Structure of interventionIntervention in our center begins during the patient’s second visit (after screening), and the process takes about two hours. The intervention is performed individually or in small groups of up to 4-5 people. Each patient’s level of nicotine dependence is assessed using a series of measures, including the Fagerström test for cigarette dependence (FTCD), CO in expired air, the number of cigarettes in the past 12 hours, Beck Depression Scale (BDI), and the Minnesota Withdrawal Scale. For more information on these measures, please see the section titled “Information for the patient” (in Czech).
The intervention usually takes 1.5 to 2.5 hours. In this version outlined below the average time required is 120 minutes. The approximate number of minutes required to complete each step may vary depending on the reaction and needs of the patients.
- Begin with an introduction. Explain to the patient that the intervention is meant to be interactive and that they should feel to discuss how they are feeling and ask questions at any time. (1 minute)
- Discuss patient’s expectations and how the treatment will proceed. (3 minutes)
- Assess patient’s smoking history including the total the number of cigarettes smoked per lifetime, association between smoking and other routine activities (e.g. having a coffee), and total number puffs per lifetime. (5 minutes)
- Discuss experiences with previous attempts to quit and reasons for relapse. (3 minutes)
- Describe the principles of nicotine dependence. Discuss how smoking is a learned behavior and changes that occur in the brain. (5 minutes)
- Discuss identifying with being smoke-free and enjoying it. (3 minutes)
- Discuss specific health consequences of smoking based on the patient's condition to help support motivation, including improved mental health. (5 minutes)
- Provide brochure titled “My Way to Smoke-Free”. (3 minutes)
- Discuss patient’s decision to quit smoking, including readiness, confidence in their ability to succeed, and their main source motivation. Have patient answer a series of questions found in the brochure. Responses are based on a 10 point,likert scale and responses may be revisited again at a later date. (5 minutes)
- Describe the principle behind measuring breathe CO. Explain patient’s specific values and how this relates to estimated nicotine intake from cigarettes. (3 minutes)
- Discuss importance of behavioral support and typical smoking situations they will encounter (coffee, alcohol, smoking environment, food, stress, peace / rest, waiting, in the car, in the restaurant ...). Work with the patient to prepare smoke-free solutions in advance and encourage them to look forward to these situations. (20 minutes)
- Discuss the importance of rewarding yourself for small successes. (3 minutes)
- Discuss strategies to prevent weight gain, as well as the connection between smoking and stress. (10 minutes)
- Discuss alternative relaxation techniques (deep breathing or yoga, Jacobson, etc). (3 minutes)
- Discuss possible barriers to quitting, and how being aware of these barriers can decrease the likelihood of relapse. (5 minutes)
- Discuss the importance of social support, as well as strategies for living and/or working with a smoker. Discuss how to refuse a cigarette. (3 minutes)
- Discuss withdrawal symptoms. (5 minutes)
- Discuss the principles of physical dependence, and the specific FTCD score of the patient. Show video demonstrating the effect of smoking on dopamine release. (7 minutes)
- Discuss pharmacotherapy options. Describe drug’s mechanism of action and any possible side effects. (10 minutes)
- Discuss the cost of pharmacotherapy and possibility of reimbursment. (1 minute)
- Discuss indication for use of pharmacotherapy and the recommended length of treatment. (7 minute)
- D-Day, any smoking is smoking. (2 minutes)
- Questions 8Date of the next visit (usually within two weeks after the initial intervention).