MultiCare Tobacco Cessation Workbook - www.multicare.org/tobacco-cessation - A guide towards quitting for good
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MultiCare Tobacco
Cessation Workbook
A guide towards quitting for good
www.multicare.org/tobacco-cessation
BROUGHT TO YOU BY
(Rev. 1/21)
Are you willing to make a quit attempt?
Month__________ Year___________
If you are a current smoker, please answer these simple questions
to help understand your willingness to quit smoking.
If I could quit smoking I would.
Completely Disagree Somewhat disagree Neutral Somewhat agree Completely agree
I want to quit smoking because I worry about how smoking affects
my health
Completely Disagree Somewhat disagree Neutral Somewhat agree Completely agree
I would be willing to make a plan to quit smoking.
Completely Disagree Somewhat disagree Neutral Somewhat agree Completely agree
I would be willing to cut down my number of cigarettes before quitting.
Completely Disagree Somewhat disagree Neutral Somewhat agree Completely agree
NOTE: This tool is not validated. It is intended to provide directional guidance to help assess a patient’s willingness to make a quit attempt.
MultiCare Tobacco Cessation Workbook 1 INDEX Introduction...............................................................................................................3 Increasing Your Odds of Quitting........................................................................4 Making A Quit Attempt..........................................................................................5 Things To Consider Before Your Quit Date Your Reasons To Quit..............................................................................................7 Identify Your Smoking Risk Situation............................................................. 10 Are You Addicted To Nicotine?...................................................................11-12 Being Prepared With Quit Strategies.......................................................13-14 Make a Clean Sweep.....................................................................................15-16 Form Your 24-Hour Action Plan To Succeed on Quit Day..................17-18 On Your Quit Day Quit Medication..................................................................................................... 19 Understanding Nicotine Withdrawal Symtpoms......................................... 20 Treat Your Symptoms.......................................................................................... 21 Staying Smoke Free Check Out Your Health Benefits Package..................................................... 23 Create Your Own Personal Quit Kit................................................................. 24 High Risk Situations For Relapse..................................................................... 25 Handling Set Backs........................................................................................26-27 List The Triggers That Caused You To Relapse............................................ 28 Restore Your Body Through Good Nutrition..........................................29-30 Quitting Smoking Without Weight Gain......................................................... 31 Get Physical To ImproveYour Odds of Quitting for Good....................32-33
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MultiCare Tobacco Cessation Workbook 3 INTRODUCTION Smoking cessation is one of the best things you can do to increase your quality of life. We welcome you on this journey to improve your health! This booklet provides the tools you need to: • Decide To Quit • Prepare to Quit • Choose Your Quit Day • Develop Healthy Life Habits • Stay Quit Additional Resources If you have questions, call MultiCare’s Tobacco Cessation Team between 8:00 am and 4:00 pm at 833-976-1807 • Washington State Quitline 1-800-784-8669 • https://www.quit.com • www.multicare.org/tobacco-cessation
4 MultiCare Tobacco Cessation Workbook Increasing Your Odds Of Quitting To raise your odds of permanently quitting, add these three elements to your quit plan: • Temporary quit medications, either over-the-counter or prescription as directed by your health care provider (See page 19) • Create a support system amongst your friends, family members, or support group. • Obtain counseling or coaching for effective quit skills from a health care provider
MultiCare Tobacco Cessation Workbook 5 Making A Quit Attempt If you are willing to make a quit attempt, please consider the following steps: • Call your Health Care Provider right now to make an appointment to discuss quit medications and the best treatment plan for you • Complete this booklet to gather ideas and quit strategies • OR - call the Washington State Quitline at 1-800-784-8669. Available 24 hours a day
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MultiCare Tobacco Cessation Workbook 7 THINGS TO CONSIDER BEFORE YOUR QUIT DATE Your Reasons to Quit There are many reasons to quit smoking. Which ones are most important to you? Look at the list on the next page, check off the reasons that apply to you, and add any extras you can think of.
8 MultiCare Tobacco Cessation Workbook Personal Reasons For Quitting The following is a list why I would like to stop smokng tobacco. I’m ready for a change. Smoking is affecting my relationship. I want fewer sick days and lost wages. I want to improve my health. I want to save money by not purchasing cigarettes I’m planning on having a baby I want to enjoy the smell and taste of food I am tired of standing outside in the cold It’s becoming harder to find places to smoke Almost everywhere I go smoking is not allowed I don’t want to expose my family and friends to second hand smoke ____________________________________________ ____________________________________________ ____________________________________________
MultiCare Tobacco Cessation Workbook 9 Stay Inspired! One of your reasons for quitting may be a family member. It may be an activity, hobby you currently enjoy, or a vacation you plan to take. Whatever it is, create a quick visual reminder by taping a photograph on your refrigerator or keep it in your wallet. “I want to quit for......”
