Tobacco Unfiltered: Conversations with Clinicians

Most tobacco use treatment options are indicated for those individuals who are "ready to quit" but evidence suggests that up to 70% of individuals are not yet ready.  What treatment options are available for these patients? Dr. Jessica Cook, a psychologist and investigator at the William S. Middleton Memorial Veterans' Hospital and Professor at the University of Wisconsin joins to discuss her rese...

E-cigarettes have evolved considerably since their introduction in 2007 and are now highly efficient nicotine delivery devices that often lead to physiological and behavioral dependence. Not surprisingly, there is a growing subgroup of e-cigarette users or vapers who want to stop, yet little research is available regarding cessation treatment. Ultimately, e-cigarette use can lead to nicotine depen...

Veterans with posttraumatic stress disorder (PTSD) have high rates of concurrent smoking. PTSD symptomatology can pose specific challenges to treating tobacco use in Veterans. Dr. Eric Dedert, a psychologist from the Durham VA Medical Center, VISN-6 Mental Illness Research, Education, and Clinical Center, and Duke University joins to discuss how patients may use smoking to manage PTSD symptoms, ho...

Although tobacco use is common among individuals treated for substance use disorders (SUDs), many treatment settings do not address it. Evidence indicates that tobacco related disease is more likely to cause mortality among individuals treated for SUD’s than their substance of abuse, that stopping smoking does not impede recovery and may be associated with improved SUD outcomes. Dr. Andy Saxon, an...

Mental health care providers are optimally positioned to provide tobacco use treatment as they are well trained to address behavior change and have close and trusted relationships with their patients. Drs. Jennie Leskela and Kyle Curry, clinical psychologists from the Minneapolis VA Health Care System, join to discuss their work integrating tobacco use treatment into mental health care, originatin...

Health care providers are increasingly seeing adult patients who use nicotine-containing vapes or e-cigarettes asking for assistance with stopping their use. There is limited guidance available to health care providers on evidence-based e-cigarette treatment. Dr. Andrea Pratt, a psychologist and Assistant Clinical Director at Kick It California joins to discuss the CA state quitline’s approach to...

Only 30% of tobacco users are ready to quit at any given clinical encounter. How can health care providers encourage patients to consider making changes to their tobacco use and to utilize evidence-based treatments for quitting? Dr. Brenton Roman, a psychologist at the VA San Diego Healthcare System joins to discuss motivational interviewing techniques and how they may be incorporated into a clini...

The National Director of Tobacco & Health Policy for VA, the largest integrated health care system in the US, Dr. Kim Hamlett-Berry, PhD, joins to discuss key elements to facilitate tobacco treatment at the healthcare system level, primary challenges to implementing tobacco treatment and future directions for further reducing the prevalence of tobacco use.

Tobacco use is a chronic, relapsing condition. Dr. Megan Kelly, PhD, Veterans Integrated Service Network (VISN) 1 Tobacco Cessation Lead and Associate Professor of Psychiatry at University of Massachusetts Chan Medical School, joins to discuss the continuum of addiction and treatment needs for tobacco dependence. She also describes strategies and key elements for setting up a comprehensive tobacco...

I’m busy and have limited time with patients, how do I fit this in? A pulmonologist at the Minneapolis VA and faculty at the University of Minnesota School of Medicine, Dr. Anne Melzer, MD, joins to discuss why she prioritizes and how she incorporates assessment and advice for tobacco cessation into her patient visits. She describes typical patient responses, how to address them and what constitut...

Nicotine patches, gum, lozenges, varenicline – how well do these work? And how do you decide which medication to use? Dr. Timothy Chen, PharmD, Director of the VA Tobacco Cessation Clinical Resource Center, joins to discuss how to consider medication effectiveness in the context of an addiction, the decision-making process for choosing medications, and how to address patient reluctance to use toba...

An important part of evidence-based treatment, counseling may sound a little intimidating to both patients and providers. Dr. Ellen Herbst, MD, Associate Chief of Addiction Treatment at the San Francisco VA and clinical professor at University of California, San Francisco, joins to discuss what counseling involves, how to provide brief counseling, and how to tailor your approach for patients who m...

People with mental health conditions smoke at higher rates, have more difficulty quitting and less access to tobacco treatment. Dr. Jodi Prochaska, PhD, Professor of Medicine at Stanford University, a preeminent researcher on tobacco treatment in mental health populations, joins to discuss the importance of treating tobacco use in this population, how to effectively do so, and debunks myths that p...

We know smoking is bad for health, but it goes well beyond lung cancer. Dr. Brenna VanFrank, MD, Senior Medical Officer for the Centers for Disease Control & Prevention (CDC), joins to discuss the many impacts of tobacco use –physical health (13 types of cancer), mental health and consequences of addiction. She reminds us why every single health care provider across disciplines and specialties sho...