Rocky Mountain Tobacco Treatment Specialist Certification RMTTSC Program

Rocky Mountain Tobacco Treatment Specialist Certification (RMTTS-C) Program

Rocky Mountain Tobacco Treatment Specialist Certification (RMTTS-C) Program Overview

RMTTS-C Program Overview This specialized program is designed to: § Build on your existing knowledge and skills § Provide the information, resources and skills you need to become a Certified Tobacco Treatment Specialist § Share ways to effectively implement evidence-based tobacco cessation strategies © 2016 BHWP

Tobacco Treatment Specialist Core Competencies Training covers the 11 TTS core competencies: § Tobacco dependence § knowledge and education§ § Diversity and specific health issues § § Assessment interviewing § § Treatment planning § § Pharmacotherapy § Counseling skills Relapse prevention Documentation and evaluation Law and ethics Professional development Professional resources © 2016 BHWP

RMTTS-C Program Objectives § Received training in all evidence-based tobacco cessation interventions and treatments, both pharmacological and counseling, including behavior change strategies and cognitive behavioral therapy § The knowledge and skills to successfully treat any individual for tobacco dependence and to work effectively as a Tobacco Treatment Specialist © 2016 BHWP

Certification Requirements To receive certification, participants must: 1. Score at least 80% on all components of the quizzes and combined final examination 2. Provide documentation of at least 240 hours of experience* (post-course completion) in which course content was utilized *up to 120 pre-course hours can be counted if you have a clinical degree or prior experience working in the field of tobacco cessation © 2016 BHWP

RMTTS-C Examinations § Training manual ‒ Training slides with notes ‒ Program resources & references § Training quizzes and exams ‒ Two short quizzes—Days 2 & 3 ‒ Written exam—Day 4 ‒ Oral exam—Day 4 © 2016 BHWP

Training Agenda Day One Day Two Day Three Day Four § § § § Tobacco Fundamentals Priority Populations Motivational Interviewing Assessment Interview Quiz Pharmacotherapy Cognitive & Behavioral Interventions Treatment Planning Quiz Relapse Prevention Skills Integration Documentation/Evaluation & Resources Ethical Practice & Professional Development Final Exam Oral Exam © 2016 BHWP

RMTTS-C Program Overview Discussion

Module 1: Tobacco Fundamentals

Module 1: Tobacco Fundamentals Objectives § Describe the impact of tobacco use and U. S. trends § Explain health consequences of tobacco use and the benefits of quitting § Provide information on tobacco products § Describe the physical and behavioral aspects of tobacco dependence § Introduce evidence-based tobacco cessation treatment strategies © 2016 BHWP

The Burden of Tobacco

This is a Critical Issue What is killing the majority of us is not

Burden of Tobacco § 480, 000 tobacco-related deaths in the U. S. each year ‒ 6 million tobacco-related deaths worldwide each year It is estimated that one person dies from a tobacco-related illness every 6 seconds § 16 million people living with a tobacco-related chronic illness § 42, 000 deaths each year in the U. S. due to second-hand smoke exposure © 2016 BHWP

Behavioral Causes of Death in U. S. © 2016 BHWP

Number of deaths (thousands) Annual Causes of Death in the United States, 2013 *Tobacco

Trends in U. S. Adult Smoking 60 16. 8% of adults are current smokers

Rates of Tobacco Use 21. 3% of adults in the U. S. currently use tobacco products § § § Cigarettes – 16. 8% Smokeless – 2. 6% Cigars, cigarillos or small cigars – 2. 0% Electronic cigarettes – 1. 9% Waterpipes/hookah – 0. 5% Pipes – 0. 3% © 2016 BHWP

Health Consequences of Tobacco Use

2010 Report of the Surgeon General: How Tobacco Smoke Causes Disease MAJOR FINDINGS: § Any level of exposure to tobacco smoke is harmful § Number and severity of health problems are directly related to how long a person smokes or is exposed to smoke § Smoking light, organic, or filtered cigarettes does not decrease your risk of disease © 2016 BHWP

2014 Report of the Surgeon General: The Health Consequences of Smoking MAJOR FINDINGS: § Smoking is linked to diseases of nearly all organs in the body § Research continues to identify smoking-related diseases § New evidence reveals that exposure to secondhand smoke is associated with increased risk for stroke § Disease risks for women are now equal to those for men © 2016 BHWP