10 MultiCare Tobacco Cessation Workbook Identify Your Smoking Risk Situations Smoking can become automatic for a lot of people. Your may not even realize when and why you smoke. Take time to mark the situations below that trigger you to smoke. Times of day Mealtimes, or just after a meal When I get home from work Watching TV or listening to the radio Talking on the phone Having a cup of coffee or tea When I first wake up ____________________________________________ People Being with other smokers When someone offers me a cigarette Family stress Meeting a friend who smokes ____________________________________________ Places At work At home Outdoors ____________________________________________ Feelings Angry Bored Happy or relaxed ____________________________________________
MultiCare Tobacco Cessation Workbook 11 Are You Addicted To Nicotine? The Fagerström Quiz for Nicotine Dependence is designed to help you and your doctor determine how dependent you are on nicotine found in cigarettes. How soon after you wake up do you smoke your first cigarette? After 60 minutes (0) 31-60 minutes (1) 6-30 minutes (2) Within 5 minutes (3) Do you find it difficult to refrain from smoking in places where it is forbidden,for example: in church, at the library, at the movies, et cetera? Yes (1) No (0) Which cigarette would you most hate to give up? The first one in the morning (1) Any other (0)
12 MultiCare Tobacco Cessation Workbook Are You Addicted To Nicotine? Pt.2 How many cigarettes a day do you smoke? 10 or less (0) 11-20 (1) 21-30 (2) 31 or more (3) Do you smoke more frequently during the first hours after waking up than during the rest of the day? Yes (1) No (0) Do you smoke even when you are so ill that you are in bed most of the day? Yes (1) No (0) To determine your score, add up the numbers next to each of your answers. If your score is between 0 and 5 points, your dependence on nicotine is in the low to moderate range. If your score is between 6 and 10 points, you are very dependent on nicotine. In either case, you should talk to doctor about finding a treatment plan that is right for you.
MultiCare Tobacco Cessation Workbook 13 Being Prepared With Quit Strategies A Quit Strategy is a concrete way to fight an urge to smoke. It can help you deal with specific situations. Having a Quit Strategy ready in advance may help you overcome risk situations. Take a look at the following common Quit Strategies for ideas.
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Being Prepared With Quit Strategies
Talk It Out • Call, text or visit a supportive friend to find the
distraction you need to keep you from thinking about
smoking.
• Remember, there are quit hotlines, and online
support communities that can help you through
tough moments.
Do Something • Exercise, walk, work in the garden. Keep your body
Active moving. This may energize you and make you feel
healthier.
Go Somewhere • Visit a non-smoking friend’s home, or go to the
You Can’t Smoke movies or a mall. Knowing that you’re in a place
where you can’t smoke can take some of the
pressure off you.
Carry a Water • Drinking water will keep you hydrated. And it gives
Bottle your mouth and hands something to do.
Keep Your • Take up sudoku, origami, or knitting. Perfect your
Hands Busy yo-yo or Frisbee skills. Try playing mobile games.
Leave the • Your urge to smoke may go away if what’s causing
Situation the urge is no longer in front of you. Go for a walk and
focus on something else. It can help you clear your
head.
Switch up the • By switching up your routine, you’re breaking links
Routine you have formed between smoking and certain
activities. Do something different than your usual
routine after getting home from work.
Quieting • Practice a quieting response by breathing in deeply
Response through your nose while smiling inwardly; hold that
breath for four counts; release the breath through
your mouth. Repeat about four times.MultiCare Tobacco Cessation Workbook 15 Make A Clean Sweep Create a Cigarette-Free Zone! Go through every place you may have cigarettes and get rid of them. Look in your bags and the glove compartment of your car. Check coat pockets. And don’t just throw the cigarettes in the trash. Destroy them! Tear them in half. Run water over them. Flush them down the to ilet. Oh, and get rid of all the butts, too. Make sure to get rid of all of your cigarettes; don’t keep an emergency pack hidden anywhere, because that’s planning for failure. And this quit is all about planning for success. Take a look at the blueprint below, follow the suggesti ons and make a clean sweep of your home.
