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Help To Quit Tobacco Cessation Self-Test



Q1: Smoking is more common among people with mental illness and substance use disorders.
TrueCorrect! While the smoking prevalence for the general population is around 21%, it is at least two times as high for people with major depression, anxiety and bipolar disorders, schizophrenia, post traumatic stress disorder and alcohol dependence.
FalseActually, this is true. While the smoking prevalence for the general population is around 21%, for those with mental illness or alcohol dependence it is at least two times as high. Among sufferers of Major Depression, 36-80% smoke.Try again.
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Q2: Tobacco causes fewer deaths than other drugs or violence and disasters.
TrueActually, just the opposite. On a worldwide basis, tobacco use is responsible for more death and disease than any other noninfectious cause. Nationally tobacco use causes more deaths each year than the does the use of alcohol, heroin, and cocaine with HIV, homicides, suicides, fires and accidents. combined. Try again.
FalseCorrect! Nationally tobacco use causes more deaths each year than the does the use of alcohol, heroin, and cocaine with HIV, homicides, suicides, fires and accidents. combined.
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Q3: Half of all smoking deaths are from the mental illness/substance use populations.
TrueCorrect! Tobacco use causes 200,000 deaths per year in the mental illness/substance use populations — half of all smoking deaths — while they represent only about 7% of the population.
FalseIncorrect. Even though people with mental illness and substance use disorders represent only 7% of the population, they account for half of all smoking deaths — about 200,000 per year. Try again.
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Q4: Half of deaths among addiction treatment patients are due to tobacco-related diseases.
TrueCorrect! An 11-year study showed that 51% of deaths of addiction treatment patients were due to tobacco-related diseases.
FalseIncorrect. An 11-year study showed that 51% of deaths of addiction treatment patients were due to tobacco-related diseases. Try again.
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Q5: Which of the following might contribute to a tendency to use nicotine or might complicate attempts to quit?
Neurobiological FactorsThis is just part of the challenge. Nicotine can have a positive effect on an individual’s mood and can temporarily enhance feelings of pleasure and enjoyment. Many individuals also use tobacco to help cope with stress as it may temporarily relieve feelings of tension and anxiety. Select again.
Psychological FactorsThis is just part of the challenge. More than half of addictions clients who smoke state that it would be as hard or harder for them to give up their tobacco as it would for them to give up the substance for which they were primarily seeking treatment. Select again.
Social ForcesThis is just part of the challenge. Smoking often helps individuals to feel a “part of a group.” Smoking may be associated with social activities or helping temporarily relieve boredom by providing “something to do.” Select again.
System and Institutional FactorsThis is just part of the challenge. Compared to other physicians in a recent study, psychiatrists were less likely to participate in smoking cessation training and they also reported the least access to resources and organizational supports for addressing tobacco. Select again.
All of the aboveCorrect! These factors, coupled with the stigma that is common with the Mental Illness and Substance Use Disorder populations, widely accepted myths, and barriers to treatment have contributed to the delay in addressing tobacco cessation with these individuals.
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Q6: Peer pressure and social factors have little impact on quitting tobacco.
TrueIncorrect. Smoking often becomes a social habit and part of a daily routine. Try again.
FalseCorrect! Smoking might be part of the normal culture in most mental health facilities. For tobacco cessation programs to be successful, this culture must change.
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Q7: Which statement is NOT true of tobacco cessation and mental illness or substance use populations?
They have the same need to end tobacco use as everyone else.True. The reality is that people faced with other challenges such as mental illness or substance addictions have the same need to end their tobacco use as anyone else. Select again.
They are physically unable to become tobacco-free.Correct! This statement is NOT true. Despite many preconceived ideas, these individuals can succeed at becoming tobacco-free, thus improving their health and extending their lives.
People with mental illnesses want to quit tobacco, too.This is true. Two-thirds of smokers in a recent study wanted to stop (41%) or cut down (24%) on tobacco use at the time of admission to residential addictions treatment. Select again.
Studies show substance use clients are willing to quit smoking.True. Many studies have documented significant willingness of smoking clients within the context of substance abuse centers to receive treatment for smoking cessation. Select again.
