Friday Factoids: Underplaying Tobacco as a Health Issue

As an ex-smoker I understand the struggles involved in quitting. I used to joke that the messages I received to quit sounded like the nagging, wordless voice of the Charlie Brown teacher. I think that in order for any of us to change a behavior, addictive or not, we need to have an “Ah-Ha” moment.

I began working in the medical field at a young age as a respiratory therapist. I saw the effects of smoking on others, but I rationalized this by looking at how much older they were than me. Some of them were in fact in their 40’s, but in my early 20’s this seemed pretty far off. My perspective changed though. I saw patients tracheostomies beg to be taken outside the hospital to smoke. I worked with people who were very severe asthmatics who would fight with staff over being able to remove supplemental oxygen so that they could smoke. I saw burn victims who had caught a bed on fire. I worked with COPD patients who became burn victims while smoking at home on oxygen. Unfortunately for me, it took this high level of exposure to negative outcomes in order to make changes.

Every smoker or tobacco user knows that it is something they “shouldn’t” be doing. Clinical staff tends to look at smoking as a minor problem when a patient presents with high levels of substance abuse or other behaviors that threaten health and wellbeing. Despite knowing how much tobacco use will cost someone in the long run, I feel like clinicians and patients have a greater sense of complacency with this particular issue. As psychologists, we tend to shy away from the diagnosis of Nicotine Use Disorder even when it seems severe. I have often times not addressed a patient’s smoking for different reasons. If it was a substance abusing patient, I feared that smoking cessation would increase relapse risk. Research hasn’t supported this idea. I really worried that adding smoking cessation goals to patients’ care plans would prove to be too much for them.

As clinicians we have a duty to help our patients, especially when they are engaging in behaviors that have a high likelihood to result in death and disability. In my opinion, we need to take just as strong a stand on tobacco use as any other substance of abuse that is resulting in damage to our patients. Since smoking is a slower more gradual killer, it tends to get overlooked. Sometimes “over compassion” and not wanting to add additional “stress” to a patient keeps clinicians from pursuing smoking cessation/education more aggressively. I think patients need to see a strong tobacco free stance from all healthcare personnel. We ourselves should strongly consider quitting if we are smokers. Having our own stories of what led us to quit and how we did it will only help our patients.

Kentucky Department of Public Health supports an online program offering education and individual coaching: https://www.quitnowkentucky.org/

References:
Knudsen, H., Studts, C., & Studts, J. (2012). The Implementation of Smoking Cessation Counseling in Substance Abuse Treatment. Journal Of Behavioral Health Services & Research, 39(1), 28-41. doi:10.1007/s11414-011-9246-y

Rain Blohm, MS
WKPIC Doctoral Intern