Module 3 - Behavioral Interventions: Integrating Tobacco Use Interventions into Chemical Dependence Services

2 Welcome  Add Trainer Names

3 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

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

Introductions 5

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 (

7 PM 9 Module 3 Agenda  Counseling Techniques  Motivational Interviewing  Cognitive Behavioral Therapy  Relapse Prevention  Case Studies  Facilitating a Tobacco Awareness Group

8 Module 3 Objectives PM 9

Unit 1 Motivational Interviewing 9 PM 11

10PM 12

11 Discussion Understanding and Applying the Stages of Change PM 12

12 Readiness to Change PM 13

13 Discussion Treating Tobacco Use and Dependence: Clinical Practice Guideline 2008 Update PM 14

14PM 14 40% 20% When MI is Most Effective

15PM 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)

16 Discussion What is the “spirit” of Motivational Interviewing? PM

17 Discussion What are the four guiding principles of Motivational Interviewing ? PM 18

18PM 19 What ambivalence usually looks like…

19 Discussion What is resistance? What does resistance look like? What makes resistance worse?

20PM 20

21 Discussion O - open questions A - affirmation R - reflective listening S - summarizing PM 21

22 Activity Identifying open and closed questions PM 22

23 Discussion What are the different kinds of reflective responses? PM

24 Activity Reflective Listening PM 26

25 Discussion What is “problem talk”? What is “change talk”? PM 27

26 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

27 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

28 Activity Identifying change talk Ten strategies for eliciting change talk PM

29 Discussion What are the Five Rs? PM

30 Roadblocks PM 35

31 Discussion and Activity Providing Information vs. Giving Advice Using Elicit-Provide-Elicit PM

Unit 2 Cognitive-Behavioral Therapy (CBT) and Relapse Prevention 32 PM 41

33 Psychosocial Therapies  Psychosocial therapies are effective, but only received by 5% of tobacco users  Dose-response relationship  Combining with medication increases outcomes PM 42

34 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

35 When CBT Is Most Effective PM 43 When to shift from MI to CBT?

36 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

37 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

38 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

39 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

41 Relapse Prevention, cont’d  Minimal Components of Relapse Prevention  Components of Prescriptive Relapse Prevention (bio, psycho, social, and cultural)  Addressing behavioral patterns PM

42 Unit 3 Case Studies PM 57

43 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

Unit 4 Facilitating Tobacco Awareness Groups 45 PM 67

46 Review Group Facilitation Skills – using EPE, open and closed questions, non–judgmental approach, and supporting self-efficacy Shifting to Recovery Language PM 68

47 Tobacco Treatment Groups Patient-Centered Psychoeducation Tobacco Awareness Group vs. Tobacco Recovery Group PM

48 Tobacco Awareness Groups (TAG)  Outcomes for TAGs  Topics for TAGs  Importance of using MI skills PM

49 TAG Activity 1 Trainer demonstration Leading a tobacco awareness group Debrief PM

50 TAG Activities 2 and 3 Participants practice facilitating a tobacco awareness group Debrief PM and

51 PM Resources The Tobacco Recovery Resource Exchange E-Learning and Online Resources OASAS

Workshop Evaluations and Post Test 52