Set 1 Flashcards
Is tobacco the single largest preventable cause of morbidity and mortality in the US?
Yes
Top causes of death related to smoking?
Cancer
Cardiovascular disease
Respiratory disease
90% lung cancer men
70-80% women
How many quite attempts are needed for smoking on avg?
6
Lung cancer screening recommendations?
USPSTF
Yearly, low dose CT Chest for:
- 20 pack years +
- Current smoker / quit in past 15 yrs
- 50 - 80 y/o
What are screening tools for nicotine dependence?
Fagerstrom Test for Nic Dep
Heaviness of Smoking Index (HSI)
Minnesota Tob Withdrawal Scale
Fagerstrom Test for Nicotine Dependence
10-item self-report
High score, high dependence
Heaviness of Smoking Index
2-question test (6 point scale)
Q1. Time to first cigarette after wake
< 5min …. 60min+
Q2. No. of cigs per day
High score, high dependence
Minnesota Tobacco Withdrawal Scale
(Hughes Withdrawal Scale)
Severity of 4 symptoms:
1. angry/irritable/frustrated
2. anxious/tense
3. depressed
4. restless/impatient
US Dietary Guidelines for alcohol consumption
Men <= 2
Women <= 1
How much is a std drink?
14g ethanol
12oz of 5% beer
5oz of 12% wine
1.5 oz of 40% spirit
Define ‘binge drinking’
BAL 0.08%
5 drinks in 2 hrs (men)
4 drinks in 2 hrs (women)
Define ‘heavy alcohol use’
Binge drinking 5+ drinks on %+ days in the past month
> 4 drinks on any day (men)
3 drinks on any day (women)
Define ‘at risk drinking’
Exceeds levels for any day or week
Binge drinking at least 1/month
Increases risk of future probs
Screening tools for alcohol use?
CAGE
AUDIT
NMASSIST
CRAFFT
TAPS
MSASQ
What is the NIAAA single-item screening test?
(ORAL)
How many times in the past year have you had >4 (women) or > 5 (men) in a day?
If one day or more, then:
1. no of drinks / wk
2. no of drinks / day
3. Advise to reduce if
- women 3+ per day, 7/wk
- men 4+ per day, 14/wk
AUDIT-C
(WRITTEN)
- How often drinks in past year?
- How many / day typically?
- How often 6+ drinks?
If positive, then full AUDIT
What tool to use for drug use screening?
(> 70% sens to ID substance use disorder, NIDA)
TAPS-1
- tobacco
- alcohol > recommended
- prescription med use in non-medical way
- illicit (cocaine, metamph)
TAPS-2
- longer tool triggered by +ve
Criteria for substance use (DSM-5)
- larger amounts or over a longer period than intended
- persistent desire or unsuccessful efforts to cut down / control
- much time spent to obtain, use or recover from effects
- cravings/urge
- fail to fulfill obligations
- social or interpersonal issues
- Occ, recreational, social activities given up
- physically hazardous
- continued use despite awareness
- tolerance
- withdrawal
What therapy options are helpful in substance use?
MI
CBT
DBT
5A’s of Behaviour Change
Assess
- practices for health risks
Advise
- change; clear/specific
Agree
- on focus, based on pt’s interest/will
Assist
- setting and achieveing goals
Arrange
- regular follow up and support
5A’s of Tobacco Cessation
Ask
- tobacco use
Advise
- to quit in clear, strong, personalised
Assess
- ready and willing to quit?
Assist
- quit plan
- counselling, pharmacotx, if ready
Arrange
- follow up
Motivational Interviewing
Principles
Express empathy
Develop discrepancy
- between values and present behav
Roll with Resistance
Support self-efficacy
5 R’s of Motivational Interviewing
Relevance
Risks of use
Rewards of quitting
Roadblocks to quitting
Repetition
