it is breif note for leaner

1. TOBACCO CEASATION COUNSELLING
SIBA KARMI
M.PHIL .IN PSW
CIP,RANCHI

2. Introduction
 Prevention of oral cancer mainly focuses on modifying habits with
the use of tobacco.
 India is the largest consumer of tobacco and their producer of
tobacco.
 There are about 250 million tobacco users in India.
 In India , at least 80,00000 death every are related to tobacco , and
700000 of them due to smoking.
 The National Health Policy 2017 targets- relative reduction in
prevalence of current tobacco use by 15% by 2020 and 30% by
2025’

3. STAGES OF DEVELOPMENT OF ADDICTION
 Forming Attitudes and Beliefs about Tobacco .
 Trying Tobacco
 Experimenting with Tobacco
 Regularly Using Tobacco
 Becoming Addicted to Tobacco
This process generally tak.es about 3 years

4. DEPENDENCE SYNDROME
• Desire or sense of compulsion.
• Difficulty in controlling substance taking behavior.
• Withdrawal state.
• Tolerance.
• Progressive neglect of alternative pleasure.
• Persisting use of substance despite clear evidence of
harmful consequence.

5. WITHDRAWAL & IT’S SYMPTOMS
Withdrawal means attempts to stop use lead to
craving, withdrawal symptoms, and high rates of
relapse. Withdrawal begins within a few hours of the
last cigarette and manifests symptoms such as;
 Dysphoric or depressed mood
 Insomnia
 Irritability, frustration, or anger
 Anxiety
 Difficulty in concentrating
 Restlessness
 Decreased heart rate
 Increased appetite or weight gain

6. THE ADDICTION TRIANGLE TO ASESS TREATMENT
NEEDS

7. WHY DO PEOPLE NOT CHANGE ?
 There are usually four forces, which influence change
people with tobacco user (PWTU) behaviour :
 Forces keeping a person in his/her current behavior:
1. What I like about my current behavior
2. What I fear about the new behavior
 Forces encouraging change to a new behavior:
3. What I dislike about my current behavior
4. What I imagine the advantages of the new behavior
would be

8. THE DECISIONAL BALANCE

9. WHAT IS CRAVING
 Merriam-Webster: A strong desire to consume a
particular substance .( food, sex & drugs)
 RF Anton(1999) : Craving is defined as a conscious
experience that occurs when the drinker pays excessive
attention to alcohol-related stimuli .

10. STAGE OF CRAVING

11. PSYCHOLOGICAL MANAGEMENT OF CRAVING
 Stimulus control.
 Cue exposure.
 Aversion therapy.
 Coping Imagery.
 Urge surfing (HALT technique ) Deny, Delay, Distraction, Deep
Breathing & Drinking water .
 Self-monitoring of urges and craving.
 Social skill training.
 Behavioral strategies.
 Cognitive strategies.

12. MOTIVATIONAL ENHANCEMENT THERAPY (MET)
Motivational Enhancement Therapy (MET) is a
systematic intervention approach for evoking change
in problem drinkers. It is based on principles of
motivational psychology and is designed to produce
rapid, internally motivated change.

13. STAGES OF READINESS TO CHANGE
(Prochaska and DiClemente 1984, 1986)

14. TECHNIQUES OF MOTIVATION
The acronym of FRAMES:
 FEEDBACK of personal risk and impairment.
 Emphasis on personal RESPONSIBILITY for change .
 Clear ADVICE to change.
 A MENU of alternative change option.
 Therapist EMPATHY .
 Facilitation of client SELF EFFICACY or optimism.
(Miller 1985; Miller and Rollnick 1991).

15. PRINCIPLE OF MOTIVATION
Miller and Rollnick (1991) have described five basic
motivational principles such as ; (DARES )
 Develop discrepancy .
 Avoid argumentation .
 Roll with resistance .
 Express empathy.
 Support self-efficacy.

16. SOLUTIONS TO THE PROBLEM
The 5 A’s is a brief intervention method (or approach in
counseling), used to guide the clinician in tobacco
cessation counseling. This brief intervention essentially
can be used with numerous types of behavior change. This
method can be effective and only takes 5-15 minutes.
The 5 major steps in this intervention are:
1. Ask — about tobacco use
2. Advise — to quit
3. Assess — commitment and barriers to change
4. Assist — users committed to change
5. Arrange — follow-up to monitor progress

17. Cont…..

18. RELAPSE PREVENTION THERAPY (RPT, MARLATT &
DONOVAN, 2005)
RPT is a type of cognitive-behavioral therapy. RPT aims
to limit or prevent relapses by helping the therapy
participant to anticipate circumstances that are likely to
provoke a relapse. You can develop strategy to cope with
these high-risk situations in advance. This is termed
a relapse prevention plan. For instance, therapy
participants learn that certain feelings are common
triggers for relapse.
The acronym BHALT:
 Bored
 Hungry
 Angry
 Lonely
 Tired.

19. COGNITIVE-BEHAVIORAL MODEL OF
RELAPSE (MARLATT & GORDON, 1985)