Rocky Mountain Tobacco Treatment Specialist Certification RMTTSC Program

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

Module 8: Relapse Prevention

Module 8: Relapse Prevention Objectives § Learn about relapse prevention and related concepts § Discuss strategies and skills to reduce relapse § Identify appropriate referrals to reduce relapse § Review treatment strategies for someone who has relapsed © 2016 BHWP

Tobacco Dependence = Chronic Disease State § Often requires repeated intervention and multiple attempts to quit § Most smokers want to quit and have made serious quit attempts § 70% of current smokers have expressed a desire to quit § Effective treatments exist and increase rates of long-term abstinence © 2016 BHWP

Tobacco Use Terminology § Abstinence – no use of tobacco at all § Lapse – isolated or single use of tobacco § Relapse – return to regular use of tobacco after a period of abstinence Relapse Prevention: Intervention strategies intended to prevent a return to regular tobacco use © 2016 BHWP

Relapse Prevention § Relapse is common but not inevitable § Relapse prevention begins at the beginning of treatment, not just after a relapse occurs § Preventing relapse often involves behavioral, cognitive and pharmacological components The risk of relapse during the first 12 months after stopping tobacco use is over 50% © 2016 BHWP

Relapse Prevention Strategies § Avoid any tobacco use, particularly in the first two weeks of a quit attempt § Identify high-risk situations § Prepare and plan for ways to deal with high-risk situations when they occur § Enhance self-efficacy through supportive relationships and behaviors that support well-being © 2016 BHWP

Identify High-Risk Situations & Triggers Specific behaviors, emotions, environments or people can act as triggers for tobacco use: § § § Negative emotional state Interpersonal conflict Social pressure Positive emotional state Lifestyle factors Urges and cravings © 2016 BHWP

Saying No – Situations & Strategies © 2016 BHWP

Conversations to Support Relapse Prevention What do you like about living tobacco-free? How would you like to address the challenges around living tobacco-free? What are some successes you What makes it hard to experienced this week? live tobacco-free? What changes How has stopping do you notice in How have your tobacco use your physical relationships changed helped you? since you stopped health? using tobacco? © 2016 BHWP

Intensive Support for Relapse Prevention Challenge Suggested Intervention Lack of support § Schedule follow-up visits or telephone calls § Help identify other sources of support § Provide or refer the person to tobacco cessation counseling or support Negative mood or feelings of depression § If significant, provide counseling or refer the individual to a specialist § Encourage the person to engage in behavioral interventions for smoking cessation © 2016 BHWP

Intensive Support for Relapse Prevention Challenge Suggested Intervention Strong or prolonged withdrawal symptoms § Extend, add or combine the use of FDAapproved tobacco cessation medications § Encourage the individual to engage in behavioral interventions Reduced § Reassure the person that these feelings are motivation or common feeling deprived § Recommend rewarding activities § Encourage the individual to engage in behavioral interventions § Emphasize that periodic tobacco use will increase urges and make quitting difficult © 2016 BHWP

Intensive Support for Relapse Prevention Challenge Suggested Intervention Weight gain § Recommend increasing physical activity and discourage strict dieting § Reassure the individual that weight gain after quitting is common § Emphasize the importance of a healthy diet § Maintain the client on pharmacotherapy known to delay weight gain § Refer the person to a specialist or program § Help connect the individual to additional support, as needed © 2016 BHWP

Post-Relapse Conversations What have you learned from this relapse (or lapse) ? What was going on for you just before your relapse (or lapse)? What helped you to stop using tobacco? How did you decide to start using tobacco again? What did you learn from this experience? What will you do differently next time? What do you need (going forward) to support a tobacco-free life? © 2016 BHWP

Additional Support and Referrals § Quitline: 1 -800 -Quit-Now ‒ ‒ Telephone counseling Referrals for additional support May provide NRT or other medications May be available in multiple languages § Nicotine Anonymous ‒ http: //www. nicotine-anonymous. org ‒ In person, telephone and online meetings ‒ Printed materials © 2016 BHWP

Relapse Prevention Pre-Cessation Discussion

Pre-Cessation Discussion Evelyn is a 58 -year-old African American woman who says she is ready to quit smoking. She smokes just under a pack a day. Evelyn’s daughter has been “badgering” her to quit. Evelyn indicates that she wants to be alive and healthy to spend time playing with her three grandchildren. Her husband, who also smokes, supports her decision to quit but continues to smoke inside the house. The hospital where she works as a nurse is tobacco-free, but she has a co-worker who takes smoke breaks with her. Evelyn is worried that she will gain weight since she has worked hard over the last year to lose 14 pounds. © 2016 BHWP

Relapse Prevention Post-Cessation Role Play

Post-Cessation Role Play Evelyn has been tobacco-free for the last three weeks. She is taking bupropion and using nicotine gum (about 6 pieces per day). Her husband has agreed to smoke outside and is considering quitting. Her daughter is very happy that Evelyn has stopped smoking. Although Evelyn has more energy and continues to be active, she has gained 5 pounds, which is concerning to her. She had a cigarette when she went out for a drink with her co-worker after a particularly stressful day at work. She is upset and feels like she failed. She wonders if she will ever be “free” from tobacco. © 2016 BHWP

http: //www. bhwellness. org/resources/toolkits/ © 2016 BHWP

Relapse Prevention Discussion