Substance Use Counseling Flashcards
What are the 4 key elements to a successful smoking cessation plan?
STAR
- Set quit date
- Tell others
- Anticipate challenges
- Remove tobacco products and paraphernalia
How should you tailor treatments for difficult-to-treat smokers?
- Flexible quit date that encourages smoking reduction as an initial goal
- Treatment sampling and practice quit attempts
- Supplement standard behavioral counseling with mood management counseling
What 3 pharmacologic treatments are proven to be effective for smoking cessation?
- Nicotine replacement therapy (patch, gum, lozenge)
- Bupropion (Wellbutrin/Zyban)
- Varenicline (Chantix)
Your patient has a 20 pack year smoking history and is also struggling with depression. What drug should you recommend?
Bupropion!
What stage of change:
Patient is not even thinking about behavior change
Pre-contemplation
What stage of change:
Patient thinking about changing; often ambivalent. May be far from actually acting
Contemplation
What stage of change:
Patient actively trying to modify behavior
Active Change
What stage of change:
Patient successfully adopting new behavior, sustaining change/preventing relapse
Maintenance
General steps to motivational interviewing
- identify the target behavior (smoking, drugs, alcohol)
- ask about positive aspects of the behavior (why patient does it)
- ask about the negatives
- explore patient’s goals and values (living longer to see kids grow up, holding down a steady job, etc)
- ask for a decision (would you like to quit?)
- set a SMART goal
what’s a SMART goal?
Specific, measurable, achievable, realistic, timed
describe the ask-tell-ask approach
Ask
• Assess the patient’s baseline knowledge
Tell
• Use simple, clear, concise language
• Avoid medical jargon
• Speak slowly
• “Chunk” information by pausing after a concept
• Limit to 1-3 key messages and emphasize these messages
• Use visual aids and written instructions to reinforce key messages
Ask
• Request “teach-back”
• Expect questions: “What questions do you have?” (Instead of: “Do you have any questions?”)
What stage of change:
ready to change in the near future; on the verge of taking action
Preparation
How many times in the past year have you had X or more drinks in a day?
what number for men/women is a positive screen?
X = 5 drinks for men X = 4 for women
what are the CAGE questions?
answering yes to how many is a positive screen?
Have you ever felt the need to Cut Down on drinking?
Have you ever been Annoyed by criticism of drinking
Have you ever had Guilty feelings about drinking?
Have you ever taken a morning Eye Opener?
A response of ≥ 2 is considered a positive screen
what are the DSM criteria for substance use disorder?
- Impaired control:
(1) taking more or for longer than intended
(2) unsuccessful efforts to stop or cut down use
(3) spending a great deal of time obtaining, using, or recovering from use
(4) craving for substance - Social impairment:
(5) failure to fulfill major obligations due to use
(6) continued use despite problems caused or exacerbated by use
(7) important activities given up or reduced because of substance use - Risky use:
(8) recurrent use in hazardous situations
(9) continued use despite physical or psychological problems caused or exacerbated by substance use - Pharmacologic dependence:
(10) tolerance to effects of the substance
(11) withdrawal symptoms when not using or using less
how many of the DSM criteria do you need to have a substance use disorder?
breakdown of mild/moderate/severe
2/11 = substance use disorder!
The severity of the Substance Use Disorder is defined as:
• Mild: 2-3 criteria
• Moderate: 4-5 criteria
• Severe: ≥6 criteria
what’s the NIDA quick screen for substance use? what is a positive screen?
In the past year how often have you used prescription drugs for non-medical reasons?
In the past year how often have you used illegal drugs?
A response of at least 1 time is considered a positive screen
what are the 5 As for brief intervention
Ask about substance use Advise to quit Assess willingness to make a quit attempt Assist in quit attempt Arrange for follow-up
what are the 5 Rs for reluctant-to-quit smokers?
discuss:
RELEVANCE of tobacco cessation RISKS of continued tobacco use REWARDS of tobacco cessation ROADBLOCKS to successful cessation REPEAT all of the above regularly
what patients should NOT receive bupropion?
seizure history, eating disorder
when should patients start taking chantix/wellbutrin in regard to their set quit date?
start at least 7 days before quit date
what are some risks of alcohol use above recommended limits?
increased probability of developing:
an alcohol use disorder, liver disease, financial and marital problems, serious injuries, esophageal cancer, liver cancer, stroke
what is a patient centered way to begin asking about substance use?
“I ask all of my patients about their alcohol and other drug use as part of obtaining their medical history because it can have an important impact on their overall health”
“would it be ok if I asked you some questions about your alcohol and drug use?”
What information is useful to understand patterns of substance use?
quantity, duration of use, frequency of use, route of administration, effect of use, strategies used to acquire substance, cost, periods of abstinence, triggers to use, associated physical symptoms, patient perspective/observations about their use and consequences
