CURRENT BEST PRACTICES Substance Abuse, Mental Health and Criminal - PDF document

5/13/14 ¡ Webinar Facilitator TREATMENT OF TOBACCO DEPENDENCE IN THE Tracy McPherson, PhD HEALTHCARE SETTING: Senior Research Scientist CURRENT BEST PRACTICES Substance Abuse, Mental Health and Criminal Justice Studies NORC at the University of Chicago 4350 East West Highway 8th Floor, PRESENTED BY: Bethesda, MD 20814 THE BIG INITIATIVE, NATIONAL SBIRT ATTC, esap1234@gmail.com NORC, and NAADAC May 14, 2014 Produced in Partnership… 2014 SBIRT Webinar Series Archived - ACA and Addiction Treatment: ¨ Implications, Policy and Practice Issues Archived - Overview of SBIRT: A Nursing Response ¨ to the Full Spectrum of Substance Use Archived - SBIRT in the Criminal Justice System ¨ Archived - Reducing Opioid Risk with SBIRT ¨ Archived – How to Pitch SBIRT to Payors ¨ 5/14/14 - Treatment of Tobacco Dependence in the ¨ Healthcare Setting: Current Best Practices 6/11/14 - Applying SBIRT to Depression, ¨ Prescription Medication Abuse, Tobacco Use, Trauma & Other Concerns 7/9/14 - Training Integrated Behavioral Health in ¨ Social Work 8/6/14 - Why Integrative Care? ¨ ¨ hospitalsbirt.webs.com/webinars.htm Access Materials Ask Questions Ask questions ¨ PowerPoint Slides through the “Questions” ¨ CE Quiz Pane ¨ Recording Will be ¨ Free CEs answered live at the end hospitalsbirt.webs.com/treatmentoftobacco.htm 1 ¡

5/13/14 ¡ Technical Facilitator Presenter Misti Storie, MS, NCC Bruce Christiansen, Ph.D Director of Training & Professional Development Senior Scientist NAADAC, the Association Center for Tobacco Research and for Addiction Professionals Intervention at the University of Wisconsin School of Medicine and misti@naadac.org Public Health bc1@ctri.wisc.edu Outline I. Setting the stage II. The 5As model Current Best Practices for the Treatment of III. A note on medication Tobacco Dependence in the Healthcare Setting IV. Telephone Quit Lines V. A-A-R model Bruce Christiansen, PhD VI. Motivating the un-motivated VII. Working with smokers who have a mental May 14, 2014 illness and/or other addiction 11 I. Setting the Stage: Setting the Stage: Background Understanding Background Understanding Despite tremendous progress over the past 50 1. years, 18% of adult Americans still smoke (down from 42%). 12 13 2 ¡

5/13/14 ¡ Setting the Stage: Setting the Stage: Background Understanding Background Understanding Despite tremendous progress over the past 50 years, 18% of adult Despite tremendous progress over the past 50 years, 18% of adult 1. 1. Americans still smoke (down from 42%). Americans still smoke (down from 42%). Smoking remains the largest source of preventable Smoking remains the largest source of preventable morbidity and 2. 2. mortality. morbidity and mortality. 3. While smoking contributes to many chronic diseases, it is, itself, a chronic disease. 14 15 Setting the Stage: Setting the stage: Background Understanding Background Understanding Despite tremendous progress over the past 50 years, 18% of adult 1. Despite tremendous progress over the past 50 years, 18% of adult 1. Americans still smoke (down from 42%). Americans still smoke (down from 42%). Smoking remains the largest source of preventable morbidity and 2. Smoking remains the largest source of preventable morbidity and 2. mortality. mortality. While smoking contributes to many chronic diseases, it is, itself, a 3. 3. While smoking contributes to many chronic diseases, it is, itself, a chronic disease. chronic disease. 4. While at least 70% express a desire to quit smoking, at any one While at least 70% express a desire to quit smoking, at 4. time relatively few are willing to engage in an evidence-based method of quitting. (desire vs. immediate intention) any one time relatively few (<30%) are willing to engage Smoking is now concentrated in specific 5. in an evidence-based method of quitting . (desire vs. populations identified as tobacco disparity immediate intention) populations, that bear a disproportionate burden from tobacco. 16 17 The ¡Tobacco ¡Disparity ¡Story ¡ Great ¡News ¡about ¡the ¡US ¡Adult ¡smoking ¡Prevalence ¡ 42.6% ¡ 20.9% ¡ 19 3 ¡