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Q8: Tobacco cessation has little to do with substance abuse treatment.
TrueActually, they should go hand-in-hand: 80-90% of drug- and alcohol-dependent patients are smokers. Try again.
FalseCorrect! False. Smoking is more deadly to substance abuse patients than their primary presenting substance of abuse.
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Q9: Alcoholics represent more than one-quarter of smokers.
TrueCorrect! Smoking alcoholics account for 26% of all smokers, with regular smoking usually preceding the development of alcoholism.
FalseActually, this is true. Alcoholics are more nicotine-dependent than non-alcoholics. Heavy smokers show a ten times greater prevalence of alcoholism than nonsmokers. Try again.
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Q10: Tobacco works on the brain in a completely different way than opium, cocaine or marijuana.
TrueIncorrect. Tobacco activates the brain reward systems of the mesolimbic dopamine system in much the same way as other drugs including opiates and cocaine. Try again.
FalseCorrect! That’s right. Tobacco is a drug. Like others, it may appeal to persons with similar personality characteristics such as sensation-seeking and impulsivity, and co-occurring depression.
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Q11: Which of the following is true?
Smokers with mental illness show fewer tobacco quit attempts.This is just part of the challenge. Because of the stigma attached to mental illness the mentally ill population accesses general medical services and other community resources relatively infrequently. Select again.
Smokers with mental illness have higher relapse rates.This is just part of the challenge. Overall, smokers with mental illness get less help, make fewer attempts, and have more relapses. Select again.
Tobacco is a sensory-stimulated craving.This is just part of the challenge. Smelling cigarettes leads to an increased urge to drink among alcoholic smokers. Select again.
All of the above.Correct!
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Q12: Some disorders, including schizophrenia, bipolar disorder and substance use disorders have been associated with heavy smoking (more than 20 cigarettes per day) and higher levels of nicotine dependence.
TrueCorrect! This is true. Level of tobacco use and nicotine dependence should be identified in a comprehensive assessment and factored into treatment strategies.
FalseActually, this is true. It is of practical significance since the level of severity of nicotine dependence is a determinant of outcome in smoking cessation studies and may also indicate a greater need for pharmacotherapy in cessation attempts. Try again.
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Q13: Barriers to tobacco cessation in mental illness and substance use populations can come from:
Care providers.This is just part of the challenge. Care providers may be concerned about increased symptoms, relapse acting out, interaction with psychiatric medications, referral rates decreasing for the facility or drop-out rates increasing. Select again.
Patients and their families.Like care providers, this is just part of challenge. Beliefs that clients are not interested in quitting or that one should quit using drugs or alcohol now and quit tobacco later must change. Select again.
The organizational culture.This is just part of the challenge. Resistance comes from fears of detrimental effects on substance use disorder treatment outcomes, fears that patients will misuse nicotine replacement products or smoke while using them, or the difficulties in implementing and the effects of tobacco policies. Select again.
All of the above.Correct! Improved staff training and confidence in providing tobacco dependence treatment, coverage of the cost of medications or availability of all options and tobacco treatment resources will also help overcome barriers and resistance.
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Q14: Which of the following are helpful tools or techniques in increasing motivational levels of clients?
A. Motivational Interviewing.This is one helpful tool. Motivational Interviewing is client-centered, conversational examination of patients’ thoughts and feelings, and can be effective at raising motivational levels. Try again.
B. Personalized feedback.This is one helpful tool. Personalized, evidence-based feedback given regularly can increase motivation levels with both positive and constructive observations. Try again.
neither A nor B.Incorrect. Try again.
both A and B.Correct! This is the correct answer. Goal-directed counseling methods can help clients resolve ambivalence and address issues such as specific costs of tobacco use (both financial and physical).
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Q15: Which of the following are reasons why behavioral health practitioners should treat tobacco dependence?
Quality of life.This is only one of the reasons. Treating tobacco dependence can improve quality of life and even save lives. Select again.
Nicotine dependence is an official diagnosis.This is only one of the reasons. Nicotine dependence is a DSM-IV Substance Use Disorder. Select again.
Higher impacts in behavioral health treatment populations.This is only one of many reasons. Smoking disproportionately affects people with behavioral health problems. Select again.
