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Module 3 - Behavioral Interventions: Integrating Tobacco Use Interventions into Chemical Dependence Services - PowerPoint PPT Presentation

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Module 3 - Behavioral Interventions: Integrating Tobacco Use Interventions into Chemical Dependence Services. Welcome. Add Trainer Names. This training was developed by the Professional Development Program, under a contract with the NYS Department of Health, Tobacco Control Program.

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Module 3 - Behavioral Interventions: Integrating Tobacco Use Interventions into Chemical Dependence Services

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Module 3 - Behavioral Interventions:Integrating Tobacco Use Interventions into Chemical Dependence Services

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  • Add Trainer Names

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This training was developed by the Professional Development Program, under a contract with the NYS Department of Health, Tobacco Control Program.

PDP developed five classroom-based curricula and seven online modules, which are available at

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  • Hours of Training

  • Breaks and Restrooms

  • Tobacco Use Policy

  • Cell Phones

  • Active Participation

  • Complete Training Evaluation

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Training Modules

Module 1 - The Foundation

Module 2 - Assessment, Diagnosis, Pharmacotherapy

Module 3 - Behavioral Interventions

Module 4 - Treatment Planning

Module 5 - Co-occurring Disorders

E-Learning - All Modules (

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Module 3 Agenda

  • Counseling Techniques

    • Motivational Interviewing

    • Cognitive Behavioral Therapy

    • Relapse Prevention

  • Case Studies

  • Facilitating a Tobacco Awareness Group

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    Module 3 Objectives

    PM 9

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    Unit 1Motivational Interviewing

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    Understanding and Applying the

    Stages of Change

    PM 12

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    Readiness to Change





    PM 13

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    Treating Tobacco Use and Dependence:

    Clinical Practice Guideline

    2008 Update

    PM 14

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    When MIis Most Effective




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    Motivational Interviewing

    MI is considered an evidence-based practice for the treatment of substance use disorders, including tobacco dependence

    “A patient-centered, directive method for enhancing intrinsic (internal) motivation to change by exploring and resolving ambivalence” (Miller and Rollnick, 2002)

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    What is the “spirit” of Motivational Interviewing?

    PM 16 - 17

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    What are the four guiding principles of Motivational Interviewing?

    PM 18

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    What ambivalence usually looks like…

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    What is resistance?

    What does resistance look like?

    What makes resistance worse?

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    O - open questions

    A - affirmation

    R - reflective listening

    S - summarizing

    PM 21

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    Identifying open and closed questions

    PM 22

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    What are the different kinds of reflective responses?

    PM 23 - 25

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    Reflective Listening

    PM 26

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    What is “problem talk”?

    What is “change talk”?

    PM 27

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    The more change talk that patients demonstrate, the more likely it is that they will move towards making a change.




    PM 27

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    Using DARN-C for Identifying Change Talk

    D - Desire to Change

    A - Ability to Change

    R - Reasons to Change

    N - Need to Change

    C - Commitment

    PM 28

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    Identifying change talk

    Ten strategies for eliciting change talk

    PM 29 - 31

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    What are the Five Rs?

    PM 32 - 34

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    PM 35

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    Discussion and Activity

    Providing Information vs. Giving Advice

    Using Elicit-Provide-Elicit

    PM 36 - 38

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    Unit 2Cognitive-Behavioral Therapy (CBT) andRelapse Prevention

    PM 41

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    Psychosocial Therapies

    • Psychosocial therapies are effective, but only received by 5% of tobacco users

    • Dose-response relationship

    • Combining with medication increases outcomes

    PM 42

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    Evidence-based Methods

    • CBT/RPT have been shown to be effective

    • CBT/RPT integrates with MI skills and SOC

    • Best used for patients in later stages of change

    PM 43

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    When to shift from MI to CBT?



    Is Most Effective

    PM 43

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    Principles of CBT

    • Thoughts/beliefs drive feelings and behaviors

    • Patients learn to identify and examine thinking patterns that lead to troublesome emotional states and behavior

    • Clinicians teach practical problem-solving skills

    • Patients gain new knowledge, develop new coping skills, and change old behaviors

    PM 44

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    Principles of CBT, cont’d

    CBT Helps a Patient to Examine and Change:

    • What they believe and feel about their tobacco use

    • Their relationship with tobacco and AOD

    • Their rituals of use

    PM 44

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    Components of CBT

    • Functional Analysis – identify patient thoughts, feelings, beliefs, and circumstances

    • Skills Training – learn coping skills, change behaviors, and use “homework” to practice change

    PM 45 - 46

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    Relapse Prevention

    • Relapse is a part of the disease of addiction. It is not failure or “a character defect” of the patient.

    • What are the major factors that contribute to relapse, and specifically for tobacco relapse?

    PM 47

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    PM 47

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    Relapse Prevention, cont’d

    • Minimal Components of Relapse Prevention

    • Components of Prescriptive Relapse Prevention (bio, psycho, social, and cultural)

    • Addressing behavioral patterns

    PM 48 - 54

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    Unit 3 Case Studies

    PM 57

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    What stage of change is each patient in regarding his/her tobacco use?

    Is the patient in the same or a different stage of change for their alcohol/other drug use?

    What treatment approaches might work best regarding the patient’s tobacco use?

    PM 58

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    PM 58 - 63

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    Unit 4Facilitating Tobacco Awareness Groups

    PM 67

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    Group Facilitation Skills – using EPE, open and closed questions, non–judgmental approach, and supporting self-efficacy

    Shifting to Recovery Language

    PM 68

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    Tobacco Treatment Groups

    Patient-Centered Psychoeducation

    Tobacco Awareness Group


    Tobacco Recovery Group

    PM 70 - 71

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    Tobacco Awareness Groups (TAG)

    • Outcomes for TAGs

    • Topics for TAGs

    • Importance of using MI skills

    PM 70 - 71

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    TAG Activity 1

    Trainer demonstration

    Leading a tobacco awareness group


    PM 72 - 84

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    TAG Activities 2 and 3

    Participants practice facilitating a tobacco awareness group


    PM 85 - 97 and 98 - 105

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    The Tobacco Recovery Resource Exchange

    E-Learning and Online Resources



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    Workshop Evaluations and Post Test

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