Smoking cessation in mental health & addiction settings. Dr. Susanna Galea Community Alcohol & Drug Services, Auckland October 2013

Transcription

1 Smoking cessation in mental health & addiction settings Dr. Susanna Galea Community Alcohol & Drug Services, Auckland October 2013

2 OVERVIEW

3 Tobacco is the single most preventable cause of death in the world today

4 THE GLOBAL EPIDEMIC

5 THE NZ EPIDEMIC 23% of New Zealanders smoke tobacco Maori: 46% Pacific people: 36%

6 THE NZ EPIDEMIC Smoking kills 5000 NZers each year 17% of all deaths (> combined deaths from alcohol, drugs, murder, suicide, road crashes, air crashes, poisoning, drowning, fires, falls, lightning and electrocution) Smokers die 14 years earlier, QoL worse

7 THE NZ EPIDEMIC 1/2 those that smoke die from smoking related illnesses Maori have highest rate of lung Ca in world 1/3 deaths amongst Maori due to smoking

8 NICOTINE & PSYCHIATRY Highly prevalent 41%; Twice as likely to smoke as the general population; Schizophrenia: 74-93% + higher dependency levels; Affective disorders: 70%; Alleviates drowsiness, EPS, cognitive slowing secondary to antipsychotics; Cessation associated with depression

9 Incredibly addictive 16% will light up within 5mins of getting up 50% do so in the first half hour 70% want to stop, but only 7% give up on their own each year & only 1-3% remain abstinent 50% smoking doctors post MI continue 40% post laryngectomy soon re-start By 20yo 80% smokers regret starting

10 PUBLIC HEALTH & ECONOMIC BURDEN Risk factor for 6/8 leading causes of death Premature deaths Harm to smokers & 2 nd hand smokers Poverty & health inequalities Health care costs Decreased productivity

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12 EPIDEMIC SHIFTS The Developing World Gender Gap Convergence The Teenage Smokers

13 Tobacco companies: profit $$$ #1 product sold at service stations (35% business) Cigarettes and tobacco products make up 4% supermarket profits

14 TOBACCO HAZARDS GLOBAL COUNTRY THE LOCAL COMMUNITY FRIENDS & FAMILY SMOKER

15 SOME FACTS 3 out of 4 want to stop Public health interventions projected to stop the increase Only 5% of global population is protected The disease vector: TOBACCO INDUSTRY lives could be saved by 2050

16 PRINCIPLES OF TOBACCO INTERVENTIONS THE SMOKER PHARMACOLOGICAL NON-PHARMACOLOGICAL THE COMMUNITY HEALTH PROMOTION HEALTH INEQUALITIES THE COUNTRY POLICY, LAW ENFORCEMENT, TAXES PROVISION THE GLOBAL RESPONSE MPower TFI

17 Smoking Cessation in Hospital Settings Hospital settings represent a good opportunity for smoking cessation intervention: - Over 150,000 beds occupied on any one day - Saliency of health rises when entering hospital - Abstinence is often compulsory

18 Brief Intervention AAAAA: ABC: Ask Advise Assess Assist Arrange follow-up Ask Brief Intervention Cessation Advice

19 TREATMENT GOALS - CESSATION Achievement of abstinence Associated with reduction in tobacco-related health risks 4% annual quit rates Short periods of abstinence

20 TREATMENT GOALS HARM REDUCTION Reduction of tobacco-related harm Population level approaches: awareness of harm / taxation Individual-level approaches: Less cig./ Less toxic products / Decrease inhalation

21 Pharmacological Treatment Bupropion (Zyban) (150mg) NNT 18 Varenicline (Champix) NNT 10 NRT: Nicotine Replacement Therapy NNT 23

22 NON-PHARMACOLOGICAL APPROACHES Supportive, counselling, cognitive behavioural & behavioural Group / One-to-one Brief / intensive interventions Aversion therapy Contingency management Acupuncture

23 ASSESSMENT - COMMUNITY M Monitor Tobacco Use & Prevention Policies P Protect People From Tobacco Smoke O Offer Help To Quit Tobacco Use W Warn About Dangers of Tobacco E Enforce Bans on Tobacco Advertising, Promotion & Sponsorship R Raise Taxes on Tobacco

24 NZ Smoke-free Legislation Aims of the smokefree law protect all workers & the public from secondhand smoke reduce the harm caused to individuals by their smoking further restrict minors (under 18) access to smoking products & prevent negative influences on young people further promote a smokefree (auahi kore) lifestyle as the norm.

25 New Zealand Smokefree Law Smokefree law sets out to achieve these aims by: limiting the marketing, advertising and promotion of tobacco products protecting people from the poisons in second-hand smoke by making it illegal to smoke indoors in public areas and workplaces

26 Summary of Challenges General Engaging senior staff Time constraints of senior staff Maintaining programme saliency Psychiatric Admission & Discharge patterns Difficulties in follow up Attitudes to smoking in psychiatric care

27 - Attitudes to smoking in psychiatric care Smoking seems to occupy a unique place within the culture of psychiatric care. Solution: Gain an understanding of attitudes to smoking locally (talk to staff). Solution: Address the issues in training (eg offer alternative methods of engagement).

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29 The smoking ban in our psychiatric hospitals: Why is this a good idea? 3 main arguments: 1. The right to smoke 2. The rite to smoke 3. The right to health care

30 The right to smoke Are we reducing autonomy? In hospital against their will: Is it their de facto home? Are we increasing harm?

31 The rite to smoke If you take your tablets, I will give you a cigarette Go make your bed and you will get a cigarette It was actually work that started me smoking I needed to belong so I started smoking If I withhold their cigarettes, they will become irritable

32 The right to health care

33 It is a good idea!