All of the above.Correct! Quality of life, understanding nicotine dependence as a substance use disorder and tobacco’s significant impact on the population are all reasons to implement tobacco treatment programs.
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Q16: Wellness initiatives that incorporate practicing a range of healthy behaviors — including smoking cessation — are not useful in addressing smokers with low motivation to change.
TrueActually, this is false. One study demonstrated tat having patients participate in wellness curricula may help them become ready to participate in an action-oriented tobacco treatment effort. Try again.
FalseCorrect! That’s right: Wellness initiatives have been proven useful in addressing tobacco and smokers with low motivation to change.
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Q17: Cigarettes are best used as a reward in behavioral treatment.
TrueIncorrect. Cigarettes should no longer be used as a reward for positive behavior. Try again.
FalseCorrect! This is false. The alcohol and drug treatment systems, at least in the U.S., Australia, and Canada, either ignore or under-treat tobacco as a drug.
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Q18: Beliefs about the need and ability to quit tobacco use are changing regarding mental illness and substance use disorder populations.
TrueCorrect! but there’s room for improvement. In one study, 25% of clinic leaders reported their staff had advised patients to delay quitting smoking cigarettes.
FalseThis is false, but there is room for improvement. Only one-third of professionals surveyed from alcohol treatment programs in the U.S. agreed that clients in active treatment should be urged to quit smoking. Try again.
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Q19: Smoking cessation will interfere with other treatments.
TrueThis is not supported by studies. The majority of evidence supports concurrent treatment for tobacco and other substances, and combining treatments is the most effective way to address concurrent addictions. Try again.
FalseCorrect! Within the context of substance abuse treatment, studies show that smoking cessation is effective and does not impair treatment outcomes. Many clinical studies have found that smoking cessation can be integrated into alcohol and drug abuse treatment without jeopardizing recovery goals.
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Q20: Which of the following is NOT an advantage reported by staff after becoming a smoke-free facility?
Improved patient health.This is a reported advantage. Studies show health gains for patients at smoke-free facilities. Select again.
Cleaner environment.This is a reported advantage. The grounds and areas surrounding smoke-free treatment facilities are cleaner than facilities without a tobacco policy, according to a study. Select again.
Decrease in behavioral problems.This is also a reported advantage. It’s a myth that patients are more likely to act out without tobacco. One study shows a decrease in behavioral problems related to smoking habits. Select again.
More procrastination.Correct! This is inaccurate. Studies actually show improvements in productivity at facilities with smoke-free policies.
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Q21: Studies show that most smokers report trying to quit on their own.
TrueCorrect! Even though this is the least effective method, most patients report attempting to quit on their own.
FalseActually, this is true. Pharmacology, supportive counseling or coaching and other interventions — separately or in combination — are more effective than when a smoker tries to break their nicotine dependence alone. Try again.
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Q22: All of the following will help integrate substance use and tobacco treatments, except:
Disseminating guidelines to all counselors.This will be helpful. Clinical guidelines for smoking treatment should be disseminated to all certified substance abuse counselors. Try again.
Mandatory state education in tobacco cessation.This will be helpful. Licensure standards can be an effective mechanism for increasing the quantity and quality of tobacco treatment in residential treatment programs. Try again.
Just getting smoking at drug abuse treatment facilities outdoors.Correct! Incorrect. Outdoor smoking on drug abuse treatment facility grounds should be restricted or banned.
Targeted funding for smoking intervention in substance use facilities.This will be helpful. Funding should be targeted to support reimbursement for smoking cessation intervention for clients. Resources should be developed to enable treatment of smoking among staff at drug treatment centers. Try again.
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Q23: Integrating behavioral health and tobacco treatment will require policy change, staff training and a change in culture.
TrueCorrect! Multilevel (clinical, program, and system) changes may be needed to fully address the problem of tobacco use among patients with mental illness or substance abuse disorders.
FalseActually, this is true. Combining policy change, staff training and treatment integration can successfully change the tobacco culture in behavioral health settings. Behavioral health patients can quit smoking but may require more intensive face-to-face treatment and pharmacotherapy from someone trained to provide tobacco dependence treatment. Try again.
