Clinical Practice - Helping Clients Quit Tobacco

By Linda Guhe, LCSW

Many social work clinicians treat clients who, in addition to other behavior disorders, smoke or use tobacco. Tobacco researchers and specialists have increased our awareness of the dangers of tobacco. We now know that tobacco products contain both 1) harmful toxins that damage health and 2) nicotine, a powerful psychoactive addictive drug. Common forms of tobacco include cigarettes, cigars, pipe, snuff, and chewing tobacco.

Nicotine in tobacco smoke is absorbed in the lungs and quickly transported in the blood to the brain, providing an immediate “hit.” In addition to nicotine, the smoke inhaled from tobacco contains over 4,000 various chemical substances and gases. Chewing tobacco contains over 2,000 chemicals, along with nicotine, that are absorbed orally through the mouth. Nicotine in chewing tobacco reaches the brain more slowly than in cigarette smoke. However, smokeless tobacco contains higher concentrations of nicotine than cigarettes that can lead to an intensely intractable addiction. Most tobacco use begins during adolescence. About 5,000 adolescents a day experiment with smoking, of which approximately 2,000 will go on to become addicted to tobacco smoke.

While Nicotine Dependence 305.1 is listed as a Substance-Related Disorder in the Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR, it is rarely diagnosed in the mental healthcare community. Although it does not produce or lead to intoxication, nicotine has the same criteria for substance dependence such as tolerance, withdrawal, compulsive behavior, continued use despite health problems, etc. Also, treatment for Nicotine Dependence is rarely covered by insurance.

The majority of former smokers quit on their own without professional help. Of the remaining number of adults who smoke, around 20-25% nationally, most want to quit but experience greater difficulty and are more highly addicted to and dependent on tobacco. The more important a role nicotine plays in coping, the more difficult to give up tobacco. For example, nicotine plays a significant role in coping and managing strong emotions (like anger) for individuals suffering from mental and behavioral disorders and/or who lack basic needs such as stable environments and jobs.

This leads back to the number of clients we see in clinical practice who smoke. Treatment is focused on presenting problems such as substance use, a psychiatric disorder, or combination of both. Clinicians unwittingly may consider smoking as a secondary problem that too often takes a back seat, or worse is never confronted. But, what good is treatment if we help clients overcome other addictions, trauma, and/or manage psychiatric illness only to go on to die from tobacco-related illness?

Of all the people who smoke today, 50% will eventually die from a smoking-related illness. This is shocking news considering that there are effective treatments available for smoking cessation. Also, the cost of smoking related illness is exorbitant and puts a financial burden on society … money that could go toward the treatment programs for all those other behavior disorders we clinicians see every day.

Social workers and other health care professionals recognize that change at the social level can encourage and enhance change at the individual level. Here are just a few facts along with suggestions for effective ways to slow the impact of tobacco in Missouri from Show Me Health: Clearing The Air About Tobacco:

The problem of tobacco use in Missouri

High rates of tobacco use

The impact of tobacco in Missouri :

Health and economic costs

The solution to Missouri tobacco use

Discourage consumption -increase cost of tobacco and increase funding for prevention and cessation programs

To request a speaker, get involved, and/or to learn more about the impact of tobacco in Missouri, visit website: Show Me Health: Clearing the Air About Tobacco: www.ShowMeHealthMo.org.

To learn more about tobacco and how to help clients quit tobacco visit NASW website Help Starts Here: www.HelpStartsHere.org.

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Suggested Reading

Linda Guhe is a Licensed Clinical Social Worker, Certified Tobacco Addiction Specialist, Certified Medical/Analytical Hypnotherapist, and a member of the Missouri Partnership on Smoking or Health. She maintains a private practice in St. Louis and St. Charles, Missouri.