cigarettes you wish to smoke that day Carry no cigarettes at all Buy a smaller pack of cigarettes Increase the time between each cigarette you smoke Give up the easiest cigarette first Smoke with your opposite hand Take a few puffs and then butt out When you feel the urge to smoke, try waiting five to seven minutes. The urge should pass. Each day postpone the lighting of your first cigarette for one hour Only smoke during odd or even hours of the day Remember that cutting down can help you stop. It can be an important step to becoming tobacco free. Understanding my patterns You may find it helpful to track when and why you smoke. Keeping a smoker s diary may help you discover your patterns of tobacco use. The following is an example of a smoker s diary, and there is a blank copy at the back of this workbook. Cigarette number Time of day Need* What I was doing Who I was with Reason for cigarette 1 7:10 a.m. 8/10 drinking my coffee family to wake up 2 7:25 a.m. 9/10 driving to work alone to relax 3 10:00 a.m. 7/10 coffee break coworkers habit 4 12:00 p.m. 10/10 leaving for lunch coworkers craving * Rate your personal need for a cigarette at this time (1 = low, 10 = high) 8 TO BE TOBACCO FREE. TOBACCO INTERVENTION WORKBOOK.

11 Coping with cravings and triggers When you start trying to stop smoking, you may experience some discomfort or urges to smoke. If you can figure out what things are triggers, you can try to avoid them. Check ( ) any of the following that you think might be a trigger: Being around others who use tobacco Talking on the phone Taking breaks at home, work or school Feeling bad or down Drinking alcohol After a meal Driving Other: Other: Alternatives for triggers Being around other tobacco users Talking on the phone Taking coffee breaks at work Feeling bad or down Drinking alcohol After a meal Driving In the beginning it may be helpful for you to stay away from people who use tobacco. Tell them that you are trying to stop. Think of your reasons for stopping. Break your usual phone routine. Stand up, sit down or change rooms. Have healthy snacks available. Doodle with a pen. Keep your hands busy. Move to a new tobacco-free location. Take a walk, read a book, eat a snack or do a crossword puzzle. Plan new activities. Read a book, exercise, start a hobby or call a friend or relative for support. Drink non-alcoholic beverages for a while. Get up after a meal and leave the table. Change your routine. Gargle or brush your teeth. Change your usual routine. Remove all cigarettes from the car. Clean out the ashtray. 9 CAPITAL HEALTH. ADDICTION PREVENTION AND TREATMENT SERVICES.

12 Even with nicotine replacement therapies, you may still experience some withdrawal. Don t be discouraged. You ll be okay. Withdrawal symptoms Craving tobacco Anxiety, irritability Trouble sleeping Lack of concentration Tiredness Dizziness Headaches Coughing Hunger Constipation Make yourself more comfortable with these strategies Practice deep breathing Distract yourself Wait out the urge until it passes Stay away from caffeine Get support (see pages 6 and 13) Go for a brisk walk Take hot baths Stay away from caffeine at night Think restful calming thoughts Don t nap during the day Avoid additional stress Go for a brisk walk Organize your workload Allow yourself time to relax Do some physical activity Sit or lie down Take a mild pain reliever Sip water Take a cough drop Eat balanced meals Eat low-calorie snacks Drink plenty of fluids Eat high-fibre foods such as fruits, vegetables and whole-grain cereals Drink plenty of water 10 Use the 4 Ds to cope with tobacco cravings: Drink plenty of water, from six to eight glasses a day Delay for five to seven minutes until the urge has passed Do something else Deep breaths TO BE TOBACCO FREE. TOBACCO INTERVENTION WORKBOOK.

13 Stop-day countdown Setting a day to stop tobacco use can be another important step to becoming tobacco free. Tear out this countdown and paste it where you will see it often, such as next to your calendar. My stop date is: 5 days before your stop date: Think about why you are stopping Tell your friends and family that you re planning to stop Stop buying tobacco Get individual, group or telephone support 4 days before your stop date: Pay attention to when and why you use tobacco Think of other things to hold in your hand instead of a cigarette Think of habits or routines you could change 3 days before your stop date: Think about what you ll do with the extra money when you stop buying tobacco Think about whom you ll call when you need help 2 days before your stop date: Find out if the patch and nicotine-replacement gum are right for you Think about your tobacco-use patterns and how to make new patterns tobacco free 1 day before your stop date: Put away lighters and ashtrays 11 Throw away all tobacco and matches Clean your clothes to get rid of the tobacco smell Stop-day: Keep busy Remind family and friends that this is your stop-day Stay away from alcohol Treat yourself or do something special CAPITAL HEALTH. ADDICTION PREVENTION AND TREATMENT SERVICES.

