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Slide 1 - Tobacco Addiction, Why is It so Powerful? Gaylene Mooney, M.Ed, RRT-NPS
Slide 2 - Points to Cover Tobacco Use Statistics Two Forms of Nicotine Monoamineoxidase (MAO) Definition of Addiction Maslow’s Hierarchy of Needs Triangle of Addiction Neurobiology of Addiction Stages of Change The Association for the Treatment of Tobacco Use and Dependence (ATTUD) Brief discussion of the new Medicare reimbursement
Slide 3 - Tobacco Use Stats 46 Million Adults 15.6% 5.3% 23.9% 54.9%
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Slide 6 - One Approximately Every Two Minutes Http://phil.cdc.gov/Phil/default.asp >430,000 (1178/day)
Slide 7 - It Isn’t Breast Cancer?
Slide 8 - Sir Richard Doll Died in June at age 92 1950 study linking smoking to lung cancer 1954: Doll and Hill published “The Mortality of Doctors and Their Smoking Habits” in BMJ (lead to most M.D. giving up smoking) Follow-up study in 2004 ½ - 2/3 of all individuals who begin smoking in youth will die because of it
Slide 9 - Two Forms of Nicotine Bound to tobacco leaf Free (altered by pH of the smoke) Results when ammonia is added Immediate impact More satisfaction http://tobaccodocuments.org/product_design/00044522-4523.html pH Cigarette: 5.5 – 6.0 (filter & carbon actually increases pH, verified by tobacco documents) Spit: up to 8.3 (Source: CDC) Cigar: 6.2 – 8.2 http://cancercontrol.cancer.gov/tcrb/monographs/9/m9_6.PDF
Slide 10 - Absorption of Nicotine Rate of Absorption Cigarette : fastest route Cigar : slower than cigarettes Spit : slowest rate http://cancercontrol.cancer.gov/tcrb/monographs/9/m9_6.PDF
Slide 11 - How much Nicotine? 10mg of nicotine/cigarette 1 to 2 mg of nicotine/cigarette absorbed 10 puffs over 5 minutes 1 ½ pack/day = 300 hits Cigar = up to 1 ½ packs of cigarettes Spit = 1 can = 3 packs of cigarettes http://www.nida.nih.gov/researchreports/nicotine/nicotine2.html
Slide 12 - When is it Addiction? Three or more of the following: Preoccupation with getting tobacco Compulsive use Difficulty with controlling intake Persistent, even with health problems Relapse Tolerance Withdrawal References: World Health Organization Diagnostic and Statistical Manual - IV (DSM-IV) How long does it take to become dependent? Can be after the first cigarette! http://cancercontrol.cancer.gov/tcrb/monographs/9/m9_6.PDF
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Slide 14 - What Initiates Tobacco Use? Physiological Needs Security & Safety Needs Social Needs Esteem Needs Self Actualization Being Need Deficit Needs A. H. Maslow. A Theory of Human Motivation. Psychological Review, 50, 370-396. (1943) Maslow’s Hierarchy of Need
Slide 15 - Triangle of Addiction Emotion (emotional need) Environmental or social (relieves stress) Physiologic (changes to need of nicotine) Spiritual (Best Friend)
Slide 16 - Other Risk Factors for Initiation Children of Moms who smoke regularly Risk of nicotine addiction increased more if smoked during pregnancy Co-Twin (within two years) Same Sex Sibling who smokes Older Sibling who smokes Adolescents more vulnerable to addiction Eur Addict Res. 2003 Jul;9(3):120-30 Twin Res. 2003 June;6(3):209-17 J Adolesc Health. 2003 Jul;33 (1): 25-30 J Neurosci. 2003 Jun 1;23(11):4712-6
Slide 17 - Can School Outcome Predict Smoking Behavior? Low grades Poor teachers’ prognoses Early unemployment Scand J Public Health.2003;31 (3):229-32 Risk Factors for Initiation
Slide 18 - Count Down from Ten Dopamine “I feel good” Acetylcholine Serotonin Anti-depressant Epinephrine Adrenal gland Ventral Tegmental Area Medial Forebrain Bundle http://www.nida.nih.gov/researchreports/nicotine/nicotine3.html#how
Slide 19 - Is Nicotine the Only Chemical Causing the Addiction? Marked reduction of Monoamineoxidase (MAO) Enzyme that breaks dopamine down Something other than nicotine causing the change in MAO http://www.nida.nih.gov/researchreports/nicotine/nicotine2.html
Slide 20 - Stages of Change Model Prochaska, J. & DiClemente, C. (1983). Stages and processes of self-change in smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.
Slide 21 - Pre-Contemplation Stage Not ready to quit Not interested in changing Are defensive “I can’t quit” “It will not happen to me” “I enjoy it to much” Stages of Change
Slide 22 - Contemplation & Determination Stages Seriously thinking about changing Aware of the need to quit Taking small steps to quit “I know I need to quit” “You know, I should quit” “I want to quit within the next 30 days” Stages of Change
Slide 23 - Action Stage Ready for change Prepared mentally to change “I am going to quit smoking” “I want to live to see my grandchildren” Attends class or calls a quitline Quits smoking Last approximately 6 months Stages of Change
Slide 24 - DSM-IV Criteria for Nicotine Withdrawal (APA, 2994)
Slide 25 - Maintenance Stage Has quit smoking Prepares for stress Handles temptation Reminds themselves of what they have accomplished Continues to be smoke-free Stages of Change
Slide 26 - Relapse Stage Most experience Sees oneself as a failure A normal event A person may go through the stages of change several times before complete cessation. Stages of Change
Slide 27 - Symptoms of Nicotine Overdose upset stomach stomach pain salivation vomiting diarrhea cold sweat bad headaches dizziness blurred vision hearing difficulties weakness fainting mental confusion Source: TobaccoFreeKids.org
Slide 28 - We Must Break The Cycle Not a
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Slide 30 - The Association for the Treatment of Tobacco Use and Dependence (ATTUD) Goals Build and maintain an organization representing providers dedicated to the treatment of tobacco use and dependence. Establish standards for core competencies, for training, and for credentialing of tobacco treatment providers. Establish multiple forums (e.g., annual meeting, listserv, and journal) for information exchange on best practices, innovations in treatment, and gaps in the empirical base of tobacco treatment. Serve as an advocate and voice for tobacco users to promote the awareness and availability of effective tobacco treatments. Serve as a reliable and respected resource of evidence-based tobacco use and dependence treatment for the health care community, regulatory agencies, private foundations, and especially tobacco users. Promote the implementation of and increased access to evidence-based practice across the spectrum of treatment modalities via policy, funding, and system changes. www.attud.org
Slide 31 - The New Medicare Policy AARC review Who is covered? What is covered? What is not covered? Who can charge for services? Billing Codes
Slide 32 - Summary Be more empathetic Understand, it IS all in the head It is part of your job Advise, Assess, & Assist Every patient, every time Remember, with open hands and not pointing fingers RT as Tobacco Treatment Specialist’
Slide 33 - Do you want to have fun, while reducing stress and improving your cardiovascular health? Go Ballroom Dancing! 300 – 400 calories/hour