The following examples illustrate the wide variety of cessation providers and the importance of uniform certification standards for all providers. Additionally, the examples below show the various levels of certification a provider might choose, depending on his/her situation.

Example: Barbara Millstone is a cessation coordinator who has been providing cessation services for over a year. Prior to that, she was a counselor for five years at an alcohol and drug treatment center. She is trained as a registered nurse and worked in hospitals for over ten years. Barbara teaches a six-week class consisting of about 15 clients. She is well versed in pharmacological therapies and able to explain to clients the many advantages of using Nicotine Replacement Therapy (NRT) or non-nicotine medications. In addition to teaching classes, Barbara organizes and keeps records for all other providers at her Local Project, so she is experienced in supervision and handling difficult situations. She has a Basic Skills certificate and is scheduled to attend a Treatment Specialist training, in order learn more about the specific issues in counseling tobacco dependent clients.

Example: Jim Flores is a recent college graduate with a degree in business. He worked at a drug rehabilitation facility for a couple of months during college, as well as working as a crisis counselor for the college drug and alcohol helpline for 3 months as part of an internship. He was hired for a position in his rural community as a tobacco cessation counselor. Jim is familiar with the community and is effective at recruiting tobacco users. He counsels tobacco dependent clients once a week for 40 minutes, over five weeks. He also volunteers at a local hospital, where he commonly performs brief interventions. Jim would like to see the staff at the hospital better trained, so more brief interventions could be delivered. Jim would like to attend a Basic Skills training, and eventually become a Basic Skills Instructor.
 

Program Content (click here to see what the standards are)

The content of a tobacco treatment program is similar to the curriculum used. Content may include modifications to a published curriculum, or independently designed course material. Content also includes other printed material, videos, or audiotapes that are distributed to the clients. Cultural and language adaptations made to the material presented are also part of the program content. A guest speaker or weekly exercise routine during instruction are other examples.
 

Program Format (click here to see what the standards are)

Each tobacco cessation program has its own unique format. Format is a description of how the services are delivered. Most services include a variety of formats, such as:

• Group or individual sessions
• Follow-up interviews with clients
• Discussion by the participants
• Lectures by the instructor
• Meeting occasionally at an outside location
• Proactive telephone counseling sessions offered

Tobacco treatment programs typically offer several formats, but tend toward either group or individual treatment. Most programs emphasize either a counseling approach or an educational approach, but many successfully combine the two approaches.
 

Session Format (click here to see what the standards are)

A session is a contained period of time during which tobacco treatment clients receive services. Unless the client is receiving a brief intervention, an intensive service lasts a minimum of 10 minutes.
Sessions rarely exceed one hour, but there is no upper limit for session length. Programs generally range from 1 to 10 sessions for the length of the program. Some sessions are ongoing, which means the client can begin or end at any time. Ongoing sessions are helpful for those clients seeking a support-group to prevent relapse. An average program has 6 sessions that last 30-60 minutes. In many cases, the curriculum used or the program content will determine the length and number of sessions.

Program format, program content, and session format often overlap. The three factors interplay in the two examples below:

Example: The "B.U.T.T.-Out"Cessation program includes 5 sessions, each lasting one hour. Clients meet at the local high school track for the second session and at a local restaurant for the last session. Nicotine replacement therapy medication (NRT) is distributed at the second session, after the group has walked for 20-minutes. The program emphasizes skill-building techniques to avoid tobacco use, such as a cigarette "replacement" kit that includes gum, sunflower seeds, and an "anti-stress" squeeze ball. Clients are given NRT at a significant cost reduction after completing the second session exercise class. Programs generally include 8-12 participants, who are encouraged to continue meeting as part of an ongoing support group after the program has ended.

Example: The tobacco cessation program offered at the Windy Pines Treatment Center begins the first Thursday of each month, and lasts for four weeks. Clients learn counseling-based approaches to quitting tobacco, with a heavy emphasis on stress-reduction techniques. All sessions are held at the Treatment Center, where NRT is offered at a 15% discount. The program focuses on treating small groups (no larger than 4) or individuals. Group participants are charged a nominal fee; individuals pay $40 per session. As part of the program, clients are expected to complete homework assignments. An ongoing support-group is offered free of charge after the last session.
 

Pharmacological Therapies (click here to see what the standards are)

Often referred to as Nicotine Replacement Therapy (NRT), pharmacological therapies are medications used to help tobacco dependent individuals quit or reduce tobacco use. The most commonly used forms of NRT are the nicotine patch and nicotine gum. The oral medication Zyban® is a non-nicotine replacement pharmacotherapy. There is a wide range of cost for these medications, depending on the program. (click here to view a comparison chart of costs)