Tobacco Dependence Treatment

Unit 9 Unit 9, the final unit in the series, provides students the opportunity to demonstrate their understanding and application of some key concepts of tobacco dependence treatment in a clinical context. Read each of the case scenarios below and answer the questions associated with each case. Case studies 1. Sarah is a 20 yr. old college sophomore who presents for a periodic oral exam. Her exam was negative for dental caries and periodontitis and she has good oral hygiene. However, Sarah started smoking during her freshman year and currently smokes 5-8 cigarettes per day. When asked about tobacco use she says, “I’m not a smoker, like I’m not addicted to cigarettes or anything. I just have a few smokes when I’m at the bar with my friends, or when I’m studying because it helps me study better. I will probably quit when I graduate.” a. Considering Prochaska and DeClemente’s Transtheoretical Model of Health Behavior Change, what stage best describes where Sarah currently is in changing her behavior of tobacco use? Provide the rationale for your answer. b. Considering Sarah’s current stage of change, what is the most appropriate step for you to take in addressing her tobacco use? c. If Sarah rated her confidence in being able to quit as a “10” on a 1-10 scale with 10 being very confident and 1 being not confident at all, and she rated the importance of quitting as a “4” on the same scale, what follow-up question should you ask? d. Using your motivational interviewing skills, write out a short script of a couple sentences of exactly what you would say to express empathy toward Sarah regarding her tobacco use? e. Of the following, which is the most appropriate next step in addressing Sarah’s tobacco use at the end of today’s appointment, and WHY? A) Prescribe a nicotine replacement medication (e.g. NRT gum). B) Ask if she would like information on the oral health effects of tobacco use. C) Have her complete a decisional balance worksheet to develop discrepancy. D) Refer her to the 1-800-Quit Now tobacco counseling service. 2. Pamela is a 30 year old African-American retail salesperson who tells you during her clinical appointment that she is interested in quitting smoking in three weeks. She has smoked a pack per day for the past 15 years. She tried to quit cold turkey twice and had significant withdrawal symptoms. For her third attempt, she tried the NRT patch bur still had cravings at times throughout the day. Nevertheless, she was able to quit for 8 months, but relapsed after learning that her husband, a member of the Armed Forces, was killed in action. Since then, she has moved in with her mom, who also smokes. Her medical history is positive for hypertension for which she takes hydrochlorothiazide. a. What is Pamela’s stage of health behavior change? Provide a rationale for your response. b. Considering Pamela’s stage of change, what is the most appropriate next step for you to take in addressing her tobacco use? c. Provide two behavioral interventions that could be recommended for Pamela. d. Consider tobacco cessation pharmacotherapy that would be appropriate in this case, and write out your choice of medication(s) using the format shown below. Rx Disp: Sig: Explain the rationale for your response. 3. Mason is a married, 58 yr old plumbing contractor and periodontal patient with a 40 pack-year history of smoking (2 ppd/20yrs). He has tried over a dozen times to quit cold turkey but has been unsuccessful. His medical history includes hypertension and type 2 diabetes for which he takes metoprolol, and metformin and glyburide, respectively. His HbA1c is 8 and BP is 137/90. His Fagerstrom nicotine dependence score is 7. a. Consider tobacco cessation pharmacotherapy that would be appropriate in this case, and write out your choice of medication(s) using the format shown below. Rx Disp: Sig: Explain the rationale for your response. b. Mason tells you: “I would like to try quitting again because I know that my smoking is affecting my health, but I am not sure this is the right time. I am having a lot of problems with my teenage son right now – he is having difficulty in school and running with a bad crowd. It’s been hard to get a handle on what’s going on because I am working 60 hours a week. On top of that, my dad, who is 84, just moved in with us due to health reasons. He has dementia and could no longer live alone, and my wife works part-time so she takes care of him when she can, but something more definite will have to be arranged soon. It’s very stressful for us right now.” What stage of health behavior change best describes Mason’s current position regarding quitting smoking? c. Using your motivational interviewing skills, write out a short script of a couple sentences of exactly what you would say to Mason to reveal discrepancy regarding his tobacco use.