Addressing Tobacco Use in Mental Health Settings Motivational Interviewing Materials Prepared By: Center for a Tobacco-Free Finger Lakes University of Rochester School of Medicine & Dentistry Department of Public Health Sciences (The information, contained in these slides, is current as of April 2015) 1

Promoting Motivation to Quit for Patients Not Ready for Action The Five Rs - Promoting Behavior Change Relevance (to their health) Risks to health (short- and long-term) Rewards (of quitting) Roadblocks (to success) Repetition (of the messages)

Promoting Motivation to Quit for Patients Not Ready for Action 5Rs Model (Motivational Intervention): This section discusses each of the 5Rs in detail (Relevance, Risks, Rewards, Roadblocks and Repetition). Discussing these with smokers who may be unwilling to quit provides a consistent message that smoking cessation is a process and it is the best thing anyone can do to improve their health. It allows for patient-centered discussions that can help clear up misconceptions about smoking and address their feelings of failure in past quit attempts. For more details click the link below:

Patient Who Has Considered Quitting But Not Ready to Quit Identify potential negative consequences of tobacco use, highlighting those that seem most relevant to the patient Encourage the person to speak specifically about why quitting is relevant to him or her Highlight benefits of stopping tobacco use… The clinician should ask the patient to identify potential benefits of stopping tobacco use Create a list with patient using: “I’m not ready to quit smoking but I am ready to…” Miller, G., Armon, T., & Bucciferro, D. The Role of Mental Health Professionals in Tobacco Dependence Treatment [PowerPoint Presentation]. Retrieved from

Encouraging Change

Strategies For Behavioral Change: Using the 5Ds The 5 Ds are behavior strategies to help fight the urge to smoke. D elay a minute or two and the urge will pass. D rink Water to fight off cravings. D o Something Else to distract yourself…walk, call a friend, clean a closet. D eep Breathe, it will relax you. Close your eyes and take 10 slow deep breaths. D iscuss your thoughts and feelings with someone close to you.

Helping Patients Identify Triggers Triggers The brain pairs smoking with ones activities, e.g., getting used to lighting up while driving or after meals. Identifying triggers and developing a plan will help when the urge to smoke hits.

Common Triggers Being around other smokers Drinking coffee Driving On Break Telephone Getting up in the morning Relaxing Finishing a meal Drinking alcohol Stress

MOTIVATIONAL INTERVIEWING STRATEGIES Explore with Empathy Develop Discrepancy Roll with Resistance Support Self-Efficacy

TECHNIQUES:  “What might happen if you quit?”  “What I heard so far is that your enjoy smoking but you’re concerned it will lead to a serious disease.”  Use Open-ended questions to explore  Use reflective listening to seek shared understanding EXPLORE WITH EMPATHY

TECHNIQUES:  “Many people worry about managing without cigarettes.”  “I’m here to help you when you’re ready.”  Normalize feelings and concerns  Support each patient’s autonomy and right to choose or reject change EXPLORE WITH EMPATHY

TECHNIQUES:  “How do you think your life would be different if you were not smoking?”  Highlight discrepancy between current behavior and expressed values DEVELOP DISCREPANCY

TECHNIQUES: Reflection  “Sounds like you’re feeling pressured about your tobacco use.”  Reflecting back to the client/patient is useful when being met with resistance ROLL WITH RESISTANCE

TECHNIQUES: Past Success  “So you were fairly successful the last time you tried to quit.”  Help patient to identify & build on past successes SUPPORT SELF-EFFICACY

 Read about quitting benefits and strategies.  Change smoking patterns.  Ask patient to share his/her ideas about quitting strategies.  Call the quitline ( ) for advise and information.  Offer options for achievable, small steps toward change TECHNIQUES: Smaller Steps