Tobacco Use Increases Risk for Specific Medical Disorders § 2 to 4 times increased risk for coronary heart disease § 2 to 4 times increased risk for stroke § Relative risk for lung cancer death is now 25 times higher for smokers § 12 to 13 times increased risk of death from chronic obstructive lung diseases The rate of death from smoking-related diseases is three times higher among current smokers than those who have never smoked © 2016 BHWP

How Tobacco Harms You From The Tobacco Atlas Third Edition © 2016 BHWP

Common Tobacco-Induced Disorders Tobacco Use • Plaque build up in arteries • Prevents repair of artery walls • Increases risk of blood clots • Increases triglycerides • Decreases HDL cholesterol Cardiovascular Disease • • Heart Disease Stroke Aneurysm Peripheral Arterial Disease © 2016 BHWP

Common Tobacco-Induced Disorders Smoking can cause cancer in almost every part of your body Smoking causes Exposure to carcinogens cancer through: Formation of bonds between carcinogens and DNA Accumulation of permanent mutations © 2016 BHWP

Common Tobacco-Induced Disorders Chronic Obstructive Pulmonary Disease (COPD)— including emphysema and chronic bronchitis Tobacco use causes COPD through two mechanisms: ① Oxidative Stress ‒ Damage to lungs caused by the free radicals in tobacco smoke ② Protease-Antiprotease Imbalance ‒ Increasing destructive enzymatic activity that damages lung structure and elasticity © 2016 BHWP

The Dangers of Secondhand Smoke § There is no safe level of secondhand smoke § Being around tobacco smoke is directly linked to disease and premature death in nonsmokers § Serious health effects on children and adults include sudden infant death syndrome (SIDS), lung and ear problems, and asthma © 2016 BHWP

The Dangers of Third-Hand Smoke § Particles and gases left behind after a cigarette is extinguished § Third-hand smoke ‒ Collects on fabrics and surfaces and present in air ‒ Can remain for months § Early research links exposure to multiple adverse health outcomes § Infants and children are at particular risk due to increased exposure © 2016 BHWP

Smokeless Tobacco Health Effects § There is no safe form of tobacco § Contains 28 known cancer-causing chemicals, including tobacco-specific nitrosamines, a chemical directly related to the risk of cancer § Smokeless tobacco has been linked to these diseases: ‒ ‒ Oral cancer Esophageal cancer Pancreatic cancer ‒ Heart disease ‒ Gum disease ‒ Oral lesions Stomach cancer © 2016 BHWP

Within… Quitting Smoking has Many Health Benefits 20 minutes blood pressure returns to baseline 48 hours sense of smell and taste begin to return to normal 12 hours oxygen levels return to normal; carbon monoxide drops significantly 72 hours breathing is easier and lung function increases 1 -9 months chronic cough decreases; breathing improves, overall energy levels increase 1 year risk of heart disease, stroke, and heart attack less than half that of a smoker 10 years lowered risk of some cancers 15 years risk of heart disease is equal to someone who has never smoked © 2016 BHWP

Years of extended life Benefits of Quitting smoking at ANY age leads to a

Benefits of Quitting ① Improve health and overall quality of life ② Increase healthy years of life ③ Improve mortality from tobacco-related illnesses ④ Save money by not purchasing tobacco products ⑤ Quitting smoking is a right and individuals should have access to cessation services © 2016 BHWP

Tobacco & Nicotine Products

Tobacco Products that are Smoked Cigarettes: § Most common form of tobacco in the U. S. Cigars: § One cigar has as much tobacco as a pack of cigarettes § Contain high levels of nicotine Clove cigars/bidis: § Cloves are a mixture of tobacco and cloves and have twice the nicotine compared to cigarettes § Bidis look like marijuana joints, come in candy flavors, and have higher levels of tar, carbon monoxide, and nicotine than cigarettes © 2016 BHWP

Tobacco Products that are Smoked Waterpipe smoking (hookah): § Tobacco flavored with fruit pulp, honey, and molasses § Often used for longer amounts of time than cigarettes, so more tar and nicotine is inhaled Pipes: § Puffed into the mouth, typically not inhaled § One of the least commonly used forms of tobacco © 2016 BHWP

Smokeless Tobacco Products § In 2013, about 2. 6% of Americans used smokeless tobacco § Rates of use for smokeless tobacco have not changed over the last five decades Chewing Tobacco Dry Snuff Wet Snuff Dissolvable Tobacco Snus © 2016 BHWP

E-Cigarettes § A battery-powered electronic device that provides doses of nicotine in a vapor form § Ingredients: - Propylene glycol and/or glycerin - Nicotine, 0 -20 mg/ml - Flavoring and other additives © 2016 BHWP

