ASSESSMENT FOR TOBACCO ADDICTION 1 Hour All materials copyright © Dr. Richard K. Nongard. All rights reserved. No portion of this course may be reproduced without specific written consent of the author. Your instructor for this course is Dr. Richard K. Nongard, a Licensed Marriage and Family Therapist and the author of Transformational Leadership: How to Lead form Your Strengths and Maximize your Impact and Contextual Psychology: Integrating Mindfulness-Based Approaches Into Effective Therapy. His books can be found at any bookseller worldwide. You may also contact our office for group pricing, in-house training, conference and keynote services. We will also create courses to meet your organizations specific training needs.

Course Description: Explore the 3 key assessment issues necessary to develop targeted intervention strategies for effective smoking cessation treatment. Course Objectives: At the conclusion of this course, the professional will be able to:   

Identify three key issues for tobacco use assessment. Utilize three assessment tools for evaluating tobacco use. Develop targeted intervention strategies to aid in ending tobacco use.

Purpose of this course: The purpose of this continuing education course is to provide a current understanding of issues relevant to the mental health counselor concerning the necessity and accuracy of assessment of tobacco and smoking use cessation. Course Outline: Part 1: Reading of Course Preface and Introduction Part 2: Reading and Synthesis of The Fagerstrom Test for Nicotine Dependence Part 3: Reading and Synthesis of The Why Do I Smoke? Quiz Part 4: Reading and Synthesis of The Nongard Nicotine Relapse Indicator Checklist Part 5: Administration and Completion of the Evaluation of Learning Quiz =========== 1 Hour

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“Assessment of Tobacco Addiction” PREFACE Dear Mental Health, Social Work, Addiction, Nursing, Physical Fitness, Respiratory Therapist, Psychology and other Health Sciences Professionals: Based on both personal and professional experiences, we believe that Tobacco Cessation Treatment is one of the most important areas of health care. (That’s mental health care, behavioral health care, and physical, medical, social, etc – health care). After all, couples split up over stinky cigarettes, probationers pay for cigarettes but not restitution—leading to reincarceration, individuals reinforce their depression, anger and anxiety with nicotine, and quitting smoking is more effective than Viagra in enhancing sexual performance. If you treat smokers, you are treating not only their basic nicotine dependence, but also a wide variety of presenting problems that are caused by cigarettes; problems complicated and reinforced by smoking. Unfortunately, tobacco use has also historically been one of the most overlooked, misunderstood, and shrugged off areas of treatment – by all professions, including medical doctors. Fortunately this is changing, and more and more insurance companies, employers, judges and tobacco using individuals themselves are acknowledging the multitude of interfering problems that come with tobacco addiction. Nevertheless, there remains a shortage of professionals who are 1) qualified, and 2) actively interested in getting paid to help others quit. 1 in 4 Americans smoke, and they DO want to quit. But it is hard. It’s harder than quitting heroine or crack cocaine. However, it can be done. The key to quitting is having the right kind and combination of supports, which, of course, will be different for every individual. For the smoker, smoking is not just about ‘habit’ or ‘addiction’, it’s also about lifestyle, identity, socialization, and yes, even a level of spirituality. To quit successfully, every one of these areas must be addressed, and backed up with a relapse prevention plan unique to the individual. This course is worth 1.5 Hours of CEU credit, and offers an introduction or basic overview of three assessment tools for treating tobacco addiction.

4 Thorough and accurate assessment is important, for this is how we develop appropriate intervention and relapse prevention strategies, which leads to successful treatment. Inadequate or inaccurate assessment generally leads to ineffective interventions and treatment failure, which, of course, is not good. The text borrows materials from our QUITSUCCESS Tobacco Cessation Specialty Certification and Treatment Programs. The professional development specialty program we offer is a comprehensive 20-hour CEU course leading to certification as a tobacco dependency treatment counselor. You can learn more about these programs at www.QuitSuccess.com.

Whether you decide to pursue further education or specialty certification in Tobacco Cessation treatment or not, we hope that the following information provides a greater understanding of the challenge that 25% of Americans face when trying to quit smoking by themselves, and that through this course you will recognize the important role that mental and behavioral health professionals can play in tobacco cessation treatment.

