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
 

Due to the chronic relapsing nature of tobacco dependence, relapse prevention should be included in tobacco cessation treatment programs
(Fiore et al., 2000).  The primary goal of relapse management is to prevent the client’s setback from escalating, and to help the client develop competent coping strategies for present and possible future problems.
 

Major contributing factors to relapse

• Withdrawal discomfort
• Dependence level
• Social environment
• Stressful situations
• Loneliness and boredom
• Depression
• Postpartum
• Alcohol
• Weight gain
• Lack of social support

(Lisa Cox, Mayo Clinic Nicotine Dependence Seminar, 1999)

Relapse Prevention Methods

• Systematic follow up is critical to relapse prevention/management.
  (Fiore, 2000)
• All clients who receive tobacco dependence intervention should be assessed for abstinence upon completion of the intervention program and during subsequent contacts.
• Assessment within the first week after a quit attempt is encouraged.
• For abstinent clients, relapse prevention treatment should be provided.
• Clients who have relapsed should be assessed for their willingness to make another quit attempt. Additional treatment or an intervention to promote motivation to quit should be provided.
• Client should be offered information on more intensive treatment and support groups.(http://www.azdhs.gov/phs/tepp/index.htm) (Link to content page on Social Support)
• Pharmacotherapy should again be offered to the client.
  (link to pharmacotherapy content).
• Follow-up methods can include in-person visits, telephone, mail, e-mail.
  (Fiore, 2000)

Strategies for relapse intervention
 
“The goal is not just to prevent relapse; it is to gain the positive dimensions of recovery.” (Fisher, 2000)

Strategies for Preventing Relapse to Tobacco Use
(adapted from Fiore et al., 2000)

Minimal Strategies
To all former tobacco users, offer congratulations and encouragement to remain tobacco free. Using open-ended questions, engage clients in open discussions on the following:

• The benefits of quitting.
• Any successes client has had.
• Any problems encountered or anticipated threats to remaining abstinent.

Individualized Strategies
The following guide is suggested for responding to clients’ particular issues:
(Fiore, 2000)

Brief Strategies: Preventing Relapse to Tobacco Use
Brief Strategy C1. Components of minimal practice relapse prevention

These interventions should be part of every encounter with a patient who
has quit recently:
Every ex-tobacco user undergoing relapse prevention should receive
congratulations on any success and strong encouragement to remain abstinent.
When encountering a recent quitter, use open-ended questions designed to
initiate patient problem solving (e.g., How has stopping tobacco use helped you?).
The clinician should encourage the patients active discussion of the topics below:

• The benefits, including potential health benefits, the patient may derive from cessation.
• Any success the patient has had in quitting.
  (duration of abstinence, reduction in withdrawal, etc.)
• The problems encountered or anticipated threats to maintaining abstinence.  (e.g., depression, weight gain, alcohol, other tobacco users in the household.)

Brief Strategy C2. Components of prescriptive relapse prevention
During prescriptive relapse prevention, a patient might identify a problem that threatens his or her abstinence. Specific problems likely to be reported by patients and potential responses follow:

Problems Responses
Lack of support for cessation

• Schedule followup visits or telephone calls with the patient.
• Help the patient identify sources of support within his or her environment.
• Refer the patient to an appropriate organization that offers cessation counseling or support. Negative mood or depression.
• If significant, provide counseling, prescribe appropriate medications, or refer the patient to a specialist.

Strong or prolonged withdrawal symptoms

• If the patient reports prolonged craving or other withdrawal symptoms, consider extending the use of an approved pharmacotherapy or adding/combining pharmacologic medications to reduce strong withdrawal symptoms.

Weight gain

• Recommend starting or increasing physical activity; discourage strict dieting.
• Reassure the patient that some weight gain after quitting is common and appears to be self-limiting.
• Emphasize the importance of a healthy diet.
• Maintain the patient on pharmacotherapy known to delay weight gain.
  (e.g., bupropion SR, NRTs, particularly nicotine gum).
• Refer the patient to a specialist or program.

Flagging motivation/feeling deprived

• Reassure the patient that these feelings are common.
• Recommend rewarding activities.
• Probe to ensure that the patient is not engaged in periodic tobacco use.
• Emphasize that beginning to smoke (even a puff) will increase urges and make quitting more difficult.