Maine healthcare providers are critical in tobacco and substance abuse prevention and treatment. They provide guidance, resources, medications, and options that help guide users to support and self-management.
The provider’s role includes:
- Talking with patients about tobacco and substance use
- Delivering stage appropriate interventions and support
- Assisting in creating plans to quit and/or reduce use
- Identifying substance use concerns among patients with chronic disease
- Developing and implementing effective interventions to prevent youth from using tobacco, alcohol, and drugs
Proper assessment is key to helping patients struggling with tobacco, alcohol, and drug use. Here are some assessment tools that can help you understand your patient’s level of use and addiction. The tools can also help you determine the appropriate interventions to help your patient quit.
An effective assessment that uses a few simple questions:
- Have you used tobacco/alcohol/drugs in the past 6 months?
- Do you currently use tobacco/alcohol/drugs?
- How often do you use tobacco/alcohol/drugs?
- Have you ever tried to quit or thought about quitting?
- What strategies or medications did you use?
SBIRT is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence of alcohol and illicit drugs. Download clinician tools to help screen you screen patients for substance use and deliver a brief intervention.
Withdrawal symptoms occur when the body is addicted to a substance and then suddenly stops. Withdrawal is both physical and mental and can put the individual at risk of relapse. Here are some common symptoms to be aware of:
Decreased heart rate
Increased appetite/weight gain
Irritability, anger, frustration
Restlessness and nervousness
Increased heart rate
Loss of focus
It can take several attempts to stop using tobacco, alcohol, and drugs. Here are some tips you can give patients to help prevent relapse:
- Write down the reasons and benefits for quitting
- Document progress and what it would take to start over
- Avoid triggers like alcohol use, social situations, and stress
- Change your social behaviors and habits
- Ask for support from friends, family, and co-workers
- Introduce healthy behaviors like exercise and activities
- Seek counseling and support from a professional
- Know your loved ones will support your effort, just as much as your success
- Make a plan for cravings
- Safely discard any remaining products
- Continue medications and treatment plan as directed
- Participate in therapy programs
- Be careful not to replace addiction with another addictive substance or habit
Medication & Treatment
Nicotine Replacement Therapy (NRT)
NRT products supply enough nicotine to help relieve withdrawal symptoms:
- Nicotine Patch: A nicotine patch is applied directly to the skin and delivers stable levels of nicotine all day.
- Nicotine Gum: A chewing gum that delivers a dose of nicotine orally. Usually lasts about 30 minutes.
- Nicotine Lozenge: Similar to nicotine gum, the lozenge delivers nicotine orally.
- Nicotine Inhaler: A device to puff on, absorbing the nicotine in the mouth and throat.
- Nicotine Nasal Spray: Sprayed through the nostrils every 1-2 hours, delivering rapid peak levels of nicotine.
Prescription medications approved by the Food and Drug Administration to help tobacco users quit:
- Zyban (also called Bupropion or Wellbutrin): This drug helps control nicotine cravings in people trying to quit.
- Chantix (also called Varenicline): Another prescription medication that can be used to help smokers quit.
There are three medications used to help people with alcohol dependence:
- Naltrexone (also called Revia and Vivitrol): Helps people reduce the frequency and amount of alcohol
- Acamprosate (Campral): Used with counseling to reduce alcohol dependence
- Disulfiram (known as Antabuse and Antabus): Used to treat chronic alcohol dependence by creating a sensitivity when alcohol is consumed.
A medically assisted detoxification program provides professional help to addicted by stopping symptoms of withdrawal so they can successfully engage in treatment.
- Suboxone (buprenorphine and naloxone): Used to treat adults who are dependent on opioids
- Dolophine (methadone): used in detoxification and tapering users that are addicted to opioids
Products to Know
Finely cut tobacco leaves rolled in thin paper for smoking.
Nicotine is the primary component of tobacco, and is the primary reason tobacco is addictive.
Electronic Vapor Products
Devices used to vaporize active ingredients for the purpose of inhalation.