16 MultiCare Tobacco Cessation Workbook 1. Laundry Room: Wash that smoke out of your clothes, towels, and sheets. Try using a fabric sheet in the dryer to scent your clothes. 2. Kitchen: Do you smoke with your morning coffee or while reading the paper? Buy tea instead to try to break that link. Read the paper somewhere else. And if you smoke after meals, try getting up from the table and doing something else, like washing the dishes. 3. Bedroom: Go through all of your closets and check your pockets, handbags, briefcases, and suitcases for cigarettes, lighters, and matches. Buy an air freshener to create a more pleasant atmosphere. 4. Living Room: Vacuum. Use carpet freshener, too. Dump the ashtrays and replace them with a dish of sugar-free candy. Move your favorite smoking chair to help avoid old habits. 5. Patio: Do a clean sweep. Search for old cigarette butts on the ground and get rid of outdoor ashtrays. 6. Garage: Cigarettes, lighters, empty packs — trash them. Vacuum the interior of your car. Wipe down surfaces. Really clean out that ashtray. Consider buying a car air freshener as well.
MultiCare Tobacco Cessation Workbook 17 Form Your 24-Hr Action Plan To Succeed On Quit Day This To-Do list of strategies is designed to help you get through your Quit Day. Doing a little prep work can take some of the guesswork out of your day. This should help boost your self-confidence and resolve. Remember, you have 1 goal for the day – to get through it without smoking. Look at High Risk Situations for Relapse, page 25, and Being Prepared With Quit Strategies, page 14. Take a moment to think about today, your quit day. What situations might I run into? Which Quit Strategies can help me get past them? Use these ideas to create your plan. Consider treating yourself on your quit day. For some it may be a massage or facial, or attending a movie.
18 MultiCare Tobacco Cessation Workbook
Form Your 24-Hr Action Plan To Succeed
On Quit Day
Feel the Urge to Smoke?
Try the Four D’s
Delay - the urge will pass within 3-5 minutes
Deep breathe – holding in for four counts; out for 8 counts
Drink water - focus on drinking 8 cups a day
Distract - yourself with an activity
Smoking Risk Situations Your StrategiesMultiCare Tobacco Cessation Workbook 19 ON YOUR QUIT DAY QUIT MEDICATIONS MAY DOUBLE YOUR CHANCES OF QUITTING SUCCESSFULLY The journey of quitting smoking includes: • Overcoming the physical addiction to nicotine • Learning how to live without tobacco Quit medications work for you by making cravings less intense and withdrawal more manageable. This helps to free your energy to find new ways to live without tobacco. Quit medications include: • Over-the-Counter (OTC) drugs – nicotine replacement patch, gum, lozenge, inhaler • Prescription drugs –Varenicline (Chantix) and Bupropion (Wellbutrin, Zyban) • Combination therapies Ask your doctor about options that may be right for you. For additional support, MultiCare offers pharmacist face to face or telehealth visits. The Pharmacy Team offers: • Prescriptions • If there are cost issues or other concerns with the medications, the pharmacist can help you explore options • Education for getting the most benefit from quit medications • Quit coaching These services are covered by most insurance plans. Ask your provider to refer you to our Pharmacy Team.
20 MultiCare Tobacco Cessation Workbook Understanding Nicotine Withdrawal Symptoms When you stop smoking, your body may go through a physical withdrawal from nicotine, which may lessen over time. Here are some of those common nicotine withdrawal symptoms to be aware of: • Depressed mood • Feelings of frustration • Anxiety • Anger • Irritability • Urge to smoke • Difficulty concentrating • Restlessness • Insomnia • Increased appetite If you experience some of these symptoms, remember, they are part of the quitting process. They will resolve, and knowing what to expect can help you be better prepared!
MultiCare Tobacco Cessation Workbook 21
Treat Your Symptoms
Remember, these problems do not last long, and they are signs that your
body is healing. Once you make it through a week or two, you’ll be on your
way to feeling a lot better!
If You Are Try...
Experiencing...
Cough, dry mouth • Drink plenty of fluids. Try cough drops.
or nasal drip
Headaches • Use over-the-counter pain relievers. Take a warm
bath or shower. Rest.
Dizziness • Take extra caution when rising from a lying or seated
position. Move slowly.
Constipation, gas • Drink lots of fluids. Add fiber to your diet (fruits,
or stomach pain vegetables, whole grains, beans, cereals). Walk daily.
Hunger • Drink water or low-calorie liquids. Be prepared with
low-calorie snacks such as raw vegetables and dry
and fresh fruit.
Fatigue • Get at least eight hours of sleep per night. Take naps.