14 Preventing and coping with return to use What is a blip? A blip occurs when you have one or two cigarettes. A blip will not keep you from stopping. What is return to use? Return to use is when you start smoking again on a regular basis. Return to use will not keep you from stopping. What situation would put you at highest risk for a blip or return to use? High risk situation: My action plan for this is: Blips and return to use usually happen when tobacco users who are trying to quit: drink alcohol feel stressed, frustrated, angry, discouraged or just plain down are with other tobacco users Avoid return to use by: saying no to that first cigarette spending time in tobacco-free places encouraging yourself to keep up the good work making a plan for high risk situations 12 Turning return to use into a recommitment to stop: Tobacco use is a health issue, not a moral issue. If you want to stop, you must have a good plan, lots of support and the best tools for you. It s not about inner strength or weakness. You may have run into a detour on your road to becoming tobacco free. You might be using tobacco again on a regular basis. DON T GIVE UP! Return to use is not failure because you have learned something about yourself that you didn t know before. Use this new information to help yourself try to stop smoking again. TO BE TOBACCO FREE. TOBACCO INTERVENTION WORKBOOK.

15 It takes some people a few tries before they stop using tobacco for good. Think about why you returned to use and adjust your plan of action: Did you need a better plan? Did you need more substitutes for cigarettes? Were there better ways to deal with tempting or stressful situations? Did you test yourself with that one magical I can do this smoke? Did depression or frustration get in the way? Did you get upset because you gained weight? Did you need more support from your friends, family members and coworkers? Next step: Use the resources in this workbook and set a new stop date as soon as possible. Where to get support 1. The Canadian Cancer Society s Smoker s Helpline is a telephone information-and-support service for smokers and the people who care about them. Trained specialists can help you develop a structured plan to stop smoking and can answer questions about quitting. The Smoker s Helpline answers questions about: withdrawal symptoms quitting methods how to deal with slips and return to use managing stress coping with cravings asking for support Call the Smoker s Helpline at for free personal counselling from Monday to Thursday, 9 a.m. to 9 p.m., and Fridays between 9 a.m. and 5 p.m. The Smoker s Helpline also directs callers to services in their community Capital Health Addiction Prevention and Treatment Services. Call to find out current program options or visit 3. Free Acupuncture Clinics in Capital Health. See page 16 for locations. 4. Visit for information and resources from the Nova Scotia Department of Health. 5. Visit Health Canada s web site for more support Click on e-quit to enroll in an on-line support program. CAPITAL HEALTH. ADDICTION PREVENTION AND TREATMENT SERVICES.

16 Medications to help you stop using tobacco Nicotine gum: Nicorette (2 mg of nicotine) Nicorette Plus (4 mg of nicotine) Nicotine chewing pieces or gum release a safe, small quantity of nicotine through the blood vessels near the surface of your gums and cheek. It should not be chewed like chewing gum; instead, take a few bites to release the nicotine and then park the gum in your cheek. Slowly turn it over for 30 minutes, then throw it away. Most people use up to 20 pieces per day. It is recommended that you use the gum for 8 to 12 weeks after you stop smoking, but some people find they need to use it for a longer period of time. Many people don t get the greatest benefit or have mild side effects because they don t use the gum properly. Make sure you read the instructions before using it. If you are pregnant or breastfeeding or you have had a heart attack in the past two weeks, have an irregular heartbeat (arrhythmia) or serious angina, you should consult a doctor before using nicotine gum. Nicotine patches and gum may be used together for a short period of time to help heavy smokers who have had trouble quitting with the patch or gum alone. Put on one patch each day (for example, a 14 mg patch) and then use gum only when you experience a strong craving to smoke. How to use the gum: Bite the gum once or twice. Park the gum between your gum and cheek. Do not chew the gum. Use the gum for a 30-minute period. Slow down if you start to feel uncomfortable. e.g. light-headed, sick to your stomach. Do not chew more than one piece of gum at a time. Do not chew more than one piece of gum an hour. Do not chew more than 20 pieces of gum a day. Wait 15 minutes after eating before using the gum. Wait 30 minutes after drinking coffee, tea, soft drinks, alcohol or orange juice to use the gum. 14 Not everyone needs to use medication to help them stop smoking. How much you smoke, what your nicotine dependence level is and how many times you have tried to stop before can help you and your doctor or pharmacist decide if the gum is right for you. These products are available at any pharmacy without a prescription. It may be helpful for you to complete the Fagerstrom Nicotine Dependency Test on page 3 of this booklet to help you and your pharmacist decide how to best use this product, if at all. Nicotine Inhaler: The nicotine inhaler is a device used to deliver a small amount of nicotine through the roof of the mouth and the back of the throat. The nictoine inhaler is available without a prescription at your local pharmacy. Please check with the Pharmacist for appropriate dosing and use instructions. TO BE TOBACCO FREE. TOBACCO INTERVENTION WORKBOOK.