There is a rapidly growing need for tobacco cessation treatment services, and we hope you decide to fill it – whether as a niche market provider, or as an added or adjunct component to your other professional services. Tobacco Cessation Specialists not only experience personal satisfaction in their work, they also enjoy high levels of financial compensation.

As always, we appreciate your business, and your comments. Please feel free to pass along your thoughts in the Grade This Course section of the Evaluation.

Sincerely,

Richard K. Nongard Licensed Marriage and Family Therapist Certified Personal Fitness Trainer Certified Clinical Hypnotherapist

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INTRODUCTION “Anyone who has ever been addicted to nicotine recognizes that quitting tobacco use is among the most difficult challenges he or she will ever face.” ~ Michael C. Fiore, M.D., M.P.H. Director, Center for Tobacco Research and Intervention, University of Wisconsin Medical School

o 50 million Americans smoke cigarettes. o 10 million Americans regularly use smokeless tobacco. o Of people who smoke cigarettes, 87% smoke every day. o Nearly two-thirds of smokers have their first cigarette within the first half-hour after they wake up. o 87% of cigarette smokers who smoke more than 26 cigarettes a day believe they are addicted. o Even after smokers have had their larynxes removed, 40% try smoking again. And most all of them want to quit - but they need help. o Most smokers try 3-9 times before they can finally quit for good. o Data suggest that more than 70 percent of the 50 million smokers in the United States today have made at least one prior quit attempt. o Approximately 46 percent try to quit each year. o Among the 17 million adults who attempted cessation in 1991, only about 7 percent were still abstinent 1 year later. These discouraging statistics have led many clinicians to report that they feel ineffective in the treatment of tobacco dependence. Clinicians should remain cognizant that relapse is likely, and that it reflects the chronic nature of dependence, not their personal failure, nor a failure of their patients.

6 However, o Less than 15 percent of smokers who saw a physician in the past year were offered assistance. o Only 3 percent had a follow-up appointment to address tobacco use. o Fewer still have received specific advice on how to quit smoking successfully. Studies show that the more treatment a person receives when they quit, the more successful they are in the long run. Abstinence Success rates are as follows, from Best (1) to Worst (5): 1. Individual Counseling 2. Group Counseling 3. Proactive Telephone Counseling 4. Self-Help 5. No Structured Format Furthermore, research indicates that structured yet personalized programs involving Individual Counseling combined with Group Support and Nicotine Replacement Therapies have the greatest success.

The point of the above information is as follows: o 60 Million people use tobacco products in America. o Almost all of them are addicted – physically, psychologically, socially and spiritually. o Almost all of them truly want to quit. o Almost all of them cannot quit on their own, or they would have. o Research shows that certain specific quit strategies can and do work. o There is a shortage of trained people who understand these methods, and can offer and implement an effective treatment program. o You can become a well-trained QuitSuccess Program Facilitator and help people quit using tobacco.

Nicotine is a psychoactive drug that people can very easily become addicted to. Breaking this addiction – and habit - is amazingly difficult. Quite possibly, you may have faced the hardships of trying to quit yourself. There is very little difference between the nicotine addict and the person addicted to cocaine, alcohol, or narcotic analgesics like Lortab or Oxycontin.

7 The Surgeon General states that the smoker, during the cessation process, will experience the same withdrawal as a long-term heroin user. The difficulty in overcoming cigarette addiction lies in the dual nature of dependency on the drug nicotine: the obvious physical addiction is coupled with a psychological obsession. Smokers have a serious relationship with the cigarette. It is always there – through good times and bad. Many hours are spent not only smoking, but when not smoking, thinking about that next cigarette. According to the Food and Drug administration, 87% of the people who smoke cigarettes do so every day. It is interesting to note that there are few “social” cigarette smokers. The majority are chronic, long-term users. When reading books on smoking cessation, studying the programs included with over-thecounter medications, or viewing government literature on this subject, you may begin to think of diet plans: No matter what, one – and only one - particular approach is advocated. But even common sense says that when dealing with behavioral or habit change, no single approach is one-size-fits-all. Every client is different and needs to be assessed and treated individually. In order to be truly successful at helping your clients, a wide variety of approaches should be incorporated and integrated. The QuitSuccess Program is intended for those who would like to stop smoking cigarettes or using smokeless tobacco. Quitting takes far more effort than simply avoiding smoky bars or not buying cigarettes or even just chewing nicotine gum. The QuitSuccess Program is unique in that it addresses the multiplicity of factors that make it difficult for tobacco users to quit. For long-term success, the client needs to be ready and able to look beyond the first step.

