Intensive Tobacco Intervention

Question 1

What is the half-life of nicotine?

Answer 1

2 hours

Question 2

Why is ammonia added to tobacco products?

Answer 2

Facilitates absorption and bioavailability of nicotine

Question 3

The 2013 World Health Assembly called on governments to reduce the prevalence of smoking by how much?

Answer 3

By one third by 2025

This would avoid more than 200 million deaths during the remainder of the century

Question 4

Name the areas in which Canada did not achieve high achievement with regard to reducing tobacco product harm.

Answer 4

National mass media campaigns (USA did though, which may help Canadians)
Complete bans on all tobacco advertising, promoting, and sponsorship
Raising taxes to increase prices of tobacco products
Adequately staffed national tobacco control government structures

Question 5

Smoking worldwide releases how much greenhouse gases?

Answer 5

2. 6 billion kg of CO2 annually

5. 2 billion kg of methane annually

Question 6

What percentage of total healthcare costs in developed countries is due to tobacco?

Answer 6

Up to 15%

Question 7

Tobacco cessation would cost $X per year to save 20,000 lives

Answer 7

$2000

Question 8

According to CAN-ADAPTT, what are the two counselling approaches that result in higher rates of abstinence?

Answer 8

Practical counselling: provides the client with problem-solving skills and training
Motivational counselling: provides support and encouragement

Both should be included in cessation interventions

Question 9

Offering cessation support increases quit attempt rates by how much compared to only advising?

Answer 9

Twice as much (217%)

Of note, when offered Rx only they were 68% more likely to quit compared to being advised only.

Question 10

Define addiction.

Answer 10

Primary, chronic disease of brain reward, motivation, memory, and related circuitry.

Question 11

Name the 4 “C”s of addiction.

Answer 11

Loss of control
Compulsion
Craving
Use despite consequences

Question 12

When was tobacco use disorder added as a diagnostic category in the DSM?

Answer 12

2013 (DSM-5)
In the DSM-4, the same diagnostic criteria were present but tobacco was included in substance use disorders rather than recognised as its own classifiable disorder

Question 13

How do we measure severity of tobacco use disorder?

Answer 13

Number of the 11 diagnostic criteria identified within a 12-month period.

2-3: mild
4-5: moderate
6+: severe disorder

Question 14

What are the criteria for substance use disorders?

Answer 14

1. Impaired control over substance (signs of tolerance; persistent desire to use; unsuccessful attempts to reduce or quit)
2. Social impairment (substance use has social or interpersonal consequences, resulting in failure to meet obligations at work/school/home. In other words, when it affects your life)
3. Risky use of the substance (despite know the physically harmful effects or using it in hazardous situations)
4. Pharmacological criteria (requiring increased dose of substance to achieve the desired effect. Includes smoking within 30 minutes or waking.)

Question 15

Name some barriers to quitting

Answer 15

Stress
Weight gain
Living with someone who uses tobacco

Question 16

What is the success rate of quitting?

Answer 16

13%

Question 17

What percentage of people who “lapse” during the first eight weeks relapse by 6 months?

Answer 17

78% were back to smoking by 6 months

Question 18

What are the success rates (stopping for at least 6 months) of the different levels of interventions?

Answer 18

Self-directed without supports: 1%
Self-directed with supports: 2%
BTI: 1-3% or 3-13% depending on which source you use
ITI: up to 27%; up to 40% depending on which source

Group treatment (2 hours once per week) had more success than one-on-one (30 minutes once per week)

Question 19

Nicotine is an agonist for which neurotransmitters?

Answer 19

Catecholamines (through monoamine oxidase inhibition): dopamine, serotonin, and norepinephrine
Adrenaline by direct action on the adrenal medulla

Question 20

What are the 5 Rs?

Answer 20

Strategy for motivation

Relevance (why this is important to client)
Risk (potential negative effects of tobacco use)
Rewards (potential benefits of quitting
Roadblocks (possible obstacles to quitting, including those faced on previous attempts)
Repetition (includes aspects of these in each clinical contact with individuals not ready to change their tobacco use)