Counseling Clients to Quit and Facilitating Groups
Motivational Interviewing
Motivational Interviewing Techniques
Reflective Listening
Recovery-Oriented Therapies
Solution-Focused Brief Therapy
Social Support
Behavior Modification
Relapse Prevention / Management
Components of Group Work
What Makes a Good Group Facilitator?
Intervening
Types of Interventions
Providing Constructive Feedback Tips
Open and Closed-ended Questions
Working with Client Behavior
 

Recovery-oriented therapy is based on an addictions model. This treatment modality approaches tobacco use as a “real drug,” comparable to other major addictive substances such as alcohol, cocaine, and heroine. The addictive aspects of nicotine and tobacco use are used in the service of quitting tobacco, as opposed to viewed as obstacles to quit (Rustin, 1977). Within the scope of the addictions framework, it is imperative that treatment providers set boundaries with, and serve as role models for, their clients
(Rustin, 1999; 1998).

How Addiction Recovery Principles Can Be Applied to Nicotine Dependence Treatment

Acceptance of the Problem: Stages Involved

• Dealing with denial (the unconscious inability to see the truth).
   
  Using logic is ineffective at this point. When clients are in denial, the goal is to increase their level of ambivalence.
  
  “Assume you can recover.”
  “Your energy level (coughing, emphysema) is going to improve after you quit smoking.”      
   
• Exploring Ambivalence
   
  Spend time decreasing fear, reframing fearful feelings/statements.
  A client’s anxiety about losing his tobacco-using friends if he quits using tobacco can be reframed with a questions such as, “What else do your friends like about you?”
   
  
• Investing in the future 
   
  “What would be good about being a non-smoker?"
  “How’s your life going to be better off after you have quit tobacco?”
  
  Agree with whatever the client responds and prompt client to be as specific as possible.
    
  
• Surrendering
   
  Client is able to give up preconceived notions regarding the addiction.
   
• Support
   
  Client is able to seek support in the form of either individual or group or both.
  (Rustin, 1999; 1998).
   
  

Relapse Prevention

• Action Stage
   
  Client is not yet totally comfortable with newly adopted behavior. The cognitive process my involve wondering, “How hard do I have to work at this?”
   
  Evaluate the specific threats with the client. Ask what has worked in the past. Offer what other clients have tried that was successful and ask if any of those options could help.
   
• Maintenance
   
  Encourage clients to give support to others as a way to remain committed to abstinence.
  (Rustin, 1999; 1998)
   
  

How Treatment Providers can use Recovery-oriented therapy with tobacco-dependent clients

• Frame the discussion around tobacco use by using the terms “addiction” and “dependency.”
   
• Help clients understand that tobacco use is an addictive disorder that alters perception, affects thinking, and reduces choices; it is not merely a habit.
   
• Help clients to recognize and address defenses and to accept loss of control.
   
• Emphasize the “relationship” clients have with tobacco; how their behaviors and thoughts express that relationship (Rustin, 1997)

Example: A client recounts how, when she was on vacation with her husband and they had unpacked and settled in for the night at the hotel, she realized she had run out of cigarettes. She had to get dressed, drive to the nearest store, and purchase cigarettes.

The question to pose to the client would  be: “What does that tell you about your relationship with tobacco?”

• Suggest to clients to consider using recovery programs
  (www.nicotine-anonymous.org)