HELPING PEOPLE STOP SMOKING

Using motivational interviewing skills

JENNIFER PERCIVAL
RGN. RM .RHV. FETC Counselling Dip

RCN TOBACCO POLICY ADVISOR

TOBACCO IS A SERIOUS PROBLEM

In the year 2000

1 in every 6 deaths worldwide
was caused by smoking

By the year 2030

1 in every 3 deaths worldwide
will be due to smoking

70% of these deaths will be in

developing countries.
Source: WHO
 Why should we help smokers to quit??

WORLD HEALTH ORGANIZATION

Epidemiologist Sir Richard Peto
stated:
“Tobacco use is increasing.
Over 100 million deaths from
tobacco will occur during the next
20 years……. and if nothing changes
there will be
a billion deaths this century.”
Research has shown:

• Half of all regular smokers die prematurely:

¼ in middle age (35-69)
¼ in old age

• Stopping before 35 avoids most of the risks of premature death.

• Stopping smoking works.

Smokers’ attitudes

• Reluctant and disillusioned

– 83% say they would not smoke if they had their time
again
– 71% want to quit
• Reasons
– 61% Health
– 43% Expense
– 20% Addiction
– 17% Disgust
– 5% Social stigma
What is smoking?
• Chronic relapsing dependence syndrome
• Smoking is use of the addictive drug nicotine
• Delivered to the brain by tobacco smoke via
lungs and blood
• Reinforced by sensory, behavioural and
social conditioning
• Entrenched by powerful withdrawal syndrome
• Great harm caused by toxins in the smoke
• Promoted commercially, exempt from
consumer protection legislation
Hospital and Health Centre
Policies need to reinforce the
importance of giving advice to
all smokers about stopping
Most smokers want to stop, but their
chances of success are low unless they are
offered support and treatment.

Brief advice, pharmacotherapy's and

intensive behavioural support have all
been shown to increase a smoker’s chance
of stopping.
 Recommendations for Clinical Practice

Ask about smoking at every opportunity

and update records

Advise all smokers to stop in a personalised

and appropriate manner

Assess motivation to stop

Assist the smoker to stop

Arrange follow up if possible

Recommend smokers to use NRT/Zyban
and provide accurate information and on treatment options
That’s all well in theory but!!!

How do you engage the

reluctant smoker???
GOOD ADVICE
 SMOKERS GIVE MANY
REASONS FOR CONTINUNING

• Enjoyment
• Habit
• Social norm
• Ritual
• Routine
• Few mention addiction.
Nurses Attitudes to the Topic of Smoking

Myth No.1

If I ask about my patient’s smoking habits they:

Will not like me or let me care for them

Will think I don’t understand

Will not return for their care

Will not let me into their home again

 Instead of listening to your advice
they can often spend quite a bit
of time justifying their
smoking habit!!

Which leads you to the

‘Tennis match’ conversation
 THE CHANGE PROCESS

• No-one changes their behaviour without

first changing their attitudes and beliefs.
• When a patient argues with you it means
you have made a wrong assumption.
• Long term behaviour change takes time
• If you lose the sense of urgency you will
find opportunistic interventions much
easier
 The
Public’s
attitude to
health
advice is
not always
positive!!
 STEPS TO QUITTING
1. Deciding

2. Preparing

3. Quitting

4. Staying stopped

5. Coping with setbacks

 Current
Behaviour
Giving Advice to Stop Smoking?
• Most smokers know ‘its bad for them’.

• Most can give you ‘good reasons’ why

they do not want to stop right now.

• When you discuss this it often polarises

them into taking a defensive position
Do you
follow all
the good
advice you
are given?
 What works?

• Elicit what the smoker already knows

and their interest in receiving
information

• Provide information neutrally

• Elicit the smoker’s interpretation

 QUESTIONS SMOKERS NEED TO CONSIDER

Why do I want to stop smoking?

What is the major benefit to me?
When will I stop?

Living without my cigarettes

What will I do when I want a cigarette?

What happened last time I failed to stop smoking?
How will I avoid this happening this time?

The day I stop smoking

What will I do to prepare?

Am I prepared to STOP, not cut down?

After I stop smoking

What will I spend the money on?

What will be better about my life without cigarettes?
 RELAPSE
Why do smokers fail to quit?
• Stopping under pressure from someone else
• Lack of personal motivation
• Attaching insufficient importance to stopping
• Withdrawal symptoms
• Poor timing
• A question of self-image
• “I thought `just one’ wouldn’t hurt”
 People succeed when they:
• Invest time and thought in quitting
• Want to stop and know what to expect
when they do
• Have enough information and have
developed coping strategies
• Can plan ahead for difficult or unexpected
situations
• Have encouragement from others
• Can see themselves as non-smokers
 Stopping Smoking - Not ready!
• Respect this decision

• Ask: What would need to be different

for you to consider change?

• Explain your own concern

• Leave the door open for future

discussions
 Unsure about change?

• Examine the pros and cons

• Understand ambivalence

• Explore concerns
Instead help smokers weight up the pros and cons
 Making Changes
A change I’d like to make:

The Advantages of The Disadvantages of

Current
behaviour

Making
the
Change

Take into consideration:

 Consequences to self  How I feel about myself
 Consequences to others  How others feel about me

My Conclusion / Decision / Goal:

Self-efficacy: a belief in one’s own
ability to achieve change
• Normally, people only attempt
things which they feel they
succeed at
It’s important to make an
assessment of their Motivation
and Confidence to change
 Building confidence
• Ask: What did you learn from previous
stop smoking attempts?
What works and what doesn’t work?

• Ask: What Do you know of anything

that has worked for other people?

• Theses question can help the smoker

develop a plan of action
 Key aspects of
Motivational interviewing
• Express acceptance and affirmation

• Ask questions to understand how they see the problem

Use reflective listening skills

• Elicit and reinforce self-motivational statements:

concerns, desire, intention and ability to change

• Assess and feedback their readiness to change

• Affirm their freedom of choice

 Basic principles of motivational interviewing

• Avoid making pressure to change: this will

create resistance. You can never win and, in
the process, may lose the chance to help

• Roll with any resistance: do not argue with

the patient if they say their action is not
harmful. Instead, respectfully clarify their own
thoughts or views

• Support the patient’s self-confidence: look for

the positive aspects and build on them
 In summary changing the conversation helps

From A tennis match

Telling Counter The patient Collusion /

them why arguments / thinks … Resistance
they Justification ‘You don’t to change
should understand’ Denial
change
To Self re-evaluation

Giving Time to ‘I can see Movement

personally analyse the effect through the
relevant their own on me.’ cycle of
facts motivation `Believing I change
and have the
confidence power to
change.’
NEW SELF HELP BOOK