17 Nicotine Patches: Nicotine patches release a small amount of nicotine into your skin. The nicotine helps reduce cravings to smoke and the withdrawal side effects some people experience when they stop smoking. The patch is safe for most people because it doesn t contain any of the harmful chemicals in cigarettes. The small amount of nicotine it releases also means that you won t become addicted to the patch. Patches are sold at pharmacies without a prescription and come in three strengths: 21 mg, 14 mg and 7 mg. You should apply one patch each day starting when you decide to stop using tobacco. Most people should try to use the patch for eight to 12 weeks, although some find it helpful to use it for longer. Don t use nicotine patches if you are allergic to bandages. If you have an irregular heartbeat or active angina or if you have suffered a heart attack or a stroke in the past month, you should only use nicotine patches under a doctor s supervision. Women who are pregnant or breastfeeding also should consult a doctor before using these patches. Again, not everyone needs to use medication to help them stop smoking. How much you smoke, what your nicotine dependence level is and how many times you have tried to stop before can help you and your doctor or pharmacist decide if the patch is right for you. These products are available at any pharmacy without a prescription. It may be helpful for you to complete the Fagerstrom Nicotine Dependency Test on page 3 of this booklet to decide how best to use this product, if at all. Zyban: (also known as bupropion) Bupropion is a pill that is available only by prescription from your doctor. The most common type of bupropion for smoking cessation is called Zyban. Like the patch and gum, this medication helps reduce cravings to smoke and withdrawal symptoms. You must start taking bupropion seven to 14 days before you stop smoking. Most people take one pill in the morning and one in the afternoon for seven to 12 weeks after they stop smoking. It may be used for longer periods of time if needed. Bupropion may be used with the patch and gum. You should ask your doctor if combining bupropion with the patch and gum is right for you. 15 Bupropion is generally not recommended for women who are pregnant or breastfeeding. However, if you are pregnant and if other methods of stopping smoking have not worked, you may wish to speak to your doctor about the possibility of using bupropion since continuing to smoke is very dangerous to developing and newborn babies. If you have ever had a seizure disorder or an eating disorder, you should not use bupropion. It should not be used if you are taking a special drug to treat depression called an MAO inhibitor. If you have high blood pressure, your doctor should monitor you. *Adapted from material written by Paul McDonald, Ph.D. CAPITAL HEALTH. ADDICTION PREVENTION AND TREATMENT SERVICES.

18 Alternative therapies Acupuncture Acupuncture can help you relax, sleep better, improve your mood, and decrease your feelings of stress. Used with other treatments such as counselling, it may help in your stop attempt. Acupuncture is most effective if it is delivered in a series of treatments over a period of time. It is a free service offered by Addiction Prevention & Treatment Services at Capital Health. Acupuncture clinics are available at all these sites. No appointment is necessary. Call for Acupuncture Clinic schedule Dartmouth Simpson Hall, The Nova Scotia Hospital Halifax 1673 Bedford Row Sackville Cobequid Community Health Centre Spryfield Captain William Spry Centre Windsor Hants Community Hospital Sheet Harbour Eastern Shore Memorial Hospital Acknowledgements Capital Health s Addiction Prevention & Treatment Services gratefully acknowledge the contributions of Paul McDonald, PhD. Dr. McDonald is a professor of Health Studies at the University of Waterloo. He is internationally recognized for his more than 15 years of research and practice in the field of smoking cessation. 16 TO BE TOBACCO FREE. TOBACCO INTERVENTION WORKBOOK.

19 Diary Cigarette number Time of day Need* What I was doing Who I was with Reason for cigarette * Rate your personal need for a cigarette at this time (1 = low, 10 = high) CAPITAL HEALTH. ADDICTION PREVENTION AND TREATMENT SERVICES.

20 05/05 Tobacco Intervention Programming Addiction Prevention and Treatment Services (902)

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