Tobacco and Alochol

Question 1

Is tobacco the single largest preventable cause of morbidity and mortality in the US?

Answer 1

Yes

Question 2

Top causes of death related to smoking?

Answer 2

Cancer
Cardiovascular disease
Respiratory disease

90% lung cancer men
70-80% women

Question 3

How many quite attempts are needed for smoking on avg?

Answer 3

6

Question 4

Lung cancer screening recommendations?

USPSTF

Answer 4

Yearly, low dose CT Chest for:
- 20 pack years +
- Current smoker / quit in past 15 yrs
- 50 - 80 y/o

Question 5

What are screening tools for nicotine dependence?

Answer 5

Fagerstrom Test for Nic Dep
Heaviness of Smoking Index (HSI)
Minnesota Tob Withdrawal Scale

Question 6

Fagerstrom Test for Nicotine Dependence

Answer 6

10-item self-report

High score, high dependence

Question 7

Heaviness of Smoking Index

Answer 7

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

Question 8

Minnesota Tobacco Withdrawal Scale

(Hughes Withdrawal Scale)

Answer 8

Severity of 4 symptoms:
1. angry/irritable/frustrated
2. anxious/tense
3. depressed
4. restless/impatient

Question 9

US Dietary Guidelines for alcohol consumption

Answer 9

Men <= 2
Women <= 1

Question 10

How much is a std drink?

Answer 10

14g ethanol
12oz of 5% beer
5oz of 12% wine
1.5 oz of 40% spirit

Question 11

Define ‘binge drinking’

Answer 11

BAL 0.08%
5 drinks in 2 hrs (men)
4 drinks in 2 hrs (women)

Question 12

Define ‘heavy alcohol use’

Answer 12

Binge drinking 5+ drinks on %+ days in the past month

> 4 drinks on any day (men)
3 drinks on any day (women)

Question 13

Define ‘at risk drinking’

Answer 13

Exceeds levels for any day or week
Binge drinking at least 1/month
Increases risk of future probs

Question 14

Screening tools for alcohol use?

Answer 14

CAGE
AUDIT
NMASSIST
CRAFFT
TAPS
MSASQ

Question 15

What is the NIAAA single-item screening test?
(ORAL)

Answer 15

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

Question 16

AUDIT-C
(WRITTEN)

Answer 16

1. How often drinks in past year?
2. How many / day typically?
3. How often 6+ drinks?

If positive, then full AUDIT

Question 17

What tool to use for drug use screening?

(> 70% sens to ID substance use disorder, NIDA)

Answer 17

TAPS-1
- tobacco
- alcohol > recommended
- prescription med use in non-medical way
- illicit (cocaine, metamph)

TAPS-2
- longer tool triggered by +ve

Question 18

Criteria for substance use (DSM-5)

Answer 18

1. larger amounts or over a longer period than intended
2. persistent desire or unsuccessful efforts to cut down / control
3. much time spent to obtain, use or recover from effects
4. cravings/urge
5. fail to fulfill obligations
6. social or interpersonal issues
7. Occ, recreational, social activities given up
8. physically hazardous
9. continued use despite awareness
10. tolerance
11. withdrawal

Question 19

What therapy options are helpful in substance use?

Answer 19

MI
CBT
DBT

Question 20

5A’s of Behaviour Change

Answer 20

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

Question 21

5A’s of Tobacco Cessation

Answer 21

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

Question 22

Motivational Interviewing
Principles

Answer 22

Express empathy
Develop discrepancy
- between values and present behav
Roll with Resistance
Support self-efficacy

Question 23

5 R’s of Motivational Interviewing

Answer 23

Relevance

Risks of use

Rewards of quitting

Roadblocks to quitting

Repetition