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Don't quit yet
In contrast to the low cost, widely targeted smoking cessation model of NRT plus advice on quitting, there is a case to be made for a more extended and intensive counselling approach that attends to significant emotional and cognitive factors around smoking with clients who have already had several attempts at quitting. With this group, the first intervention may be to advise the client: "don't quit yet". This is not intended as a paradoxical injunction, but a realistic approach to the problem of premature resolutions to quit (Miller and Rollnick, 2002).
In this paper, case studies (from the presenter's experience as a smoking cessation practitioner in a general hospital setting) will be discussed that illustrate ways of working with clients who have a strong desire to stop smoking, but a history of failed attempts along with current unresolved thoughts and beliefs around smoking that act to consolidate powerful emotional and social reinforcement of the habit. Addressing these aspects of the smoking habit prior to quitting helps to prepare these clients for demoralizing reactions of anxiety, grief and loss, and a feeling of being overwhelmed by an unexpectedly difficult task. The client's preparation to progressively disassociate from all features of the smoking habit helps to minimize withdrawal distress, enhance confidence, and promote long-term success.
Ultimately, this is a model for adequate preparation as opposed to 'relapse prevention'.
My first involvement in smoking cessation work occurred some years ago in my practice as a public health nurse. This was followed by employment at the Otago Cancer Society as a trainer in providing brief intervention skills and NRT knowledge for health professionals. For the last 6 years I have been employed as a smoking cessation practitioner in a general hospital, receiving inpatient and outpatient referrals across the range of medical and psychiatric services. Working with such a variety of clients and associated issues around tobacco smoking continues to provide challenge and interest, particularly in an environment where the provision of specialist services is in the early stages of development.
Along the way I have received further training and support from mainstream addiction services and training institutions, including the use of Motivational Interviewing and cognitivist techniques. I have a particular interest in working with clients who have co-existing mental health and nicotine depedence problems.
My place of work is Dunedin Hospital in Dunedin(population 110,000), the southern part of New Zealand
Author 1: Heather Muir
Smoking Cessation Practitioner
Private Bag 1921