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Breakout Session B – Tobacco Cessation and Recovery

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Breakout Session B – Tobacco Cessation and Recovery Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B Welcome to the Virtual Spring Tobacco Control Institute Breakout Session B – Tobacco Cessation and Recovery Thursday, April 23, 2020 1:00pm – 2:30pm CT Welcome to Breakout Session B Tobacco Cessation and Recovery Roshal Rossman Thursday, April 23, 2020 South Dakota Tobacco Control 1:00pm – 2:30pm CT Program 1 Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B Traditional Tobacco We acknowledge the spiritual and ceremonial value of tobacco in our American Indian culture. All references to tobacco at the Institute refer to commercially produced tobacco products and not traditional tobacco. About Adobe Connect 2 Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B South Dakota QuitLine • 1-866-SDQUITS (737-8487) • www.sdquitline.com • Free cessation counseling • Free NRT or cessation medication • Enroll through phone, web enrollment or fax/EHR referral Who can use the SD QuitLine? • SD Resident • Tobacco user (including e-cigarette users!) • 13 years of age or older • Ready to quit or has quit in the last 30 days • Eligible to re-enroll 3 Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B QuitLine Medications *QL participants and their coach may choose one of the following for FREE • Zyban (physician RX required) • Bupropion SR 150mg (Disp: 1 per day x3 days; BID thereafter) OR • Nicotine Replacement Therapy (OTC): • Patch: 7 mg, 14 mg, 21 mg • Gum: 2 mg, 4 mg • Lozenge: 2 mg, 4 mg QuitLine Kickstart Program SDQuitLine.com/kickstart Option 1: • 2 or 4 week supply of NRT patches, gum lozenges • Quit guide Option 2: • Quit Guide 4 Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B Tobacco Cessation and Recovery Recovery is everywhere…. 5 Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B More than just smoking cigarettes… • Cigarettes • Chewing tobacco • Snuff • Cigars • Pipes • Clove cigarettes • Vaping Nicotine • Nicotine is the psychoactive drug in tobacco products that produces dependence • Most smokers are dependent on nicotine • Nicotine dependence is the most common form of chemical dependence in the United States • Research suggests that nicotine is as addictive as heroin, cocaine, or alcohol (Surgeon General Report, 2014) 6 Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B Nicotine Dependence Tobacco Use Disorder DSM‐5 states: A problematic pattern of tobacco use leading to clinically Specifier: significant impairment or distress, as manifested by at least two • Early Remission – No use of Tobacco products for at least 3 of the following, occurring within a 12‐month period: months • Tolerance • Sustained Remission – No use of Tobacco products for • Withdrawal more than 12 months • Uses in larger amounts or over a longer period than • On Maintenance Therapy – Using Nicotine Replacement intended Products • Persistent desire or unsuccessful attempts to cut down or • In a Controlled Environment – Within a restricted setting quit (e.g. hospital, correctional facility) • A lot of time spent obtaining, using, recovering from use • Craving or strong desire to use tobacco Level of Severity: • Recurrent tobacco use resulting in a failure to fulfill major • Mild (Z72.0) – 2‐3 symptoms are present role obligations at work, school, or home. • Moderate (F17.20) – 4‐5 symptoms are present • Continued tobacco use despite having persistent or • Severe (F17.20) – 6 or more symptoms are present recurrent social or interpersonal problems cause or exacerbated by the effects of tobacco (e.g. arguments with others about tobacco use). • Important social, occupational, or recreational activities are reduced because of tobacco use • Recurrent tobacco use in situations in which it is physically hazardous (e.g. smoking in bed, smoking while filling your car up with gas). • Use continues despite physical or psychological problems caused or exacerbated by use The Trouble with Tobacco • Tobacco related deaths number more than seven million worldwide each year (WHO, 2017) • Smoking remains the leading preventable cause of death and disease in the United States. (Surgeon General Report, 2014) • Smoking leads to disease and disability and harms nearly every organ of the body. (Surgeon General Report, 2014) • In 2018, 13.7% of all adults (34.2 million people) currently smoked cigarettes: 15.6% of men, 12.0% of women. (MMWR, 2019) • Nicotine is a highly addictive substance with a capture rate greater than that of heroin, cocaine, or alcohol. 