Tobacco Addiction and Mental Health
"Are you doing all you should?"
Thoughts on smoking cessation preventative counseling strategies - for REAL SUCCESS.
~ by Richard K. Nongard, LMFT/CPFT/CCH
When I began working in addiction counseling 18 years ago, the counselors and the clients would always choke down a quick cigarette before going into group therapy, then we would take a smoke break half-way through the session, and then we would have a cigarette and lighter in hand on our way out the door when group was over. In those days, we told new admissions that they didn’t need to bring anything with them to treatment—not even clothing—but don’t forget to pack a carton of cigarettes.
Fast forward 18 years: We now work in smoke-free buildings and most of the addictions counselors I know, even the ones in personal recovery from drug or alcohol addiction, have quit smoking.
As a marriage and family therapist, I have worked with couples who divorced over smoking. In our adversarial family court system, the continued smoking of one parent has become a battle cry for child custody fights. In my work with offenders, I have met clients who were reincarcerated for their inability to pay restitution, yet somehow they had always found $300 a month to continue feeding their nicotine addiction with cigarettes.
But in some ways our therapeutic point of view remains unchanged: tobacco is still viewed as a “minor” thing, like caffeine or video game addiction, even though cigarette smoking impacts more client lives than alcoholism or drug abuse, and with quite similar devastating consequences.
Mental Health Counselors are in the business of promoting health and happiness!
We know that quitting smoking reduces depression and anxiety, decreases physical pain, promotes healing and is more effective than Viagra for helping people achieve sexual satisfaction.
We should recognize that smoking cessation treatment is both a professional obligation and opportunity. Acting on this recognition can open doors and enhance our professional identify.
If we treat the depressed client who smokes, and we fail to also provide intervention and support for overcoming their nicotine dependency, the powerlessness of their addiction is self-defeating. The physical impact of nicotine on the brain reinforces their depression, and their recovery will be slowed. This is not good therapy.
Effective treatment for depression must include the assessment of nicotine dependency and interventions designed to assist clients in becoming smoke free. Clients with sleep disorders, sexual difficulties, anxiety disorders and many other psychiatric conditions simply cannot fully recover without quitting smoking, and therapists are uniquely qualified to provide this service.
Treatment of tobacco dependency is also an opportunity, especially for private-practitioners and those who desire to build niche markets and create relationships with organizations outside the traditional world of counseling, such as with fitness centers and corporate clients. I meet a lot of therapists and social workers who are frustrated by limited vocational opportunities, but progressive clinicians will find new avenues of practice by offering smoking cessation treatment services.
For example, as more and more employers demand smoke-free workplaces, they also seek experts to assist their employees with the transition. Becoming a part of this growing trend is an opportunity to use our counseling skills in unique corporate settings.
In order to effectively treat tobacco dependency, those who provide social work and counseling services must understand and recognize certain truths – then take action on them.
- There is a need for professionals to become educated about tobacco addiction counseling and the use of Clinical Hypnotherapy and Nicotine Replacement Therapy.
Nicotine addiction treatment is different than alcoholism counseling, and unique training programs designed to assist the 58 million tobacco users in our country must be created.
The US Surgeon General’s office has done the research and determined that the most effective way for a person to quit smoking is to receive individual counseling, in conjunction with NRT and structured peer support. Without using NRT, Clinical Hypnosis counseling has been found to be a most effective intervention.
Who is more suited than a mental and behavioral health counselor to provide individual and group therapy sessions, clinical hypnotherapy services, and work with physicians for medication referrals?
After 30+ years of primarily applying an “AA” model of recovery to addiction, the concepts of clinical hypnotherapy and NRT therapy can be awkward to clinicians. Taking CEU or continuing education training courses to gain knowledge on how to effectively recommend NRT and how to assist clients in succeeding at smoking cessation using clinically proven methods such as hypnosis, rather than unproven techniques, is essential.
- A person can only function as well emotionally as they are physically.
Smoking decreases oxygen flow to the brain, the heart and other vital organs. Smoking causes and exacerbates anxiety and depression. Smoking creates and complicates debilitating illnesses, and contributes to fatigue, back pain and sexual dysfunction.
