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Module 2 - Assessment, Diagnosis, and Pharmacotherapy: Integrating Tobacco Use Interventions into Chemical Dependence Services. This training was developed by the Professional Development Program, under a contract with the NYS Department of Health, Tobacco Control Program.
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 www.tobaccorecovery.org
Module 1 – Foundations
Module 2 – Assessment, Diagnosis, Pharmacotherapy
Module 3 – Behavioral Interventions
Module 4 – Treatment Planning
Module 5 – Co-occurring Disorders
E-Learning – All Modules
Please refer to the list of objectives in your participant manual
Assessment is revisited many times during treatment
How do you currently assess or evaluate patients regarding their alcohol, drug, and tobacco use?
What are some issues/domains that you assess with your clients through the intake assessment process?
Heaviness ofSmokingIndex(HSI – Questions1 and 4 of theFagerström)
PM 16 - 20
Immediate measure of success
Additional assessment tool
Stage of change vary for each problem and substance used. Patients may be willing/unwilling to:
PM 30 - 32
Clinical Practice Guideline 2008 Update:
How not to use nicotine gum!
An old nicotine lozenge attempt
Considerations Psychiatric history
Side effects: nausea, insomnia
Precautions History of kidney disease
Pregnancy Category C
Note: Varenicline is 93% excreted unchanged from the kidneys and has no drug-to-drug interactions
Dosage 0.5mg 1x/day for 3 days
& Duration 0.5mg 2x/day for 4 days
1.0mg 2x/day for 3 months
Stop tobacco use on day 8
Use up to 6 months
Availability Prescription only
Note: FDA now requires black box warning for adverse effects
Combinations of medication works better
Clinicians should consider the use of certain combination of tobacco medications that have been identified as effective.
(Fiore, Jaen, Baker, et al., 2008 Clinical Practice Guideline, 2008 Update)
(Fiore, Jaen, Baker, et al., 2008)
(Ebbert, et al., 2009)
1. Can a Fagerström score be determined?
2. Is DSM-IV-TR criteria evident for tobacco dependence and nicotine withdrawal?
3. Patient stage for tobacco use? Stage for other AOD use?
4. Key patient issues needing immediate attention?
5. Recommended treatment medications?