5/13/14 ¡ From http://www.rootsweb.com/~txecm/midphoto.htm 20 21 22 23 25 4 ¡

5/13/14 ¡ The Emergence of Tobacco Disparities 27 ¡ Possible Origins of Disparities “We Reserve the Right to Smoke for the Young, the Poor, the Black, and the Stupid.” • Targeting by Tobacco Industry Quoted from a tobacco company executive (see Paul Davis, “The Winston Man Repents” Times Picayune, December 3, 1995) The Emergence of Tobacco Disparities The Origins of Disparities The Rhetoric and Reality of Gap Closing: When the “Have-Nots” Gain but the “Haves” Gain Even More” Stephen Ceci and Paul Papierno (2005) American Psychologist 60(2) 149 – 160 1. Widely distributed (health and education) programs designed for maximum improvement across a population inherently create disparities. 2. Given finite resources, working to close a disparity gap (through targeted programs and resources) will reduce overall population progress. 3. The trade off between population progress and closing gaps is not a question for science; it’s a question of cultural values and priorities. ¡ 5 ¡

5/13/14 ¡ 32 33 The Origins of Disparities Unintended consequences of our tobacco control policies: • tobacco ¡adverFsing ¡restricFons ¡while ¡permiHng ¡point ¡of ¡sale ¡ adverFsing ¡ 35 The Origins of Disparities The Origins of Disparities Unintended consequences of our tobacco control policies: Unintended consequences of our tobacco control policies: • tobacco ¡adverFsing ¡restricFons ¡while ¡permiHng ¡point ¡of ¡sale ¡ • tobacco ¡adverFsing ¡restricFons ¡while ¡permiHng ¡point ¡of ¡sale ¡ adverFsing ¡ adverFsing ¡ Smokers ¡living ¡in ¡poverty ¡have ¡fewer ¡cost ¡minimiza:on ¡strategies ¡ Smokers ¡living ¡in ¡poverty ¡have ¡fewer ¡cost ¡minimiza:on ¡strategies ¡ • • available ¡as ¡a ¡response ¡to ¡tax ¡increases ¡ available ¡as ¡a ¡response ¡to ¡tax ¡increases ¡ Medica:on ¡packaging ¡requirements ¡make ¡it ¡more ¡difficult ¡for ¡smokers ¡ • living ¡in ¡poverty. ¡ 6 ¡

5/13/14 ¡ The Essential Components of Effective Tobacco II. The 5As model Dependence Treatment Interventions 38 39 The Essential Components of Effective Tobacco Dependence Treatment Interventions Support Medication Counseling 40 41 Evidence-based Best Practice II. The 5 As Intervention Model Meta-analysis (2000): Effectiveness of and estimated abstinence rates for various intensity levels of session length (n = 43 studies) � Number of Estimated Estimated Level of contact arms odds ratio abstinence rate (95% C.I.) (95% C.I.) No contact 30 1.0 10.9 Minimal counseling (< 3 19 1.3 (1.01, 1.6) 13.4 (10.9, 16.1) minutes) Low intensity counseling 16 1.6 (1.2, 2.0) 16.0 (12.8, 19.2) (3-10 minutes) • 1996 - Initial Guideline • 2000 - Revised Guideline • 2008 - Updated Guideline published published published Higher intensity 55 2.3 (2.0, 2.7) 22.1 (19.4, 24.7) counseling (> 10 minutes) • Literature from 1975 -1995 • Literature from 1995 -1999 • Literature from 1999 – 2007 • 3000 articles • 6000 articles • 8700 articles 43 7 ¡

5/13/14 ¡ II. The 5 As Intervention Model II. The 5 As Intervention Model — Ask — Ask about tobacco use. Identify and document tobacco use status for every patient at every visit. 44 45 II. The 5 As Intervention Model II. The 5 As Intervention Model — Ask — Ask — Advise — Advise to quit. In a clear, strong and personalized manner urge every tobacco user to quit. “The most important thing you can do to improve your health is to quit smoking, and I can help you.” 46 47 II. The 5 As Intervention Model II. The 5 As Intervention Model — Ask — Ask — Advise — Advise — Assess — Assess willingness to make a quit attempt. Is the tobacco user willing to make a quit attempt at this time? “Are you willing to try to quit at this time? I can help you.” 48 49 8 ¡