Currently unregulated by the U.S. Food and Drug Administration, so amount of nicotine is unknown. Nicotine is addictive in any form and lethal in high doses.
Smokeless tobacco consumed by placing a portion of the tobacco between the cheek and gum or upper lip.
It is highly addictive, containing high levels of nicotine and many cancer-causing chemicals. In addition to the cancer risk, other oral side effects include concerns with gums, teeth, and bad breath.
Flavored smokeless tobacco.
Same risks as chewing tobacco, but faded sweeteners and flavors make it more appealing to youth.
Tightly rolled bundle of dried and fermented tobacco leaf in a series of types, flavors, and sizes.
Cigars contain the same hazards as cigarettes and are taxed at a much lower rate, resulting in lower prices.
Hand-rolled tendu leaves tied up with string.
Bidis contain low-grade tobacco and more tar, nicotine, and carbon monoxide than cigarettes.
Kreteks (Clove Cigarettes)
Cigarettes made with a blend of tobacco, cloves and other flavors.
Contain the substance “Eugenol” which is a mild anesthetic that causes a person to smoke more deeply, making them even more of a hazard than cigarettes.
All natural, additive-free cigarettes.
Contain hundreds of different chemicals, many of which can be extremely dangerous when burned and inhaled.
Hand held devices made specifically to smoke tobacco with a chamber, stem, and mouthpiece.
Use black (air cured) tobacco, which carries a higher risk of esophageal and lung cancer, even for those that do not inhale.
Water Pipes (Hookahs)
An instrument that mixes tobacco vapor with water or other liquid, then draws into the mouth.
The water does not filter out toxic chemicals and group sharing can increase spread of germs.
Potentially Reduced Exposure Products (PREPS)
Alternative tobacco products put out by various tobacco companies with the explicit or implied claim that they are less harmful than mainstream products.
Sometimes confused with products such as nicotine gum, lozenge or inhaler, which have been approved to help with smoking cessation. PREPS are not lower-risk and are not approved for this use.
Recreational or medicinal drug.
Long-term side effects may include addiction, decreased mental ability.
A prescription drug typically used to treat patients with severe pain or to manage pain after surgery.
50 to 100 times more potent than morphine, heroin, and other dangerous drugs.
Typical products such as glue, spray cans, paints or sprays are inhaled.
Inhalants are a serious risk to youth. Users can die the 1st, 10th or 100th time a product is misused as an inhalant.
Hallucinogens (LSD, Acid)
A psychedelic drug known for its psychological effects.
Used as an escape drug, with possible adverse psychiatric reactions such as anxiety, paranoia, and delusions.
MDMA (Molly, Ecstacy)
A hallucinogen or stimulant.
Risks of overdose includes high blood pressure, faintness, panic attacks, and in severe cases, a loss of consciousness and seizures.
(K2, Spice, Bath Salts)
Man-made chemicals rather than natural ingredients.
Due to growing number of chemicals developed, there is no way of knowing what the drugs contain and the effects are unknown.
Treating High Risk Populations
Pregnant women who have received brief counseling on the effects of tobacco, alcohol, and other drug use on their unborn child are more likely to abstain. Clinicians should discuss tobacco and substance use at the first prenatal visit and continue throughout the pregnancy. There are effective interventions for those addicted to tobacco and other substances including medications safe for pregnant women.
Smoking rates of those with behavioral health disorders, which includes psychiatric disorders and substance abuse disorders, are two to four times higher than that of the general population. These individuals are a priority in efforts toward prevention in our state and the development of policy, prevention, and treatment.
Treating a smoker with chronic disease presents additional challenges. Smokers with diabetes, heart disease, asthma, and COPD can experience increased hospitalization time, complications, and increased risk of death. It is important for clinicians to have the latest information about the impact of chronic disease on patients who use tobacco.
Social and economic factors directly influence health behaviors. Addiction and poverty create a vicious cycle: there are more low income people addicted, which causes more suffering, more spending, and eventually more disease and death. Providers should offer advice and support to all patients and ensure all persons, no matter what their income level, have access to the resources and interventions to help them quit.