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Q24: Nicotine withdrawal may exacerbate psychiatric conditions.
TrueCorrect! All smokers with psychiatric disorders, including substance use disorders, should be offered tobacco dependence treatment. However, the clinician may wish to offer the tobacco dependence treatment when psychiatric symptoms are not severe.
FalseActually, this is true. Although patients in inpatient psychiatric units are able to stop smoking with few adverse effects (e.g., little increase in aggression), stopping smoking or nicotine withdrawal may exacerbate a patient’s comorbid condition. For instance, stopping smoking may elicit or exacerbate depression among patients with a prior history of affective disorder and this must be anticipated. Try again.
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Q25: Tobacco cessation can follow and reinforce alcohol treatment.
TrueCorrect! One study suggests that alcohol treatment should precede tobacco dependence treatment to maximize the effect of the alcohol treatment. However, considerable research also indicates that tobacco dependence treatment does not interfere with patients’ recovery from the abuse of other substances.
FalseIncorrect. Alcohol treatment might be maximized by preceding tobacco treatment. Try again.
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Q26: Which of the following are necessary in becoming a tobacco-free facility?
Leadership and policy.This is part of the solution: Establish a leadership group or committee and secure the commitment of the organization in writing. Develop a tobacco-free policy. Establish a policy implementation timeline with measureable goals and objectives. Select again.
Training and treatment options for staff.This is part of the solution: Conduct staff training. Provide ongoing recovery options for staff who use tobacco. Select again.
Secrecy.Incorrect. On the contrary, best practices include establishing ongoing communication with 12-step recovery groups, professional colleagues, and referral sources about policy changes. Select again.
Both A and B are correct.Correct!
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Q27: Substance abuse counselors already possess valuable expertise in helping with tobacco addiction.
TrueCorrect! In addition, clear and accurate feedback from a coach regarding their treatment performance is helpful. Enhanced instructional methods, like the use of patient-centered counseling, standardized patient instruction, role playing, motivational interviewing or a combination of these, are more effective than lecture for teaching tobacco intervention.
FalseIncorrect. Counselors who work in substance abuse already have expertise in helping people with addiction problems, and these skills can be applied with the smoking client. Treatment for tobacco dependence utilizes similar treatment and relapse prevention techniques. Try again.
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Q28: Mental health and substance use populations require assessments and tailored tobacco interventions.
TrueCorrect! Use a comprehensive assessment to tailor services and provide more intensive treatments.
FalseActually, this is true. Assess and diagnose tobacco use in patients and use this in treatment planning. Incorporate tobacco and nicotine information in patient education curriculum. Try again.
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Q29: Smoke-free policies are vital to successful tobacco cessation programs.
TrueCorrect! This is true. A smoke-free environment alone, without smoking cessation treatment, however, may not markedly affect the smoking status of patients.
FalseIncorrect. Smoke-free buildings and grounds eliminate the dangers of secondhand smoke and the problem of staff and patients smoking together. Facility-wide no-smoking policies indicate providers' concern for the health and well-being of both clients and staff. A nonsmoking policy does not negatively impact attendance in substance abuse programs nor does it jeopardize treatment adherence. One study found that any disruption caused by becoming a smoke-free addiction treatment unit stabilized after 3 months. Try again.
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Q30: Designated smoking areas will keep patients and counselors from smoking together.
TrueIncorrect. Designating smoking areas creates the problem of patients and counselors smoking together, reinforcing the perception that tobacco is acceptable and not a substance of much concern. Within each treatment center, a goal of 100% smoking cessation by staff should be encouraged.
FalseThis is false. Within each treatment center, a goal of 100% smoking cessation by staff should be encouraged. A first step in program change can include policies to restrict staff smoking with patients, since staff serve as role models for their patients.
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Q31: Which of the following are included in the 10 Core Recommendations of Treating Tobacco Use and Dependence Clinical Practice Guidelines (2008)?
It is essential that clinicians and health care delivery systems consistently identify and document tobacco use and treat every tobacco user seen in a health care setting.This is a best practice guideline. For a full list see the 10 Core Recommendations, see the Resources section of this site. Select again.
