TOBACCO RECOVERY

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Southwestern is committed to supporting clients who are ready to overcome their addiction to nicotine using an evidence-based “5A Model” of intervention:

Ask every client about their tobacco use
Advise clients about the importance of stopping
Assess clients’ readiness to change
Assist with recovery attempts through care coordination
Arrange for follow-up contacts during their post-cessation recovery period

Tobacco use is the leading cause of preventable disease, disability, and death globally, and used more prevalently by individuals with mental illness. Southwestern has chosen to take extra steps to incorporate support for our clients because extensive research has demonstrated that adults with mental illness die earlier than the general population; most commonly from diseases strongly correlated with tobacco use, like heart disease, cancer, and lung disease. Additionally, nicotine has mood-altering effects that can mask symptoms of mental illness, ultimately predisposing those affected to an increased likelihood of use and addiction. And finally, tobacco smoke can interact with and inhibit the effectiveness of certain medications to the extent that higher doses may be required than what would have otherwise been recommended for non-smoking clients.

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TOBACCO USE AND DEPENDENCE ASSESSMENT

Research has shown that the more frequently a patient is approached about quitting tobacco use, the more likely they will be to initiate a recovery attempt. Southwestern’s goal is to work with clients to increase their motivation and confidence toward making as many tobacco recovery attempts as necessary to achieve total abstinence from nicotine. Therefore, all Southwestern clients are screened for tobacco use and dependence at intake and ongoing treatment planning.

CARBON MONOXIDE SCREENING

Carbon monoxide (CO) screening is a test that shows the amount of CO in the breath upon exhalation, an indirect and non-invasive means of measuring the amount of Carboxyhemoglobin, the level of carbon monoxide, in the blood that would otherwise by occupied by oxygen. Breath CO monitoring provides a biochemical way to verify self-reported claims of abstinence from cigarettes as well as a tool for clients to view their CO levels decrease over time as they reduce or abstain from cigarettes.

MEDICATION ASSISTED TREATMENT

Nicotine Replacement Therapy (Patch, Gum, Lozenge, Nasal Spray, Oral Inhaler)

Gum and lozenges might serve as an oral substitute for tobacco
Gum and lozenges might help reduce or eliminate weight gain
All can be titrated to manage withdrawal symptoms
All can be used in combination with other agents to manage urges

Bupropion (Zyban/Wellbutrin)

Twice-daily oral dosing is simple and associated with fewer adherence problems
Might reduce or eliminate weight gain
Might be beneficial for clients with depression
Can be used in combination with nicotine replacement medications

Varenicline (Chantix)

Twice-daily oral dosing is simple and associate with fewer adherence problems
Offers a difference mechanism of action for clients who have struggled with other medications

COORDINATION OF CARE

External Provider Referrals

When clients are ready to engage in a recovery attempt, they will often do so with the assistance of medication prescribed from their primary care provider. Southwestern can help facilitate this process through communication with individual providers in order to verify their involvement with our recovery support services.

Referrals to the Indiana Quitline (1.800.QUIT.NOW)

Some clients will elect to engage in a recovery attempt utilizing the services of the Indiana Quitline for free nicotine replacement medication and phone/web/text support services. Southwestern is a part of the Indiana Quitline’s Preferred Provider Network and can make direct referrals for their services.

Relapse Prevention Follow-up Calls

Since most relapse occurs within 3 months of quitting, follow-up support is important during this period. Southwestern has trained Tobacco Treatment Specialists who engage in follow-up support calls for clients who indicate an openness to this added layer of service.

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