QuitSuccess  Praxis Point 1 – ASSESSMENT In order to be successful with tobacco cessation treatment, a thorough and accurate client assessment must be made. It is imperative that we know when and why they use tobacco, and what they think about their tobacco use, as the answers will help determine what modalities of treatment will be most effective for both their immediate and long-term success. As with any client, there should be a complete oral interview. The three quiz assessments provided in this section can be given orally during the interview, or they may be completed separately on paper. The interview should also include a discussion of any prior attempts to quit using tobacco; what was tried, what worked and what did not, as well as questions about previous nicotine withdrawal symptoms.

8 Topics to ask about in reference to nicotine withdrawal symptoms experienced with prior quit attempts: (4 or more indicate nicotine dependency) o o o o o o o o o o o o

. Craving Cigarettes (or Smokeless Tobacco) . Restlessness . Irritability, Frustration or Anger . Fatigue . Dizziness . Tightness in the Chest . Insomnia . Dysphoric/Depressed Mood . Anxiety . Increased Appetite or Weight Gain . Cough, Dry Throat, Nasal Drip . Constipation, Gas, Stomach Pain

Education about nicotine withdrawal symptoms is important. For the client, sometimes simply knowing what to expect – and that it will pass – is a big help. As a QuitSuccess Facilitator, knowledge of the symptoms the client experienced in the past will help you develop strategies to either avoid or overcome these and other potential symptoms in the future, which will dramatically increase their odds for success. The following are three different short and simple assessment quizzes. They may be administered to the client orally or on paper. Additionally, a sample copy of each quiz is included in the QuitSuccess Participant’s Guidebook in the Praxis Point 1 - Assessment section, so the client can review the questions and consider the answers before or after taking the quiz.

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1) “The Fagerstrom Test for Nicotine Dependence” From Heatherton, T., The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire, British Journal of Addiction, (1991)86, 1119-1127.

This quiz (shown on the next page) assesses when the client smokes, which can offer insight into their level of nicotine addiction. It also uncovers other key factors behind their dependency that will make it easier for us to create a program that targets their specific needs. For example, a person who has a strong physiological dependence will be more inclined to respond positively to a nicotine replacement therapy program. However, a client who seems to be more psychologically dependent on cigarettes will need a wider repertoire of coping strategies than some of our other clients in treatment.

INTERPRETATION: Score of 6 or higher: Indicates high nicotine dependency. These individuals are likely to benefit from tapering and the use of nicotine replacement therapy (gum, patch, spray, etc) at high or the highest recommended dosage levels, in order to decrease nicotine withdrawal symptoms - as an adjunct to standard counseling, proper nutrition and exercise.

Score of 5 or less: Suggests low to moderate nicotine dependency. These individuals would likely also benefit from the use of nicotine replacement therapy (gum, patch, spray, etc), however they should start at a lower or the lowest recommended dosage - as an adjunct to standard counseling, proper nutrition and exercise. For example, those with lower scores might occasionally use the 2mg nicotine gum when a craving hits, instead of frequent use of the 4mg gum as would be recommended for those with higher scores and therefore higher nicotine dependency.

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“The Fagerstrom Test for Nicotine Dependence” o What is your current level of nicotine dependency? The results of this short 6 question quiz will help determine the best strategies for helping you quit, such as Nicotine Replacement Therapies, social supports, exercise programs, and so on. Please complete The Fagerstrom Test for Nicotine Dependence. Your QuitSuccess Facilitator will go over the scoring and interpretation of the test with you.