Inidvidual, group and telephone counseling are effective and their effetiveness increases with treatment intensity.This is a best practice guideline. For a full list see the 10 Core Recommendations, see the Resources section of this site. Select again.
If a tobacco user is unwilling to make a quit attempt, clinicians should use motivational treatments in increasing future quit attempts. This is a best practice guideline. For a full list see the 10 Core Recommendations, see the Resources section of this site. Select again.
All of the above. Correct. For a full list see the 10 Core Recommendations, see the Resources section of this site.
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Q32: A patient’s willingness to quit has no influence on the tobacco treatment strategy.
TrueIncorrect. Among proven strategies for tobacco treatment, “The 5As” begins with assessing the person’s willingness to quit, which determines the the treatment strategy.
FalseThis statement is false. Patients unwilling to quit should be treated with different strategies than those who are willing to quit.
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Q33: Clear, strong and personalized advice should be given to patients willing to quit tobacco.
TrueCorrect. According to “The 5As” treatment strategy, clear advice on quitting is important.
FalseActually, this is true. According to “The 5As” treatment strategy, advise is accompanied by “assisting” the quit attempt and “arranging” follow-up to prevent relapse.
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Q34: Clinicians should not assist with or offer advice regarding quit attempts.
TrueIncorrect. According to “The 5As” treatment strategy, clinicians should assist with making a quit plan.
FalseThis statement is incorrect. Research also shows that by affirming past successes and acknowledging client strengths, practitioners increase treatment adherence.
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Q35: Try to get patients who are not ready to quit to:
Indicate specifically why quitting is personally relevant.This is just part of the approach. Encourage the patient to speak specifically about why quitting is relevant to him or her. Select again.
Identify potential negative consequences of tobacco use.This is just part of the approach. The clinician should ask the patient to identify potential negative consequences of tobacco use, highlighting those that seem most relevant to the patient. Examples of risks could include acute, long-term and environmental. Select again.
Highlight benefits of stopping tobacco use.This is just part of the approach. The clinician should ask the patient to identify potential benefits of stopping tobacco use. Select again.
Ask what the barriers to quitting are.This is just part of the approach. The clinician should ask the patient to identify barriers or impediments to quitting and provide treatment (problem solving counseling, medication) that could address barriers. Select again.
All of the above, and repeat.Correct. “The 5Rs” is an effective treatment strategy for patients currently unwilling to quit tobacco use.
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Q36: _____________ is a possible threat to tobacco use relapse.
Depression.This is one of many threats to relapse. Others include weight gain, other tobacco users and general stress. Select again.
Reduction in withdrawal.This is a benefit to quitting, not a cause for relapse. Offering congratulations on any success and strong encouragement to remain abstinent are helpful to the patient.
Alcohol use.This is one of many threats to relapse. Others include weight gain, other tobacco users and general stress. Select again.
Both A and C are correct.Correct. Clinicians should anticipate problems and threats to relapse. A medication check-in, to include effectiveness and side effects if the patient is still taking medication, can also help prevent relapse.
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Q37: Essential aspects of the clinical assessment of any tobacco user include asking the smoker:
Neither C nor D.Incorrect. Select again.
Both C and D.Correct. Both questions should be part of a comprehensive clinical assessment addressing tobacco use.
The number of cigarettes smoked per day.This is just one question to be asked in a clinical assessment. The number of cigarettes smoked per day provides clues about a patient’s level of nicotine dependence. Select again.
How soon after they wake up do they smoke their first cigarette?This is just one question to be asked in a clinical assessment. Individuals who smoke in the first 30 minutes after waking are categorized as moderate nicotine dependence, while those who smoke within 5 minutes are estimated to have severe nicotine dependence. Select again.
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Q38: Motivational Interviewing explores a tobacco user’s feelings, beliefs, ideas and values to uncover ambivalence.
TrueThis is true. Talking about and reflecting motivations for change often causes a “click” within the client, resulting in a quiet realization of the importance of change and a decision to make it happen.
