The Role of Behavioral Health Professionals

Why Tobacco Use Treatment Should be a Priority

According to the Treating Tobacco Use and Dependence: Clinical Practice Guideline, 2008 Update, “busy clinical teams should make the treatment of tobacco use a priority based on the compelling evidence:

• Clinicians can make a difference with even a minimal (less than 3 minutes) intervention;
• A relation exists between the intensity of intervention and tobacco cessation outcome;
• Even when patients are not willing to make a quit attempt at this time, clinician-delivered brief interventions enhance motivation and increase the likelihood of future quit attempts;
• Tobacco users are being primed to consider quitting by a wide range of societal and environmental factors;
• There is growing evidence that smokers who receive clinician advice and assistance with quitting report greater satisfaction with their health care than those who do not;
• Tobacco use interventions are highly cost effective; and
• Tobacco use has a high case fatality rate (up to 50% of long-term smokers will die of a smoking caused disease).”

The Gold Standard for Tobacco Use Intervention

Asking and advising patients to quit are not just good patient care, but can actually double the chance a smokerwill make a quit attempt. According to the Clinical Practice Guideline, the gold standard for tobacco use interventionby health care providers is the “5 A’s” intervention: Ask, Advise, Assess, Assist, and Arrange.

A Team Approach to Tobacco Use Intervention

Providers have not broadly implemented the 5 A’s due to a pervasive belief that they take too much time. Many clinician groups now promote a streamlined version of the intervention, such as “Ask-Advise-Refer”. The goal of the alternate approaches is to increase the likelihood of clinicians intervening by simplifying their task: they Ask and Advise, then hand the patient off to a quitline or other cessation service provider to Assess, Assist, and arrange. Such efforts have been successful both in changing health care provider behavior and in generating referrals for cessation treatment providers.

How Behavioral Health Professionals Can Help

Behavioral health professionals are uniquely positioned to help their clients who smoke quit because they are often the clinician the client sees most, and who knows the client best. In addition, behavioral health professionals:

• Are trained in mental health and/or substance abuse treatment
• Are able to coordinate pharmacotherapy and behavioral/counseling treatment
• Can identify and address any changes inpsychiatric symptoms during the quit attempt.

Behavioral health professionals are encouraged to talk with their patients and offer them assistance in quitting. Many of the treatment strategies that work for smokers without behavioral health issues (e.g., cessation pharmacotherapy and behavioral counseling) can work for this clientele as well.