Question

1. How soon after waking do you have your first cigarette?

Answer

o

Within 5 minutes

o

6-30 minutes

o

31-60 minutes

Score (circle one) 3 2 1

o o

Yes No

1 0

o

1

o

The first on in the morning Any other

0

4. How many cigarettes a day do you smoke?

o o o o

10 or less 11-20 21-30 31 or more

0 1 2 3

5. Do you smoke more frequently in the morning than in the rest of the day?

o o

Yes No

1 0

6. Do you smoke even though you are sick in bed for most of the day?

o o

Yes No

1 0

2. Do you find it difficult to abstain from smoking in places where it is forbidden? 3. Which cigarette would you hate to give up?

From Heatherton, T., The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire, British Journal of Addiction, (1991)86, 1119-1127.

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2) “Why Do I Smoke?” Quiz

People often smoke or use smokeless tobacco for different reasons at different times. This test helps us determine whether the client’s smoking habit is more physiologically, psychologically, or socially motivated. Assessing the reasons why the client uses tobacco will go a long way in helping to decide which quitting approaches will be the most beneficial for them. Having an emotional and situational replacement strategy ready that can help make up for the things the client may miss when they stop is important.

INTERPRETATION: The client will be asked to respond to 21 statements (A through U) by assigning the number which describes their own experience, as follows: 5 = Always 4 = Most of the time 3 = Once in a while 2 = Rarely 1 = Never

Step 1: Transfer the numbers from the quiz to the scorecard (which follows the quiz) by matching up the letters. For example, take the number written for question A on the quiz and enter it on line A of the scorecard.

Step 2: Add up each set of 3 scores on the scorecard to get the total for each different category. For example, to find the score on the "Stimulation" category, add together the scores for questions A, H and U. The score for each category can range from a Low of 3 to a High of 15. A score of 11 or above on any set is High and means that the client’s smoking is probably influenced by that category. A score of 7 or below is Low and means that this category is not a primary source of satisfaction to the client when they smoke. Scores from 8 to 10 are considered to be in the gray area, and responses should be evaluated against other assessment and interview results.

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“Why Do I Smoke?” QUIZ

What do cigarettes, smokeless tobacco, or cigars do for you? We were not dependent on nicotine when we started using tobacco. There were specific reasons why we started, and there are specific reasons - socially, spiritually, psychologically and physically – that we continued to use. Understanding these reasons will help create a more effective plan for staying tobacco free. Please complete the “Why Do I Smoke?” Quiz. Your QuitSuccess Facilitator will go over the scoring and interpretation of the quiz with you.

Next to the following statements, write the number that best describes your own experience: 5 = Always, 4 = Most of the time, 3 = Once in a while, 2 = Rarely, 1 = Never

___

A.

I smoke to keep myself from slowing down.

___

B.

Handling a cigarette is part of the enjoyment of smoking it.

___

C.

Smoking is pleasant and relaxing.

___

D.

I light up a cigarette when I feel angry about something.

___

E.

When I am out of cigarettes, it's near-torture until I can get more.

___

F.

I smoke automatically, without even being aware of it.

___

G.

I smoke when people around me are smoking.

___

H.

I smoke to perk myself up.

___

I.

Part of my enjoyment from smoking is preparing to light up.

___

J.

I get pleasure from smoking.

___

K.

When I feel uncomfortable or upset, I light up a cigarette.

___

L.

When I'm not smoking a cigarette, I'm very much aware of the fact.

___

M.

I often light up a cigarette when one is still burning in the ashtray.

___

N.

I smoke cigarettes with friends when I am having a good time.

___

O.

When I smoke, part of the enjoyment is watching the smoke as I exhale.

___

P.

I want a cigarette most often when I am comfortable and relaxed.

___

Q.

I smoke when I am "blue" and want to take my mind off what's bothering me.

___

R.

I get a real hunger for a cigarette when I haven't had one in a while.

___

S.

I've found a cigarette in my mouth and haven't remembered it was there.

___

T.

I always smoke when I am out with friends at a party, bar, etc.

___

U.

I always smoke cigarettes to get a lift.

