Tobacco Treatment Specialist Training

Goal of the Course:

The goal of the course is to provide training to healthcare professionals located in Tribal Health Care Centers and public health care centers in Alaska and the United States.  Participants will learn about the counseling method of motivational interviewing; the pharmacotherapy and biology of nicotine dependence; treating tobacco users with medical conditions; treating tobacco users with substance abuse and mental health conditions; and intake assessments of patients and treatment planning.  By completing the training, training participants will learn how to deliver tobacco dependence counseling based on U.S. Public Health Service guidelines.  Training participants will receive a certificate of completion and will have the opportunity to become certified by completing additional requirements.

Module Descriptions

Tobacco Treatment Strategies: This course will provide basic knowledge about the process of quitting smoking and will present tobacco cessation theory and treatment from within a social learning perspective.  Treatment will be presented on a continuum of intensity of clinical contact, from self-help (no contact) to minimal contact/brief advice to brief counseling to intensive counseling and the empirical base for the various treatment strategies will be presented.  Evidence-based tobacco treatment strategies will be presented within a framework that includes preparation, cessation and maintenance phases.

Working with Tobacco Users with Substance Abuse and Mental Health Conditions: This course will provide the knowledge base for understanding the nature of associations between current and lifetime co-morbid psychiatric and substance abuse disorders and tobacco use prevalence, efforts to quit tobacco, and response to various forms of treatment.  This course will also help dispel myths that persons with a mental health/substance abuse (MH/SA) disorder can't quit, don't want to quit or shouldn't quit while in treatment for other issues.

Tobacco Use in Alaska: This course covers prevalence and patterns and types of tobacco use, dependence and cessation in Alaska with a particular focus on the Alaska Native People.  The course will also provide an update on tobacco-related research at the Alaska Native Tribal Health Consortium.

Introduction to the Tobacco Epidemic: This course covers prevalence and patterns of tobacco use, dependence and cessation and how these measures vary across demographic (including gender), socio-economic and cultural subgroups in the world and nationally.

Spit Tobacco: This course will cover incidence, prevalence and patterns and types of spit tobacco use, dependence and cessation in the world and nationally.  In addition, the material will address the debate around terminology (i.e. smokeless vs. spit tobacco) as well as new types of "smokeless" products being developed by the tobacco industry.

Neuroscience of Nicotine Dependence and its Treatment: This course will provide the knowledge base for understanding the biological, psychological, pharmacologic and social basis of nicotine dependence.  This course will also review the epidemiology and processes related to the development of nicotine dependence.

Pharmacotherapy for Smoking Cessation: This course will describe evidence-based pharmacologic treatments for nicotine dependence, including nicotine replacement therapies, bupropion SR, varenicline, high dose patch therapy and combination therapy.  Focus will be on how and why these compounds work, and how they can be used effectively.  In addition, the course will demonstrate how to provide appropriate patient education on medication use.  The course will also include a brief description of cotinine as an objective measure of tobacco use and will review symptoms of nicotine withdrawel versus nicotine toxicity.

Law and Ethics: This course will provide a basic understanding of the Tobacco Treatment Specialist ethical and legal requirements.

Relapse Prevention: This course will help Tobacco Treatment Specialists learn how to 1) address relapse in patients once it has occurred and 2) take proactive steps to help prevent relapse in the first place.  Strategies that will be discussed include: re-assessing dosage of pharmacotherapy; reviewing patient stressors and other factors that contributed to the relapse; developing coping strategies; assessing and increasing confidence in one's ability to quit; and assessing and building motivation to quit.

Motivational Interviewing: This course endeavors to teach principles of effective counseling for health-risk reduction by lifestyle change.  In particular, participants will learn how to engage and assist individuals seeking to modify their use of tobacco and nicotine.  Motivational Interviewing provides an effective alternative to coercion, confrontation, and exhortation as a means of promoting behavior change and treatment compliance in the nicotine-dependent individual.  This course will include discussion of validated measures of motivation to quit.

Working with Smokers with Medical Conditions: This course will discuss the anticipated effects of the four different forms of nicotine replacement therapy relative to the known acute effects of tobacco use in patients with CAD, Lung Disease/COPD, DM, and pregnancy.

Intake, Assessment and Treatment Planning: To understand and treat tobacco-using clients, a comprehensive evaluation of their smoking history and smoking behavior must be completed.  This is a multi-level process that begins with the first encounter with the client and continues throughout the treatment program including follow-up.  This session will address how to initiate this process in order to establish a foundation for an effective working relationship and how to maintain contact and support for patients over a period of follow-up.

Tobacco Use and Dental/Oral Health: Both spit tobacco use and smoking have specific negative health effects to the mouth and throat.  Emerging evidence indicates possible associations with 2nd hand smoke exposure.  The implications of tobacco use for oral health, including how to recognize signs of tobacco use in the oral cavity will be discussed.

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