Kicking the Habit(s): Tobacco & Opiate Addiction Tobacco Interventions Tailored to Individuals with Substance Use Disorders

Transcription

1 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

2

3 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

4 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

5 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.

6 Check Audio PIN Polling questions Typed questions Tech Difficulties Housekeeping & Logistics

7 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

8 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.

9 National Context: Tobacco & Substance Abuse Current Non-Smokers Illicit Drug Use (ages 12+, 2013 NSDUH) Current Smokers 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.

10 Number of Deaths (thousands) Tobacco Use is the Primary Cause of Death Among Individuals With SUD 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 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 Individuals with mental illness or substance use disorders AIDS Obesity Alcohol Motor Homicide Drug Suicide Tobacco Vehicle Induced Centers For Disease Control and Prevention: Comparative Causes of Deaths in the United States, 2002

11 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

12 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. Figure 1. Total number of Vermont drugrelated fatalities involving an opioid January 1, 2004 through December 31, Total Opioid Rx Opioid Heroin Source: Vermont Office of the Chief Medical Examiner; Campaign for Tobacco-Free Kids

13 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.

14 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.

15 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.

16 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.

17 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.

18 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

19 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

20 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)

21 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

22 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

23 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

24 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

25 Reflective Listening 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. 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 So it sounds like you re powerless over tobacco.

26 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 minutes and then felt good again.

27 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.

28 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

29 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.

30 Case Example Therapeutic Community Harlem NYC Adult Males Community Meeting Tobacco Awareness Group Odyssey House

31 Polling Question: True or False? Tobacco Awareness Sessions designed for individuals with substance use disorders focuses on tobacco morbidity and mortality data. TRUE FALSE

32 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

33 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

34 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

35 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

36 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

37 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, QUIT-NOW, Nicotine Anonymous (Internet Meetings), etc. (extra-treatment social support)

38 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

39 For More Information

40 Please type in your questions using the chat function. Questions

41 Thanks for joining us today Think Spring!