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“Why Do I Smoke?” Quiz SCORECARD "It stimulates me." You feel that smoking gives you energy and keeps you going. Think about alternative ways to boost your energy, such as brisk walking or jogging.

___ A ___ H ___ U ___

"Stimulation" Total "I want something in my hand." There are a lot of things you can do with your hands without lighting up a cigarette. Try doodling with a pencil, or playing with putty or a fake cigarette.

___ B ___ I ___ O ___

"Handling" Total "It feels good." ___ C You get a lot of physical pleasure from smoking. Various forms of exercise or ___ J other activities can be effective alternatives. ___ P ___ "Pleasure/Relaxation" Total "It's a crutch." It can be tough to stop smoking if you find cigarettes comforting in times of stress, but there are many better ways to deal with stress.

___ D ___ K ___ Q ___ "Crutch/Tension" Total

"I'm hooked." In addition to having a psychological addiction to smoking, you may also be physically addicted to nicotine. It's a hard addiction to break, but it can be done. Talk with your doctor about using nicotine replacement therapy (the gum, patch, inhaler or nasal spray) to control your withdrawal symptoms.

___ E

"It's part of my routine." If cigarettes are merely part of your routine, stopping should be relatively easy. One key to success is being aware of every cigarette you smoke. Keeping a smoking diary is a good way to do this.

___ F

___ L ___ R ___ "Craving/Addiction" Total ___ M ___ S ___

"Habit" Total "I am a social smoker." You smoke when people around you are smoking and when you are offered cigarettes. It is important for you to avoid these situations until you are confident about being a nonsmoker. If you cannot avoid a situation in which others are smoking, remind them that you are a nonsmoker.

___ G ___ N ___ T ___

"Social Smoker" Total This information was developed by the American Academy of Family Physicians, in cooperation with the American Cancer Society; American College of Preventive Medicine; American Diabetes Association; National Cancer Institute; and the National Human Genome Research Institute.

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3) “Nongard Nicotine Relapse Indicator Checklist” We need to determine psychological, social and physical indicators for potential relapse. Understanding what and how the client thinks about their tobacco use can help identify the potential triggers or ‘red flags’ that could cause stress or difficulty in the near or even far future. It is important that the client continually feels encouraged by the positive changes they are making – not using tobacco, eating nutritiously, exercising frequently and so on. The faster they fall into these healthy habits, the better their odds of succeeding in the long run. But crisis can come – stressful situations may arise - and if they are not adequately prepared, they might give in and reach for that old comfortable habit of tobacco. The more that is known about their situational and emotional positions on tobacco use, the more we can help them be prepared for surprise and even routine challenges, and the better equipped they will be to avoid relapse.

INTERPRETATION: The following checklist is not exactly scored or tallied. Instead, the QuitSuccess Facilitator will discuss the answers to each statement (both positive and negative) with the client and determine how the particular issue might potentially be troublesome – or not. Things that are not considered potential challenges are to be praised, and any skills or attitudes that can be transferred to other assist in tackling other issues should be explored. Below are the quiz questions and potential discussion points. The quiz itself follows.

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Nongard Nicotine Relapse Indicator Checklist Discussion Questions _____ 1.) I drink alcoholic beverages more than 3 times per week. If the client marks yes on this item, you know there will be two specific areas to address. One, most people who both drink and smoke will always smoke when they are drinking. Therefore, it may be difficult for the smoker to continue to drink and not smoke. They should be encouraged to eliminate or at least cut back on their drinking during the first 3-5 weeks of smoking cessation. Second, if the client drinks in social situations, they may also suffer peer and/or environment related stress and temptation, if their friends or everyone else is smoking around them. They may need to adjust their social life, find a way to socialize in non-smoking establishments, or they may have to rely heavily on nicotine replacement therapies.

_____2.) I live with a cigarette smoker. If the client lives with a smoker who is not going to quit, their journey to tobacco freedom will be difficult, but not impossible (see myths # 2 and 5 in “7 Myths About Quitting” in the Patient Education section). They must remember that everyone is responsible for their own behavior, good or bad. They have made the decision to quit; they are quitting for themselves, and it doesn’t matter if the rest of the world smokes or dips for the next 100 years, they will stay quit. You will need to discuss the relationships they have with those who will remain using tobacco in the home, as some situations will be easier to handle than others. Options range from one moving out to the other only smoking outside. Marital relationships, of course, will be the most stressed, and a session or two of couples counseling may even be in order.