31.9% of people who try tobacco will become dependent on it (NTA, 2006) 7 Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B Tobacco and Disease • Heart disease • Chronic obstructive pulmonary disease (COPD) • High blood pressure • Stroke • Emphysema • Chronic bronchitis • Impotence • Cancer • Lung, larynx, oral cavity, esophagus, kidney, stomach, ovary, pancreas, etc. 7,000 Chemicals • Arsenic (poison) • Ammonia (poisonous, in many household cleaners) • Acetone (nail polish remover) • Ammonium bromide (toilet cleaner) • Benzene (industrial solvent) • Carbon monoxide (exhaust pipe fumes) • Cadmium (used in rechargeable batteries) • Cyanide (poison used in gas chambers) • DDT (insecticide) • Formaldehyde (preservative, embalming fluid) • Lead (a poison removed from nearly all paints) • Mercury (highly poisonous and easily absorbed through respiration) • Nickel (poisonous, a known cancer‐causing agent) • Hydrogen cyanide (deadly poison used in gas chambers) • Hydrogen sulfide (sewer gas) • Polonium‐210 (radioactive substance) • 70+ cancer causing agents (carcinogens) (CDC, 2019) 8 Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B Positive Trends • Tobacco product use among US youth is increasing. More than 1 in 4 high school students and about 1 in 14 middle school students in 2018 had used tobacco products in the past 30 days. (CDC, 2018) • In 2018, 12.5% of middle school and 31.2% of high school students reported current use of tobacco products (MMWR, 2019) Who is Still Smoking? • Smoking rates among certain populations in the United States are disproportionately high: • 22.6 % of American Indians/Alaska Natives • 36% of people with GED’s • 21.3% of people with less than $35,000 annual household income • Adults with mental illness or substance use disorders smoke cigarettes more than adults without these disorders (CDC, 2013) • 63.5% of adult cigarette smokers reported co‐use of alcohol in 2016 compared to 52.8% of adult smokers (SAMHSA, 2017) • Drug users start smoking at a younger age, smoke more heavily, have a harder time quitting and have more emotional, psychological and physical problems than non drug using smokers (Sussman, 2002) 9 Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B Common Myths • “Smoking is less of a problem today. Everyone is quitting and fewer people are starting.” • “Smoking is a less serious health problem than alcohol and other drug addiction. I need to address what’s really going to kill me.” • “They’re really separate issues.” • “One thing at a time. Doing too much will increase relapse risk.” ‐Data supports dealing with this during treatment 25% higher success rate. Common Myths • “I’ll quit later, on my own.” • “I’m only hurting myself.” • “I’ll be more likely to leave or get myself discharged if I try to quit.” • “People entering treatment don’t want to quit.” • “It’s not worth it. I won’t be able to quit.” 10 Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B Myth: “Smoking is less of a problem today.” • 75% of people ages 12 and older who received substance abuse treatment at a specialty facility in the past year reported smoking cigarettes in the past month (SAMHSA, 2008) • 63% of people ages 12 and older with any Substance Use Disorder in the past year also reported tobacco use in the past month (SAMHSA, 2008) TRUTH: Tobacco use is decreasing in the general population, but is still a huge problem among addicted and recovering people Myth: “Smoking isn’t going to kill me.” • 80% of all drug related deaths are due to tobacco 200,000 annual deaths from smoking occur among patients with CMI and/or substance abuse (Unwin, 1999), (Manderscheid, 2006) • 50% of substance abusers in recovery died of tobacco related illness • Over 20 years, tobacco was the number one cause of death among substance abusers following treatment. 51% of deaths were tobacco‐related, while 34% were alcohol‐related (Hurt, 1996) TRUTH: You are more likely to die from tobacco related illness than alcohol or other drug use. 11 Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B Mayo Study • 845 clients admitted to an inpatient addiction treatment center at the Mayo Clinic between 1972 and 1983 • 75% of the clients admitted to treatment were smokers, 3% cigar or pipe smokers, and 2% used smokeless tobacco • At follow up in 1994, 222 of these clients were deceased: – 73 (34.1%) were attributable to alcohol – 19 (8.6%) were attributable to both alcohol and tobacco – 109 (50.9%) were attributable to tobacco • Tobacco was “the leading cause of death” for people who had recently been treated for alcoholism • Tobacco related deaths were “significantly more frequent than alcohol related causes of death” (Hurt, 1996) Co‐founder of AA: "Bill W. was lifted to the podium in his wheelchair, oxygen tank at his side. He was dying of lung disease. A brave, relentless visionary gave his last professional address about alcohol dependency, only to die from lung disease related to cigarette smoking. He died from nicotine addiction.“(Maheu, 1998) 12 Spring 2020 Tobacco Control Institute ‐ 4/23/2020 Breakout B Co‐Founder of AA, Dr. Bob was a cigar smoker. He died of throat cancer. Myth: “They’re really separate issues.” • Heavy smokers have worse relapses. 53‐91% of people in addiction treatment settings use tobacco (Abrams, 1992), (Guydish, et. Al., 2011) • Smoking increased urges to use (Rohsenow, 2005) • Severity of tobacco use predicts poor treatment outcomes. In Maryland, smoking prevalence for addiction treatment consumers dropped from 71.8% in 2010 to 56.6% in 2014 (Patkar, 2003), (Santhosh, et.
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