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 research to develop interventions for individuals who are not yet ready to stop smoking.

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 dependence, and while there are unique features of e-cigarette use, there remains much in common with combustible cigarette dependence, providing us an important basis for implementing e-cigarette treatment. This podcast convenes a panel of treatment professionals with experience addressing e-cigarette cessation to discuss strategies for assessment, motivations for e-cigarette cessation, behavioral and pharmacological approaches to treating vaping and some of the unique challenges to addressing this addiction.

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, how providers can address this behavior, and suggests actionable steps providers can take to concurrently address both PTSD and smoking.

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 addiction psychiatrist and Director of VA’s Center of Excellence in Addiction Treatment and Education at the VA Puget Sound Health Care System, joins to discuss the importance of addressing tobacco use in the context of SUD treatment, the impact of smoking on a patient’s recovery, how psychiatrists are ideally suited to treat tobacco use, and how they can incorporate it into their clinical practice.

Find your nearest VA: https://www.va.gov/find-locations

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, originating in a research study integrating tobacco cessation into PTSD care. They have continued implementation of the integration protocol across mental health clinics at their medical center through creation of a network of clinical champions. Drs. Curry and Leskela together have decades of experience providing tobacco use treatment and share anecdotes demonstrating the effectiveness of this model of care and the professional fulfillment they’ve experienced in being able to provide this treatment to Veterans.

Find your nearest VA:https://www.va.gov/find-locations

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 treating vape use among adults and outlines what health care providers can do to assist patients who want to stop vaping.

Find your nearest VA: https://www.va.gov/find-locations

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 clinical encounter for patients at any stage of change.

Find your nearest VA: https://www.va.gov/find-locations

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 treatment program in a medical center.

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 constitutes a minimal intervention by a provider.