_____3.) Others smoke in my work environment. Like living with a smoker, this situation can be tough, so the client will just have to be tougher. For those working at a restaurant or club where smoking is permitted, if they can’t quit and find another job, nicotine replacement therapies may be the key. For others, the answer may be as simple as not going to the smoke-hole during breaks; find an alternative way to pass the time. This situation can sometimes stress coworker friendships, so counseling on establishing healthy social supports is likely indicated.

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_____4.) I smoke more than 40 cigarettes per day (or 1 can of dip per day). A yes answer to this statement will indicate a high level of nicotine addiction. If there is time (even 2 days) before their quit date, you might recommend that they begin cutting back, and maybe even switching to a brand with less nicotine. The idea is to start reducing their nicotine level, in effort reduce the physical side effects of withdrawal when they quit. Furthermore, the greater their level of nicotine addiction, the more they may wish to consider following a 6-12 week nicotine replacement therapy program, which would allow them a longer time to taper off the nicotine, while remaining tobacco free.

_____5.) This is my first attempt to quit smoking or smokeless tobacco. If the client checks yes, this is their first real attempt at quitting, the Facilitator will have lot of educating to do in order to adequately prepare the client for the drastic emotional, psychological, social and physical changes that are about to take place in their life the moment they commit to quitting. A client who has tried to quit several times before already knows that they will have cravings and may gain some weight, etc, so the conversation may focus more on discovering what specific techniques worked at least part of the time the last time they quit, and crossing off those that did not. The first time quitter, however, is starting from scratch, and will need all the information and preparation training possible, in order to quit successfully.

_____6.) I am facing stressful life events beyond my control at this time. Using external events (both large and small) as excuses to continue smoking or dipping is nothing new. There is never a ‘good time to quit’. Whether the client is in control of situation is irrelevant – they are in control of and responsible for their own behaviors, no matter what. Counseling on choosing alternative coping strategies during stressful situations and teaching relaxation techniques may be beneficial.

_____7.) I would rather risk the damage from smoking or using smokeless tobacco than gain 10 pounds of weight. We all have thoughts about what is and what is not acceptable when it comes to our personal appearance, health and behaviors. Some people are 50-100 pounds overweight, and it doesn’t seem to bother them at all, while others may panic if they gain two pounds over the holidays. In either situation, you’ll want to explain the reasons that they may gain a few pounds (change in metabolism and eating as a response to cravings) and discuss diet and exercise strategies, which can help minimize the potential gain. Additionally, the client may need educated on or reminded of the potential health consequences of continued tobacco use, as compared with the consequences of slightly tighter jeans.

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_____8.) I like smoking and do not want to quit, even though it will be good for me. A yes answer to this statement may be one of the most difficult for the program Facilitator to challenge. Either this person really does not want to quit, or they are so fearful of failure that they won’t take the risk and try. The key will be in sorting out the true reasons that they wish to continue using tobacco – what does their smoking or dipping do for them, and in what other ways could they meet those same needs? And, if they are just not ready and willing, you may simply need to let them know that you will be there to help them in the future when they finally decide they are ready.

_____9.) I have tried to quit several times and fear I won't succeed this time. And they certainly will not succeed ever, if they do not try again. For this client, you will need to thoroughly go over their past attempts and discuss what things worked to help them not use tobacco – even for a short time – and what situations were the most tempting and caused them to relapse. Make positive use of the things that worked, set up solid prevention measures to handle the known tempting situations, and discuss implementing new ideas that they may not have tried before.

_____10.) People won't like me if I don't smoke. Some of the thoughts or beliefs the client holds about their smoking may simply be cognitive errors, which once confronted with the truth, will no longer be any threat to their success. For example, if they believe that their friends or family will no longer like them or socialize with them if they quit, they need to be educated on what real friendship is all about – and that their own health, wellness and happiness is what is most important, not what someone else thinks. And, most people respect and admire those who are able to quit. Furthermore, since most people do not use tobacco (75%), they should be encouraged to seek out new friendships with other non-tobacco users.

