Transcript Integrating Tobacco Counseling into Drug Treatment

Integrating Tobacco Counseling into
Drug Treatment
A Pilot Project
Cathyann H. Feher RN, MSN, CTTS-M
Funded by the American Legacy Foundation, Priority
Populations
Co-Authors
• Alice Dalla Palu, MPA, CTTS-M, CAC
– Executive Director, Coalition for a Smoke Free Valley
• Michael A. Usino, MHS
– Latino Coordinator, Coalition for a Smoke Free Valley
• Lissette Lahoz, BA
– Latinos for Healthy Communities
• Glenn Cooper, MPH
– Executive Director, New Directions Treatment Facility
Vision
A Lehigh Valley free from the health, social, economic
and political consequences of tobacco use.
Mission
The Coalition for a Smoke-Free Valley is a broadbased community coalition dedicated to reducing tobacco
use in the Lehigh Valley by promoting advocacy and
providing education, training and support services.
Objective
• To develop an effective integrated tobacco
treatment program in an outpatient drug
treatment facility
Methods
• Employee and client surveys were
simultaneously conducted (available in
Spanish and English) to determine
tobacco use, knowledge and willingness to
participate in a FREE tobacco treatment
program
Survey Indicators- Employee
• Demographics
– 26 employees
– 77% female
– 96% over the age of 31years with a college or
advanced degree
Survey Indicators - Employee
• Smoking Status
– 88% of the employees were either former
smokers (Range 1978-May,2003) or never
smoked
– Only 11% of employees continue to smoke
Survey Indicators - Employee
• Employee Education
– Only 50% of the staff felt comfortable with
Tobacco knowledge
– 96% willing to participate in additional
Tobacco Cessation training
Survey Indicators - Employee
• Current Practice
– 88% indicated that it was important to encourage
tobacco users to quit
– 91% regarded tobacco treatment as important as
Drug and alcohol addiction treatment
– 100% of respondents believed that stabilized
clients can be treated simultaneously for tobacco
and drug abuse successfully
Survey Indicators - Employee
• Current Practice(continued)
– 100% identified Tobacco as a drug
– However, only 43% routinely assess Tobacco
use and of those, 78% advise users to Quit.
Survey Indicators - Client
• Demographics
– 53% Male and 47% Female
– 69%, aged 31-50
– Ethnicity
• 51% Hispanic, 45% White, 4% Black
– Education
• 20% less then 10th grade
• 60% 10-12th grade
• 20% College graduates
Survey Indicators -Client
• Tobacco Status
– 94% are currently smoking
• 30% smoke less than 1 pack/day
• 61% smoke 1-2 packs/day
Survey Indicators -Client
-Tobacco Status
• 67% have tried to stop
• How many times?
– 59% 1-3 times
– 33% 4-6 times
– 8% 7+ times
Survey Indicators -Client
• Client Participation
– 92% of clients either strongly agreed or agreed that
they would like to stop.
– 87% of the smokers were willing to participate in the
pilot project
– 71% believed they can stop using tobacco while in
treatment for other drug use
Tobacco Treatment Pilot
Project
Control Group
• New Directions facility - Reading,PA
• Signs were posted to request tobacco
cessation materials/referrals – 12 requests
were made by clients in a 6 month period.
Intervention Group
• New Directions facility – Bethlehem, PA
• All staff attended a Tobacco Dependence full
day workshop
• Two treatment counselors received additional
tobacco education, emphasizing
pharmaceuticals and counseling strategies
• All staff will appropriately screen participants for
the Pilot Program and make necessary referrals
as needed to the 2 counselors
• Pharmaceuticals were prescribed by a Certified
Nurse Practioner
Pilot Project Protocols
• Inclusion Criteria
– Voluntary client program
– No elicit drug use
– 3 consecutive clean urines
– Must be in the program for 3 or more months
– Final contemplation or planning phase of the
Stages of change, and planning to quit within
the next 30 days
– Would accept up to 50 clients in the study
Pilot Project Protocols
• Exclusion Criteria
– Pregnant clients will be excluded from the
Pilot Program and referred to a local
cessation resource for treatment
– Clients who initially meet inclusion criteria will
be removed from the pilot program if unable
to set a quit date within 30 days of first
counseling session and referred to a local
cessation program
Pilot Project Protocols
• Counseling Schedule
– First Visit – Smoking history, review of medical
conditions, setting up a Quit Plan and Date
– Second Visit- 3-5 days before the Quit Date – review
coping skills, meet with CRNP for NRT, NRT
instructions and planning for triggers
– Third Visit – 3-5 days after the Quit Date – Follow up
review coping skills, plan for triggers and assess
withdrawal symptoms and NRT effectiveness
– Fourth-Sixth Visits – will be determined by client and
counselor (phone/in person)
Preliminary Results
• 44 clients accepted into the program until
March 31, 2005
• Several clients remain in treatment until
May 31, 2005
Client Comments
• Anecdotal comments included:
– “Powerless”
– “last thing to give up”
– “more habit then craving”
Counselor Comments
• Clients who previously tried to quit felt it
was very beneficial in providing more
awareness
• Other counselors referring clients into the
program validated its potential success.
Conclusions
• Final data analysis will be completed and
disseminated
• This pilot project can be replicated in other
drug treatment facilities.
Contact Information
Cathyann H. Feher RN, MSN, CTTS-M
Health Care Coordinator
Coalition for a Smoke Free Valley
17th and Chew St
Allentown, PA 18105-7017
[email protected]
www.smokefreevalley.org