E-Cigarettes § Not an FDA-approved cessation device § Do not address addiction to nicotine or behavior patterns § Unknown health risks - E-cigarettes are not “emission-free” - Contain harmful chemicals - No long-term studies © 2016 BHWP

Chemicals in Tobacco Products Arsenic Ammonia Butane Cadmium © 2016 BHWP

Marijuana Smoke § Marijuana smoke contains several of the same carcinogens as the tar from tobacco § Secondhand marijuana smoke contains 50 harmful chemicals (70% more than tobacco smoke) § Marijuana smoke contains significant amounts of mercury, lead, ammonia, and hydrogen cyanide, among others § Respiratory symptoms caused by marijuana smoke include: ‒ Chronic bronchitis ‒ Frequent phlegm ‒ Shortness of breath ⁻ Frequent wheezing ⁻ Chest sounds without a cold © 2016 BHWP

Tobacco Dependence

Bio-Psycho-Social Model Psychological Factors Biological Factors Social Factors Tobacco Use © 2016 BHWP

Tobacco Dependence Has Two Parts Tobacco dependence is a 2 -part problem Physical Behavior The addiction to nicotine The habit of using tobacco Treatment Medications for cessation Behavior change program Treatment should address both the addiction and the habit. Courtesy of the University of California, San Francisco © 2016 BHWP

Nicotine Delivery § Cigarettes and other devices are the vehicles for maximal delivery of nicotine to the brain § Cigarettes can readily deliver approximately 1 -2 mg of nicotine which is delivered approximately 10 seconds after inhalation § Smokers manipulate the intake of nicotine from different cigarettes to achieve and maintain the desired level of nicotine § Nicotine is readily absorbed through oral and nasal mucous membrane (e. g. , smokeless tobacco) © 2016 BHWP

Psychoactive Effects of Nicotine § Stimulant (short puffs, low blood level) ‒ Stimulates nerve transmission ‒ Norepinephrine, dopamine • • • Enhanced concentration Alertness Increased arousal § Sedative (long puffs, high blood level) ‒ Inhibits nerve transmission ‒ Serotonin, opioid • • Pain reduction Reduced anxiety © 2016 BHWP

Tobacco Use Cycle Tobacco Product Used Craving Nicotine Absorption Withdrawal Symptoms Arousal, Mood Modulation,

Nicotine Withdrawal Effects § Irritability, frustration, anger § Anxiety Most symptoms: § Difficulty concentrating § Appear within the first 1– 2 days § Restlessness, impatience § Depressed mood § Insomnia § Increased appetite § Peak within the first week § Decrease within 2 – 4 weeks © 2016 BHWP

Tobacco Dependence Has Two Parts Tobacco dependence is a 2 -part problem Physical Behavior The addiction to nicotine The habit of using tobacco Treatment Medications for cessation Treatment Behavior change program Treatment should address both the addiction and the habit. Courtesy of the University of California, San Francisco © 2016 BHWP

Psychological Factors § Relieves tension and anxiety in the short-term and is often used

Social Considerations § § § Want to feel like “part of a group” Social

Changing Behaviors People smoke in many different situations: § § § When drinking coffee While driving in the car When bored While stressed When on the computer After meals § During breaks at work § While on the telephone § When spending time with family or friends who use tobacco § While drinking alcohol or using drugs © 2016 BHWP

The Challenges of Quitting requires: § Motivation § New coping skills § Changing behaviors

Factors that Influence Tobacco Cessation

Biological Factors § Nicotine = powerful chemical compound § Dopamine reward pathway § Physical

Psychological Factors § Perception of inability to handle stress § Fear of failure §

Socio-Cultural Factors § Contextual and demographic variables § Change in public attitudes toward tobacco

Environmental Factors that promote quitting: § § Household tobacco bans Community “anti-smoking” norms Workplace

Introduction to Tobacco Cessation Treatment Strategies

Tobacco Cessation Treatment Strategies There are many different options for tobacco cessation. The most effective approach combines elements of numerous strategies, such as: ① Tobacco cessation medications ② Cognitive and behavioral treatments ③ Supportive education about costs of tobacco use ④ Referral to tobacco cessation resources and supports © 2016 BHWP

Tobacco Cessation Treatment Strategies Treatment Format Abstinence Rate Unaided 4 -7% Self-help 11 -14% Quitline 11 -15% Individual counseling 15 -19% Group counseling 12 -16% Medication alone 22% Medication + counseling 25 -30% © 2016 BHWP

Tobacco Fundamentals Discussion