_____11.) I will be dull and boring if I quit smoking. This is another cognitive error to confront. On one hand, it is surely better to be dull and boring than to use tobacco and endanger your health. On the other hand, there is no reason that someone would become dull and boring simply by becoming healthy. Conversely, the client will likely find that they are able to go and do far more things as a non-smoker than they ever did before – sit through a whole movie, play sports (or even enjoy sex) without getting winded, socialize with new people or find new job opportunities.

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_____12.) If I can cut down to only a few cigarettes a day I will be happy. While it’s true that approximately 10% of those who smoke report that they only smoke occasionally – meaning not every day – these people are apparently not truly addicted to nicotine or the physical habit of handling cigarettes or snuff cans. If the client is not able to easily quit on their own at the drop of a hat – or more realistically, if they must even consider ‘quitting’, then they are likely not one of those rare people who can only smoke once a month at a party. And while it may be true that less tobacco usage is certainly better than more, any at all is still not good for you, and most who “cut down” to “just a few a day” cannot maintain this level for very long before they are right back where they started.

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The Nongard Nicotine Relapse Indicator Checklist What obstacles may impede your ability to stay tobacco free? We all have situational or emotional ‘triggers’ that can set off our urges to smoke or dip, puff or chew. Recognizing these triggers will help us build strategies to successfully avoid or confront the surprising or even routine challenges ahead. Please complete the Nongard Nicotine Relapse Indicator Checklist. Your QuitSuccess Facilitator will go over the results with you.

Checkmark or write YES next to any of the following statements that may apply to you: _____ 1.) I drink alcoholic beverages more than 3 times per week. _____ 2.) I live with a cigarette smoker. _____ 3.) Others smoke in my work environment. _____ 4.) I smoke more than 40 cigarettes per day (or 1 can of dip per day). _____ 5.) This is my first attempt to quit smoking or smokeless tobacco. _____ 6.) I am facing stressful life events beyond my control at this time. _____ 7.) I would rather risk the damage from smoking or using smokeless tobacco than gain 10 pounds of weight. _____ 8.) I like smoking and do not want to quit, even though it will be good for me. _____ 9.) I have tried to quit several times and fear I won't succeed this time. _____ 10.) People won't like me if I don't smoke. _____ 11.) I will be dull and boring if I quit smoking. _____ 12.) If I can cut down to only a few cigarettes a day I will be happy.

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CONCLUSION It is our hope that by evaluating these assessment tools you will have a better understanding of the key issues that will need to be addressed when helping someone to quit using tobacco products. Common sense combined with your existing clinical skills may help you to create a practical and effective treatment plan for those who wish to quit smoking. However, if this is a line of work you wish to pursue, whether full or part time, or as an added component of your existing services, we highly recommend that you consider completing our 20-hour CEU and Specialty Certification program, which offers intensive education on providing effective tobacco cessation treatment services. Furthermore, we have also put together essentially a complete ‘treatment program in a box’, which not only provides step-by-step guidance on the clinical aspects of structuring and implementing individual, couples, group and corporate tobacco cessation programs, but also addresses the business and marketing side of setting up a tobacco cessation practice, and working with fitness centers, community agencies, schools and private companies, as well as with individuals, both part and full time. More information on both the Specialty Certification and the QuitSuccess Facilitator’s Treatment Program can be found at www.QuitSuccess.com, or please feel free to call our office at (800) 390-9536.

PeachTree also offers 300+ hours of CEUs on a variety of other subjects - from anger management to obsessive/compulsive disorders, personality disorders, ADHD, family violence, psychosexual disorders and more - through both audio and video homestudy, and online text based courses. www.FastCEUs.com

Be a hero to your friends & coworkers ~ tell them about this CEU course!

Course Conclusion Instructions for earning continuing education hours: Thank you for taking this course. All quizzes are now online at www.PeachtreeCE.com We no longer support submission through mail, fax or email. You must use a credit card to complete payment for this course. If you have any questions, email our office at: [email protected]