FalseIncorrect. Once ambivalence is uncovered, the clinician selectively elicits, supports, and strengthens the patient’s “change talk.” MI researchers have found that having patients use their own words to commit to change is more effective than clinician exhortations, lectures, or arguments for quitting, which tend to increase rather than lessen patient resistance to change.
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Q39: Nicotine replacement medications are dangerous, prone to abuse and can be used only in a few situations.
TrueIncorrect. NRT medications are safer than tobacco, have little abuse potential and few contraindications to use.
FalseCorrect — just the opposite is true. In addition, NRT medications are available commercially and can be used in combination with bupropion and other forms of non-nicotine medications.
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Q40: Nicotine replacement therapy paired with counseling helps about a third of successful quitters.
TrueYes. When paired with counseling, NRT shows quit rates of 30-40%.
FalseIncorrect. NRT products help tobacco users quit by reducing their nicotine withdrawal symptoms and avoiding the harmful tars, toxins, and chemicals found in cigarettes and other tobacco products. Abstinence from tobacco products is necessary to use NRT.
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Q41: There are no contra-indications for pharmacotherapy.
TrueIncorrect. Contra-indications and medical concerns such as diabetes, heart disease, high blood pressure, and allergies are all issues for tobacco cessation pharmacotherapy.
FalseCorrect. Like all medications, clinicians should be aware of limited data on specific treatment groups, side effects, and drug interactions.
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Q42: Nicotine replacement therapy won’t help alcoholics or substance use clients.
TrueOn the contrary, because smokers with substance abuse problems have higher levels of nicotine dependence, NRT may be particularly important in substance abuse treatment.
FalseThe statement is false. One study concluded that recovering alcoholic smokers are likely to be more nicotine dependent than nonalcoholic smokers but could achieve comparable short-term cessation rates with nicotine patch therapy. In another study, the nicotine patch treatment group had significantly improved smoking abstinence continuing to 6-month follow-up compared to the placebo group.
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Q43: Problem solving skills and training is an especially effective component of counseling in tobacco dependence treatment.
TrueCorrect. Problem solving skills, when combined with social support, will increase the chances for success in tobacco cessation.
FalseActually, this is true. Helping individuals identify potential problem situations and anticipate how to effectively deal with them is one example of problem solving and support which has been shown to be effective in tobacco treatment.
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Q44: Telephone quitlines and aftercare programs are helpful and increase abstinence rates.
TrueCorrect. The National Quitline Number (1-800-QUIT-NOW) reaches quitlines in every state.
FalseActually, this is true. Medication assistance is sometimes available through the quitlines in addition to counseling, and their effectiveness has increased with the addition of free NRT. When contacted after smoking cessation treatment, two thirds of smokers in a Veterans Affairs study who attempted to quit, but began smoking again, wanted to quit again right away, most requesting behavioral and pharmacological treatment.
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Q45: Strategies used in preparation for quitting show little benefit to patients with tobacco dependence.
TrueNo. Setting a quit date, removing tobacco from the home, and removing paraphernalia and tobacco triggers such as ashes, butts, lighters and old packs, can help smokers prepare to quit.
FalseCorrect. Preparation strategies include a tobacco treatment medication plan, seeking support from others and stopping buying tobacco products.
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Q46: All of the following are true, except:
Tobacco treatment can be successfully integrated into addictions treatment.This statement is true. The State of New Jersey has led the way in implementing a licensure standard for all residential addiction treatment programs. The standard requires facilities to assess and treat tobacco dependence and maintain tobacco-free grounds. The definition of chemical dependence also was expanded to explicitly include tobacco.
Treating tobacco does not cause clients to leave primary treatment early.This statement is true. Pioneering work in the State of New Jersey showed that most (87%) substance abuse treatment program directors affected by the policy thought that, overall, it had either a positive or neutral effect on clients or staff.
The greatest resistance often comes from staff.This statement is true. In addition, smoke-free facilities report decreases in behavioral problems and violence, and an increase in staff satisfaction.
Enforcement of licensure will have no effect on tobacco cessation.Incorrect.Actually, enforcement of licensure standards is key in tobacco cessation policy.
NRT helps withdrawal symptoms.This is true. In addition, the increasing experience of staff in treating nicotine dependence has resulted in improved patient outcomes.
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