Module 3 - Behavioral Interventions:

Integrating Tobacco Use Interventions into Chemical Dependence Services

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Welcome

Add Trainer Names

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This training was developed by the Professional Development Program, under a contract with the NYS Department of Health, Tobacco Control Program.

PDP developed five classroom-based curricula and seven online modules, which are available at www.tobaccorecovery.org

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Housekeeping

Hours of Training Breaks and Restrooms Tobacco Use Policy Cell Phones Active Participation Complete Training Evaluation

Introductions

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6 PM 8

Training Modules

Module 1 - The Foundation

Module 2 - Assessment, Diagnosis, Pharmacotherapy

Module 3 - Behavioral Interventions

Module 4 - Treatment Planning

Module 5 - Co-occurring Disorders

E-Learning - All Modules (www.tobaccorecovery.org)

7 PM 9

Module 3 Agenda

Counseling Techniques Motivational Interviewing Cognitive Behavioral Therapy Relapse Prevention

Case Studies Facilitating a Tobacco Awareness Group

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Module 3 Objectives

PM 9

Unit 1Motivational Interviewing

9 PM 11

10 PM 12

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Discussion

Understanding and Applying the

Stages of Change

PM 12

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Readiness to Change

PM 13

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Discussion

Treating Tobacco Use and Dependence:

Clinical Practice Guideline

2008 Update

PM 14

14 PM 14

40%40%

20%

When MI is Most Effective

15 PM 15

Motivational Interviewing

MI is considered an evidence-based practice for the treatment of substance use disorders, including tobacco dependence

“A patient-centered, directive method for enhancing intrinsic (internal) motivation to change by exploring and resolving ambivalence” (Miller and Rollnick, 2002)

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Discussion

What is the “spirit” of Motivational Interviewing?

PM 16 - 17

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Discussion

What are the four guiding principles of Motivational Interviewing?

PM 18

18 PM 19

What ambivalence usually looks

like…

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Discussion

What is resistance?

What does resistance look like?

What makes resistance worse?

20 PM 20

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Discussion

O - open questions

A - affirmation

R - reflective listening

S - summarizing

PM 21

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Activity

Identifying open and closed questions

PM 22

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Discussion

What are the different kinds of reflective responses?

PM 23 - 25

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Activity

Reflective Listening

PM 26

25

Discussion

What is “problem talk”?

What is “change talk”?

PM 27

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The more change talk that patients demonstrate, the more likely it is that they will move towards making a

change.

Change Status Quo

PM 27

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Using DARN-C for Identifying Change Talk

D - Desire to Change

A - Ability to Change

R - Reasons to Change

N - Need to Change

C - Commitment

PM 28

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Activity

Identifying change talk

Ten strategies for eliciting change talk

PM 29 - 31

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Discussion

What are the Five Rs?

PM 32 - 34

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Roadblocks

PM 35

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Discussion and Activity

Providing Information vs. Giving Advice

Using Elicit-Provide-Elicit

PM 36 - 38

Unit 2Cognitive-Behavioral Therapy

(CBT) andRelapse Prevention

32 PM 41

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Psychosocial Therapies

Psychosocial therapies are effective, but only received by 5% of tobacco users

Dose-response relationship

Combining with medication increases outcomes

PM 42

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Evidence-based Methods

CBT/RPT have been shown to be effective

CBT/RPT integrates with MI skills and SOC

Best used for patients in later stages of change

PM 43

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When CBT

Is Most Effective

PM 43

When to shift from MI to CBT?

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Principles of CBT

Thoughts/beliefs drive feelings and behaviors

Patients learn to identify and examine thinking patterns that lead to troublesome

emotional states and behavior

Clinicians teach practical problem-solving skills

Patients gain new knowledge, develop new coping skills, and change old behaviors

PM 44

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Principles of CBT, cont’d

CBT Helps a Patient to Examine and Change:

What they believe and feel about their tobacco use

Their relationship with tobacco and AOD

Their rituals of use

PM 44

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Components of CBT

Functional Analysis – identify patient thoughts, feelings,

beliefs, and circumstances

Skills Training – learn coping skills, change behaviors,

and use “homework” to practice change

PM 45 - 46

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Relapse Prevention

Relapse is a part of the disease of addiction. It is not failure or “a character defect” of

the patient.

What are the major factors that contribute to relapse, and specifically for tobacco

relapse?

PM 47

40 PM 47

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Relapse Prevention, cont’d

Minimal Components of Relapse Prevention

Components of Prescriptive Relapse Prevention (bio, psycho, social, and cultural)

Addressing behavioral patterns

PM 48 - 54

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Unit 3 Case Studies

PM 57

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Discussion

What stage of change is each patient in regarding his/her tobacco use?

Is the patient in the same or a different stage of change for their alcohol/other drug use?

What treatment approaches might work best regarding the patient’s tobacco use?

PM 58

44 PM 58 - 63

Unit 4Facilitating Tobacco Awareness

Groups

45 PM 67

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Review

Group Facilitation Skills – using EPE, open and closed questions, non–judgmental

approach, and supporting self-efficacy

Shifting to Recovery Language

PM 68

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Tobacco Treatment Groups

Patient-Centered Psychoeducation

Tobacco Awareness Group

vs.

Tobacco Recovery Group

PM 70 - 71

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Tobacco Awareness Groups (TAG)

Outcomes for TAGs

Topics for TAGs

Importance of using MI skills

PM 70 - 71

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TAG Activity 1

Trainer demonstration

Leading a tobacco awareness group

Debrief

PM 72 - 84

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TAG Activities 2 and 3

Participants practice facilitating a tobacco awareness group

Debrief

PM 85 - 97 and 98 - 105

51 PM 107 - 108

Resources

The Tobacco Recovery Resource Exchange http://www.tobaccorecovery.org

E-Learning and Online Resources

OASAS http://www.oasas.state.ny.us/tobacco/index.cfm

Email: TobaccoFree@oasas.state.ny.us

Workshop Evaluations and Post Test

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