Coaching, Motivational Interviewing and Brief Interventions (2)

Question 1

How do brief interventions differ from coaching and motivational interviewing?

Answer 1

Brief Interventions = takes a view that the medical professional know best and they tell you how to do something
Opportunistic
High impact
Talking at the patient, not a conversation
Not specialist, psychological skills

Question 2

What are the 3 common steos of brief interventions?

Answer 2

Identifies behaviour risk factor
Explains how to best change their high risk behaviour
And

Question 3

What is MECC?

Answer 3

Make Every Contact Count

Opportunistic approach to behaviour change
Uses the millions of daily interactions in healthcare
Consistent and concise info
Focusing on the most important lifestyle issues

Question 4

What are the targets of MECC?

Answer 4

x

Question 5

What is the size of the smoking problem?

Answer 5

Largest preventable cause of premature death

>50% of long-term smokers die prematurely to smoking-related diseases

Question 6

Why are cigarettes bad for you?

Answer 6

Smoke inhaled is unfiltered as it diffuses straight into the arteriole system - allows every cell in the body to be affected
Cigarettes contain over 4000 chemicals and over 60 carcinogens / metabolic poisons

Question 7

What diseases does smoking making you more likely to get / exacerbate?

Answer 7

Cataracts
Cancer
Stroke
CVD
Peptic ulcers
Psoriasis 
Infertility 
Erectile dysfunction - suggests small blood vessels are being affected = early signs of CVD

Question 8

What are the effects of passive smoking? What conditions do they exacerbate?

Answer 8

Exacerbate:

Asthma
Premature births
Malnourished babies

Question 9

Why do people smoke?

Answer 9

Stress relief
Social 
Cognitive dissonance
Confirmation bias 
Boredom
Weightloss
Taste
Habit

BUT the real reason = nicotine addiction

Question 10

How addictive is nicotine?

Answer 10

As much or more so than cocaine and heroine?

Question 11

What questions can you ask to assess addiction level?

Answer 11

How long do you wait until for you first cigarette after you wake up?

Question 12

Why might asking ‘how many cigarettes do you smoke a day?’ not be appropriate?

Answer 12

Recall bias

Question 13

Why is ‘cutting down’ smoking not appropriate?

Answer 13

Doesn’t reduce risk proportionately
Only safe level of smoking is no smoking
x
Low cigarette consumption = longer smokes

Question 14

How should addictive behaviours be treated?

Answer 14

All or nothing

No cutting down

Question 15

What is the neurophysiology of nicotine addiction?

Answer 15

Most start at 14-15 y/o
Neuroplasticity - the nicotine allows for alpha-4-beta-2 receptors to develop and be activated
These receptors send a signal to the nucleus accumbens (pleasure centre)
Leads to sudden flood of dopamine release = pleasure rush
Once developted, they remain (do not go away)
When the dopamine hit goes away, leads to low mood and craving, leads to negative reinforcement to smoke

Question 16

What is nicotine addiction / smoking addiction?

Answer 16

Chronic relapsing organic disease in the brain, not a lifestyle choice

Question 17

What percentage of smokers:
Want to stop?
Succeed?

Answer 17

70% want to stop
30% try each year
Only 3-5% manage through willpower akibe

Question 18

How cost-effective are smoking cessation interventions?

Answer 18

Very
Estimates cost-effectiveness - costs below £2000 per Life Year Gained
£11,800 spent on statins compared to £2000 for smoking cessation

Question 19

Smoking cessations signpost to what?

Answer 19

Behavioural support
Pharmacological therapies
x

Question 20

What do the NHS Stop Smoking Services offer?

Answer 20

x

Question 21

What is the standard supported quit regime?

Answer 21

Pre-quit appointment
Quit appointment
Follow up appointment
Final appointment?

Question 22

What are the advantages of a doctor offering the smoking cessation service instead of other medical professionals?

Answer 22

Trust and rapport between patient and doctor already established
Smokers visit their GP more than non-smokers
Independent prescribing = tailored pharmacological interventions for smoking cessation

Question 23

What are the 3 key things required for long term cessation rates?

Answer 23

x

Question 24

Number Needed to Treat (NNT) to obtain 1 long term quitter?

Brief Advice alone =
NRT =

Answer 24

Brief Advice alone = 51

NRT = 23

Question 25

What behaviours do behavioural support groups target?

Answer 25

Reduce motivation to smoke
Commitment to abstain
Enhance x

Question 26

What is the efficacy of somking cessation?

Answer 26

Most effective

Group
1-2-1
telephone calls
smartphone apps

Least effective

Question 27

What is NRT?

Answer 27

Nicotine Replacement Therapy
8-12 week treatment, needs to weaned off slowly
9 different forms
Increases smoking cessation rate by 1.58x compared to placebo
Start NRT on quit date

Question 28

What are the pros and cons of E-cigarettes?

Answer 28

Pros: 
Does not contain the carcinogens found in tobacco
Mimics their behaviour more closely
95% safer than smoking
As effective as NRTs

Cons:
Long-term side effects unknown
Many people decide to smoke actual cigarettes alongside e-cigarettes

Question 29

What to consider for patients using NRTs?

Answer 29

Use enough - avoid under-dosing and irregular use
Long enough - don’t stop early, continue 8-12 weeks to desensitise the receptors
x

Question 30

What is Bupropion (Zyban)?

What are it’s side effects?

Answer 30

Originally developed to treat depression
Modifies dopamine levels and noradrenergic actvity
Significantly increased smoking cessation rate by 1.94x compared to placebo

Insomnia
Dry mouth
Headache
Nausea

Question 31

What is Varenicline (Champix)?

Answer 31

Partial nicotine agonist and partial nicotine antagonist
Part blocking - reduces pleasurable effects of smoking
Part stimulating - relieves craving and withdrawal symptoms
Higher abstinence prevalence than bupropion