Sunday, July 10, 2011

Smoking

7/6/2011
This week, we talked about smoking. The social worker and nurse were very excited about this class. Out of the 14 consumers at Jasper House, 11 smoke, 1 chews tobacco, and 2 do not use tobacco. The class was all about the facts. Fact #1 :75% of people with mental illness  or addictions smoke compared to 22% of the general population. All but 1 raised their hand to the question, how many of you wish you didn't smoke, or wish you never started smoking? We talked about the relationship between smoking and pceople with mental illness. Smoking increases the breakdown of some psychiatric medications, this means the amount of medication has to be increased to be work properly! Quit rates are lower than the general population.
  Why?
Lower motivation to quit
 -Fewer quit attempts
 -Increased severity of nicotine dependence

I read that the more personal the education is, the more effective. I found a website that calculates how much one would spend on cigarettes in 1 day, week, month, year, and 10 years. http://www.smoking-calculator.com/cigarette_bank/index.php I used this for whoever wanted to know how much exactly they were spending. Most of them were very surprised at how much money they could be saving.

Then we talked about a some of the ingredients in cigarettes and what other things they were used for. Such as:
Cyanide: Rat poison and gas chambers
Formaldehyde: preserving dead bodies
Nicotine: used in pesticides; what causes the addiction
Tar: paves the streets, turns your teeth yellow
Benzene: used to make gasoline
Vinyl chloride: what garbage bags are made of
Acetone: nail polish remover
Lead: batteries, bullets
Ammonia: house cleaner


Then, I gave everyone a piece of paper and a pen and I gave them a quiz (FAGERSTROM TEST FOR NICOTINE DEPENDENCE). I asked the questions as simply as I could. The questions are based on amount, frequency, and time of smoking. Because they have designated times and a limit on how many cigarettes that the consumers can smoke at Jasper House, none of them scored over a moderate nicotine dependence. The scoring ranges from mild, to moderate, to heavy nicotine dependence.


We discussed a few of the consequences of  smoking such as heart disease, stroke, COPD, lung cancer, and head and neck cancer. I showed them some gruesome pictures.




 
Then, we talked about quitting.  There has been a much higher success rate for people with mental illness using specific medications to assist them with quitting, than for the people who did not. Medications DOUBLE their success rate! Nicotine withdrawal can have the same effects as medication side effects and mental illness relapse. I told them about the FDA approved medications including Nicotine Replacement Therapies (NRTs) and the pill medications. I used http://www.becomeanex.org/ to prepare for this part of class. We discussed what actions to take before you can quit smoking, and then how to go about trying to quit. I discussed specific time related health benefits of quitting smoking.
The last fact: Smoking kills those with mental illness FASTER, and more PAINFULLY, because it is a LEADING RISK FACTOR of DISEASE and EARLY DEATH in this population. To end the class, I shared a poem with them:


To Smoke or Not to Smoke by Bill Newbold


To smoke or not to smoke
there is no question about it
whether it is lung cancer or a long life
the choice to choose is obvious.
Life is good, life is great,
life is hard
but much harder when I smoked.
When I smoked I had no time to be in life
so smoking is not to be and is not nobler too.
What a cigarette does hurts
not only myself but the others about.
There are no more places left to smoke in my life
or even in the world at large.
I have decided to ban smoking in my apartment
and so far that has happened.
No one for over two weeks has smoked here.
I can feel the fresh air
keeping me healthy.
Once there was money
to smoke
and time to waste
but now the days are shorter
and my life too.
I can not waste my time
and money
doing something to hurt myself.
I love me
and who I am becoming.
I think therefore
I know not to smoke.
I know not to smoke
so I am an ex-smoker.
I am an ex-smoker
therefore I have become free
of the addiction.
I am free of the addiction
and now it is time
to help others
free themselves from the smoking.



There were lots of distractions this week. In the middle of the class, half of them had to leave. It was hard to keep everyone's attention, especially since this wasn't one of their favorite subjects. I know this is an incredibly important topic, and I really tried to present it in a relevant way, and really mix it up. However, they still did not seem nearly as receptive as with other classes that we've had. After class, I brought out a new bag of goodies. I did not give these away so freely. I bought bags of sugar free candy, sugar free gum, sugar free water bottle drink mix packets, and a big bowl. I put everything in the bowl and showed it to them. I explained the bowl was to "beat their triggers." I would put it behind the front desk (where they go to get their cigarettes), and if they wanted something out of the bowl, they could pick out of the bowl as many items as they would have asked for cigarettes. Some of them were interested, but others flat-out said they would rather smoke. Everyone behind the front desk was really excited about the new intervention and promised they would let all the people from the other shifts know. All in all, this had to be the hardest class so far. Next week is 'Improving Memory,' and I am really excited about it! Wish me luck!

Resources:
Williams, J., Ziedonis, D., Vreeland, B., Speelman-Edwards, N., Zechner, M., Williams, M., & ... Eilers, R. (2009). A wellness approach to addressing tobacco in mental health settings: learning about healthy living. American Journal of Psychiatric Rehabilitation, 12(4), 352-369. doi:10.1080/15487760903248580

Association of State Mental Health Program Directors. (2007, September ). Tobacco-Free Living in Psychiatric Settings: A Best- Practices Toolkit Promoting Wellness and Recovery. National Association of State Mental Health Program Directors. Retrieved July 1, 2011, from http://www.nasmhpd.org/general_files/publications/NASMHPD.toolkitfinalupdated90707.pdf

Alliance for Tobacco Cessation. (2008.). How to Quit Smoking | Steps to Successfully Quit Smoking: BecomeAnEX. Become An EX Smoker, Learn to Quit Smoking, Stop Smoking Cigarettes. Retrieved July 1, 2011, from http://www.becomeanex.org/how-to-quit-smoking.php

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