If a client’s body is under assault from years of tobacco addiction, is it any wonder that they are depressed, anxious, angry, confused, frustrated, manipulative, resistant, desperate, despondent, unmotivated, or lack follow-through, and that their recovery is slowed, hampered or even completely impeded?
The days of treating sexual dysfunction, emotional difficulties, anger management, major depression and other conditions without addressing our clients’ addiction to nicotine are over. Or, if they are not over for you, they need to be! The relationship between physical and emotional wellness is unmistakable, and ignoring the issue most damaging to a client’s physical health is not a hallmark of good therapy.
- Smoking meets specific needs.
Yes, smoking is bad for a person and everyone knows it will kill them, but the minute a smoker lights up, these long-term consequences are outweighed by the immediate short-term rewards.
Everyone smokes for different reasons, and at different times. Thorough assessment should be done with each client to discover exactly when and why they smoke, so that you can create effective and appropriate intervention and relapse prevention strategies. A popular tool to aid in this assessment is the “Why do I smoke?” Quiz, developed by the American Academy of Family Physicians, with help from the American Cancer Society.
From socialization to relaxation and stress management, any successful tobacco cessation program must recognize a client’s specific short-term positive needs that are met (albeit negatively) through smoking, and incorporate alternative methods of meeting these same needs in the client’s life.
- Relapse prevention strategies must draw on a client’s existing strengths and resources.
Anyone can quit; it’s staying quit that is so difficult. Relapse prevention must begin during the initial assessment process, not at the end of treatment. The clinician needs to know exactly what the client’s strengths and resources are, and exactly how they should be implemented before, during and after the quit date.
When we incorporate relapse prevention into counseling at the commencement rather than the conclusion of therapy, we increase our efficacy and client satisfaction.
- We must demand recognition and reimbursement.
Medicare will now cover smoking cessation counseling for certain senior beneficiaries - but only when services are provided by medical doctors, psychologists, nurses or clinical social workers.
As a profession, we must lobby for equal access to third party reimbursement and educate lawmakers on the efficacy of mental health counselors treating tobacco addiction. The mental health counselor is uniquely qualified to provide smoking cessation services. There are indicators that counselors are even more successful in helping clients succeed at smoking cessation than nurses and other healthcare providers.
There are so many compelling reasons to impact clients by incorporating tobacco cessation counseling into our repertoire of services. As the importance of this practice becomes the normal attitude in our profession rather than the exception, we can easily create even more business opportunities by lending our services to corporations creating smoke-free work zones, consulting with fitness centers seeking to provide wellness services to customers, and offering extended private practice services.
Mental and behavioral health counselors who are able to incorporate smoking cessation services into treatment not only enhance client outcomes, but also increase vocational options and opportunities. Incorporating important components such as relapse prevention and fitness into treatment plans, enhances outcomes and allow counselors to offer unique services drawing on their existing professional skills.
I hope this information has been helpful to you, and that in encourages you to “think outside the box” when it comes to delivering practical mental and behavioral healthcare services.
~ Richard K. Nongard, Executive Director
Licensed Marriage and Family Therapist
Certified Personal Fitness Trainer
Certified Clinical Hypnotherapist
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NBCC, NAADAC and State Board approved Online and Homestudy CEU courses and intensive professional development continuing education specialty certification training programs on tobacco cessation treatment and clinical hypnosis training are available for substance abuse, social work and mental health counseling professionals by PeachTree Professional Education. For complete state CE board approval listings, see our approvals page.
For more information on these Certification and CEU programs, see:
Certified Tobacco Cessation Treatment Specialist
Certified Clinical Hypnotherapist
The contents of these CE/CEU/CNE courses and certification programs are appropriate for use all mental health professional counseling counselors (LPC, LCPC, LPCC, MHC, RMHC, NCC), marriage and family therapy therapists (MFT, LMFT, RMFT), social work social workers (SW, LCSW, LMSW, SWA, LICSW), psychologists, psychology associates (LPA), chemical dependency substance abuse counselors (LCDC, CADC, CAD, DAC, CAAD, CSAC), and nursing registered nurses (RN, CRN, CNA, LPN, LVN), and related behavioral health professionals.
Peachtree Professional Education, Inc.
Voice: (800) 390-9536
Fax: (888) 877-6020
