Substance Use Counseling

Question 1

What are the 4 key elements to a successful smoking cessation plan?

Answer 1

STAR

• Set quit date
• Tell others
• Anticipate challenges
• Remove tobacco products and paraphernalia

Question 2

How should you tailor treatments for difficult-to-treat smokers?

Answer 2

• Flexible quit date that encourages smoking reduction as an initial goal
• Treatment sampling and practice quit attempts
• Supplement standard behavioral counseling with mood management counseling

Question 3

What 3 pharmacologic treatments are proven to be effective for smoking cessation?

Answer 3

• Nicotine replacement therapy (patch, gum, lozenge)
• Bupropion (Wellbutrin/Zyban)
• Varenicline (Chantix)

Question 4

Your patient has a 20 pack year smoking history and is also struggling with depression. What drug should you recommend?

Answer 4

Bupropion!

Question 5

What stage of change:

Patient is not even thinking about behavior change

Answer 5

Pre-contemplation

Question 6

What stage of change:

Patient thinking about changing; often ambivalent. May be far from actually acting

Answer 6

Contemplation

Question 7

What stage of change:

Patient actively trying to modify behavior

Answer 7

Active Change

Question 8

What stage of change:

Patient successfully adopting new behavior, sustaining change/preventing relapse

Answer 8

Maintenance

Question 9

General steps to motivational interviewing

Answer 9

1. identify the target behavior (smoking, drugs, alcohol)
2. ask about positive aspects of the behavior (why patient does it)
3. ask about the negatives
4. explore patient’s goals and values (living longer to see kids grow up, holding down a steady job, etc)
5. ask for a decision (would you like to quit?)
6. set a SMART goal

Question 10

what’s a SMART goal?

Answer 10

Specific, measurable, achievable, realistic, timed

Question 11

describe the ask-tell-ask approach

Answer 11

Ask
• Assess the patient’s baseline knowledge

Tell
• Use simple, clear, concise language
• Avoid medical jargon
• Speak slowly
• “Chunk” information by pausing after a concept
• Limit to 1-3 key messages and emphasize these messages
• Use visual aids and written instructions to reinforce key messages

Ask
• Request “teach-back”
• Expect questions: “What questions do you have?” (Instead of: “Do you have any questions?”)

Question 12

What stage of change:

ready to change in the near future; on the verge of taking action

Answer 12

Preparation

Question 13

How many times in the past year have you had X or more drinks in a day?

what number for men/women is a positive screen?

Answer 13

X = 5 drinks for men
X = 4 for women

Question 14

what are the CAGE questions?

answering yes to how many is a positive screen?

Answer 14

Have you ever felt the need to Cut Down on drinking?
Have you ever been Annoyed by criticism of drinking
Have you ever had Guilty feelings about drinking?
Have you ever taken a morning Eye Opener?

A response of ≥ 2 is considered a positive screen

Question 15

what are the DSM criteria for substance use disorder?

Answer 15

1. Impaired control:
   (1) taking more or for longer than intended
   (2) unsuccessful efforts to stop or cut down use
   (3) spending a great deal of time obtaining, using, or recovering from use
   (4) craving for substance
2. Social impairment:
   (5) failure to fulfill major obligations due to use
   (6) continued use despite problems caused or exacerbated by use
   (7) important activities given up or reduced because of substance use
3. Risky use:
   (8) recurrent use in hazardous situations
   (9) continued use despite physical or psychological problems caused or exacerbated by substance use
4. Pharmacologic dependence:
   (10) tolerance to effects of the substance
   (11) withdrawal symptoms when not using or using less

Question 16

how many of the DSM criteria do you need to have a substance use disorder?

breakdown of mild/moderate/severe

Answer 16

2/11 = substance use disorder!

The severity of the Substance Use Disorder is defined as:
• Mild: 2-3 criteria
• Moderate: 4-5 criteria
• Severe: ≥6 criteria

Question 17

what’s the NIDA quick screen for substance use? what is a positive screen?

Answer 17

In the past year how often have you used prescription drugs for non-medical reasons?
In the past year how often have you used illegal drugs?

A response of at least 1 time is considered a positive screen

Question 18

what are the 5 As for brief intervention

Answer 18

Ask about substance use
Advise to quit
Assess willingness to make a quit attempt
Assist in quit attempt
Arrange for follow-up

Question 19

what are the 5 Rs for reluctant-to-quit smokers?

Answer 19

discuss:

 RELEVANCE of tobacco cessation
 RISKS of continued tobacco use
 REWARDS of tobacco cessation
 ROADBLOCKS to successful cessation
 REPEAT all of the above regularly

Question 20

what patients should NOT receive bupropion?

Answer 20

seizure history, eating disorder

Question 21

when should patients start taking chantix/wellbutrin in regard to their set quit date?

Answer 21

start at least 7 days before quit date

Question 22

what are some risks of alcohol use above recommended limits?

Answer 22

increased probability of developing:

an alcohol use disorder, liver disease, financial and marital problems, serious injuries, esophageal cancer, liver cancer, stroke

Question 23

what is a patient centered way to begin asking about substance use?

Answer 23

“I ask all of my patients about their alcohol and other drug use as part of obtaining their medical history because it can have an important impact on their overall health”

“would it be ok if I asked you some questions about your alcohol and drug use?”

Question 24

What information is useful to understand patterns of substance use?

Answer 24

quantity, duration of use, frequency of use, route of administration, effect of use, strategies used to acquire substance, cost, periods of abstinence, triggers to use, associated physical symptoms, patient perspective/observations about their use and consequences