Philadelphia Medicine Fall 2021 - 25

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When Minutes Matter
Concerned, busy physician delivers brief,
effective tobacco use disorder treatment
By Ryan Coffman
L
et's say that as a physician you readily recognize that tobacco
use is a leading cause of death and disability for Philadelphians.
And if tobacco use isn't causing the serious health issues
your patient is presenting with, it's certainly making it worse.
You're concerned about your patients' tobacco use and want to
do your best to help them. However, it can be challenging to find
the time during a busy clinical encounter, or know what guidance
to provide beyond the advice of " you need to quit smoking. "
Existing research strongly supports that counseling from a health
care provider significantly increases the likelihood of your patient
becoming tobacco-free. In fact, counseling by a physician for tobacco
use disorder treatment has been shown to be especially impactful.
Moreover, the majority of your tobacco-using patients want to be
tobacco-free and will try to recover from their tobacco use every year.
How can a concerned and busy physician provide evidence-based
and effective counseling for tobacco use disorder treatment in a
matter of a few minutes to make the recovery process from tobacco
use easier and more successful?
As a tobacco treatment specialist who has provided tobacco use
disorder treatment in a variety of community, physical health and
behavioral health settings, I recommend what we call the " STARTed "
program, an acronym title that uses these directives to become
tobacco-free:
* Set a recovery start date. This date should be chosen directly
by the patient with the goal of being completely tobacco and
vape-free. The date will be supported by the other components
of the patient's treatment plan. I generally recommend setting
this date within the next 2-4 weeks to allow the patient time to
get ready; however, their date could be sooner
* Tell others. The more social support your patient has, the better
they will do in their recovery from tobacco use. Support could
include their family, friends, co-workers or anyone that is supportive
and encouraging of the patient's recovery attempt. Your patient
may need to be explicit about what kind of support works best
for them. Support can also come from external resources, such
as evidence-based online, text messaging or telephonic treatment
resources, such as the PA Free Quitline. The PA Free Quitline
(1-800-Quit-Now) provides free tobacco use disorder treatment
medications and free counseling to any Pennsylvania resident
* Anticipate triggers with coping skills. An essential part of the
recovery process from tobacco use is developing coping skills
for cues and triggers for tobacco use. Some of these cues and
triggers, such as stress, waking up in the morning and driving,
will happen whether someone uses tobacco or not. The key is
to help your patient develop healthy and productive coping
skills in response to these situations, rather than harmful and
unproductive " coping skills " like tobacco use.
* Remove all remainders and reminders from home, vehicle and
workplace. The removal of any tobacco products, paraphernalia
or receptacles to create 100% tobacco and vape-free environments
eliminates prominent cues or triggers for tobacco use. This is not
just for the patient, but would apply to any friends, family or
co-workers within these spaces. I recommend that my patients
set a date for this step in advance of their recovery start date.
* Talk to your patient about tobacco treatment medication
options. Your patient may ask you directly for a prescription for
these medications or how they can access them. Many private
and public insurance plans now cover the seven FDA-approved
tobacco treatment medications. As mentioned earlier, patients
can also get medications such as the nicotine patch, gum and
lozenge by calling the PA Free Quitline. Physicians should
strongly consider combination therapy, or the use of more
than one tobacco use disorder treatment medication. The use
of combination therapy has been demonstrated to make the
recovery process from tobacco use easier and more successful
over the use of a single medication.
As a physician, you are perfectly poised to positively impact your
patients' tobacco use.
Tobacco use disorder is a substance use disorder and a chronic
disease, not simply a bad habit. Physicians are highly skilled in
managing other chronic diseases, such as diabetes, asthma and
hypertension, every day.
With practice and a commitment
to dedicate only a few minutes in your
clinical practice to create a treatment plan
for tobacco use disorder, you can be the
catalyst for your patients to experience
the lifelong benefits that await them
from living life tobacco-free. *
Ryan Coffman is the Tobacco Policy and
Control Program manager with the Philadelphia
Department of Health.
Fall 2021 : Philadelphia Medicine 25
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Philadelphia Medicine Fall 2021

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