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Is it Time to Quit?

Is it Time to Quit?

The Comprehensive Tobacco Treatment Program at Dartmouth-Hitchcock Medical Center (DHMC) offers both an inpatient and outpatient support program to assist users in breaking their dependence on tobacco and other nicotine-driven addictions. Alexandra Fannin, MS, APRN, NP-C, NCTTP, a thoracic surgery nurse practitioner, and Andrea Christian, MSN, RN-BC, NCTTP, a tobacco treatment coordinator, are also both certified tobacco treatment specialists who help run the program. Fannin handles outpatient referrals to the program, while Christian covers inpatient referrals.

Outpatient referrals

The outpatient services are available to individuals referred by any provider, including those outside of Dartmouth-Hitchcock. Once referred, there is an initial appointment consisting of assessing the patient’s tobacco usage and discussing available tools, such as nicotine replacements, like a patch or gum, or medicines, like Chantix or Wellbutrin and behavioral techniques for recognizing and changing habits that drive the dependency. Patients then return for follow up appointments based on need.  “I want them to drive their quit attempt; it’s not the same for every person,” says Fannin.

The program also provides a rapid response for patients who express an interest in quitting, while they are seeing a provider at DHMC. If a provider has a patient who expresses interest in quitting tobacco, there is a pager number available to refer a patient right then. “We can immediately come to see patients to avoid having to wait for a follow-up appointment,” says Fannin.

Inpatient referrals

The inpatient referral process is slightly different from the outpatient process. “Within 12 hours of admission, tobacco use needs to be assessed,” Christian says. “Once this occurs, if it is determined that the patient shows a readiness to quit, they are automatically referred to us.” Some patients are automatically referred to the Comprehensive Tobacco Treatment Program due to their condition, such as after a heart attack.

For tobacco dependent patients, nicotine replacement therapy, such as a nicotine patch, is often administered automatically in order to help avoid nicotine withdrawal. Members of the Comprehensive Tobacco Treatment team will continuously check in with these patients during their hospital stay, encouraging them to consider quitting permanently explains Fannin. The program also works closely with the New Hampshire and Vermont quit lines, who assist with follow-up calls and checking in on the patients after they are discharged.

For visitors or patients waiting for an appointment at DHMC, the program provides “Nicotine Comfort Kits.” These packs contain two, 4mg. nicotine lozenges and help to reinforce with patients that Dartmouth-Hitchcock is a smoke- free campus, and if they help to break the urge to use tobacco, allows for an opportunity to consider quitting. These comfort packs are available at the Main Rotunda, North Entrance, and South Entrance.

Most insurances cover the counseling sessions, but each varies on what they will cover in terms of nicotine replacements and medications. Both Fannin and Christian stress that to be successful in quitting, it is important not to rely on any one method, but rather, it is often a combination of methods that proves most successful. “Medication along with behavioral modification has better outcomes. Regardless of what medication you choose, the behavioral modification component is extremely important, which is where the counseling and the coaching come in,” says Christian.

While the Comprehensive Tobacco Treatment Program references tobacco in its title, they are seeing patients with addictions to other forms of nicotine delivery, such as e-cigarettes. While these devices may help to alleviate dependency on tobacco products, some young users are trying to break addictions to these delivery systems.

For information on successful quitting, The Comprehensive Tobacco Treatment Program recommends the following tips for quitting:

Five Keys to help you quit

Studies have shown that these five steps will help you quit and quit for good. You have the best chances of quitting if you use them together:

  • Get ready
  • Get support
  • Learn new skills and behaviors
  • Get medication and use it correctly

Be prepared for relapse or difficult situations.

  1. Get ready
    • Set a quit date.
    • Change your environment.
    • Get rid of ALL cigarettes and ashtrays in your home, car, and place of work
    • Don't let people smoke in your home.
    • Review your past attempts to quit. Think about what worked and what did not.
    • Once you quit, don't smoke—not even a puff!
  2. Get support and encouragement—studies have shown that you have a better chance of being successful if you have help. You can get support in many ways:
    • Tell your family, friends, and coworkers that you are going to quit and want their support. Ask them not to smoke around you or leave cigarettes out.
    • Talk to your health care provider (for example, doctor, dentist, nurse, pharmacist, psychologist, or smoking counselor).
    • Get individual, group, or telephone counseling. The more counseling you have, the better your chances are of quitting. Programs are given at local hospitals and health centers. Call your local health department for information about programs in your area.
  3. Learn new skills and behaviors
    • Try to distract yourself from urges to smoke. Talk to someone, go for a walk, or get busy with a task.
    • When you first try to quit, change your routine. Use a different route to work. Drink tea instead of coffee. Eat breakfast in a different place.
    • Do something to reduce your stress. Take a hot bath, exercise, or read a book.
    • Plan something enjoyable to do every day.
    • Drink a lot of water and other fluids.
  4. Get medication and use it correctly
    • Medications can help you stop smoking and lessen the urge to smoke. The U.S. Food and Drug Administration (FDA) has approved five medications to help you quit smoking:
      • Bupropion SR, available by prescription
      • Nicotine gum, available over-the-counter
      • Nicotine inhaler, available by prescription
      • Nicotine nasal spray, available by prescription
      • Nicotine patch, available by prescription and over-the-counter
    • Ask your health care provider for advice and carefully read the information on the package.
    • All of these medications will more or less double your chances of quitting and quitting for good.
    • Everyone who is trying to quit may benefit from using a medication. If you are pregnant or trying to become pregnant, nursing, under age 18, smoking fewer than 10 cigarettes per day, or have a medical condition, talk to your doctor or other health care provider before taking medications.
  5. Be Prepared for Relapse or Difficult Situations—most relapses occur within the first 3 months after quitting. Don't be discouraged if you start smoking again. Remember, most people try several times before they finally quit. Here are some difficult situations to watch for:
    • Alcohol. Avoid drinking alcohol. Drinking lowers your chances of success.
    • Other smokers. Being around smoking can make you want to smoke.
    • Weight gain. Many smokers will gain weight when they quit, usually less than 10 pounds. Eat a healthy diet and stay active. Don't let weight gain distract you from your main goal—quitting smoking. Some quit-smoking medications may help delay weight gain.
    • Bad mood or depression. There are a lot of ways to improve your mood other than smoking.

If you are having problems with any of these situations, talk to your doctor or other health care provider.

You can also visit the Comprehensive Tobacco Treatment Program website for more information.