Stay active. Consider nicotine replacement therapy.
Insomnia • Avoid caffeine after 6pm. Take warm baths or do a
relaxation exercise before going to bed.
Irritability • Go for walks. Do the relaxation exercise. Try using a
quit-smoking medication.
Lack of • Plan workload accordingly. Avoid extra stress as
Concentration much as possible during the first few weeks.
Cravings for • Wait out the urge - urges last only a few minutes.
Cigarette Use the Four D’s: Delay; Deep breathe; Drink water;
Distract yourself to take your mind off smoking.22 MultiCare Tobacco Cessation Workbook
MultiCare Tobacco Cessation Workbook 23 STAYING SMOKE FREE CHECK OUT YOUR HEALTH BENEFITS PACKAGE
24 MultiCare Tobacco Cessation Workbook Create Your Own Personal Quit Kit EMERGENCY KIT ESSENTIALS Make an emergency kit you can turn to when you have an urge to smoke. Your kit can help you substitute healthier habits for cigarettes. Here are some ideas: • Breath mints or Nu-Breath • Fruit and Veggies • Mobile Games • Sudoku, Crossword Puzzles • Snacks • Straws • Flavored Toothpicks • Water Bottle
MultiCare Tobacco Cessation Workbook 25 High Risk Situations For Relapse • Being around friends who smoke • Places where you used to smoke • Feeling hungry, angry, tired or lonely • Bars and alcohol • Telling yourself “I can have just one”
26 MultiCare Tobacco Cessation Workbook Handling Set Backs What if you slip up and relapse? Know that it is common to slip or relapse as well as to feel disappointed if it happens. Remember, most tobacco users try to quit several times before quitting for good. Ways to Get Going Again Instead of blaming yourself if you slipped and used tobacco, think about what you learned, and how you feel about yourself for slipping. Remember, it takes courage and persistence to quit. Approach your slip with understanding and acknowledgement. Slipping up is not a new pattern, it is simply a setback.
MultiCare Tobacco Cessation Workbook 27 Handling Set Backs Here are a few immediate steps to get back on track: • Stop smoking or chewing immediately. Take action. • Get rid of all tobacco from your surroundings, or leave the scene if necessary. • Think about what went wrong. Who were you with? What were you doing? Where were you? Identify the trigger that caused you to use tobacco. • Figure out what you will do if this situation comes up again. Complete page 28 • Go back to notes on Your Reasons to Quit and Stay Inspired and review your quit plan. • Replenish your quit kit, if necessary. • Consider calling your doctor, a friend or support person, or call the Washington State Quitline at 1-800-784-8669. • Try again!
28 MultiCare Tobacco Cessation Workbook List The Triggers That Caused You To Relapse: What did you learn from your relapse? What triggered you to use tobacco? How does your relapse make you feel about yourself and your quit efforts? Review your answers to Your Reasons to Quit, Stay Inspired, and Identify Your Smoking Risk Situations. What stands out to you? What are three things you can do differently to re-establish a tobacco-free lifestyle? 1______________________________________________ 2______________________________________________ 3______________________________________________
MultiCare Tobacco Cessation Workbook 29 Restore Your Body Through Good Nutrition We believe there is no better time than now to do everything possible to promote a healthy immune system. We know that smoking can weaken the immune system and increase the risk of infectious diseases and respiratory infections. Here are a few tips to keep our immune system strong and balanced. Certain foods and healthy habits promote a strong immune system, whereas other food and unhealthy habits can impair our immune system by increasing internal inflammation. Nutrients that Improve Our Immune System While we point to specific nutrients below, it is helpful to know that each of us should strive to find an eating pattern that is built to last a lifetime. Beta Carotene is found in plants like carrots, sweet potatoes, winter squash, spinach, kale and fruits like cantaloupe and apricots. Vitamin C is found in many plants including broccoli, cantaloupe, cauliflower, kale, kiwi, orange juice, papaya, red, green or yellow pepper, sweet potato, strawberries and tomatoes. Vitamin E is found in plant-based oils, nuts, seeds, fruits and vegetables. Good sources include wheat germ oil, sunflower, safflower, and soybean oil, sunflower seeds, almonds, peanuts, peanut butter, collard greens, spinach and red bell pepper. Zinc is found in lean meats, seafood, wheat germ, beans, nuts and tofu. Protein comes from plant and animal sources. Nuts, seeds, beans and lentils are important sources as well as eggs, lean meat, poultry and seafood.
30 MultiCare Tobacco Cessation Workbook Gut Health A healthy gut helps regulate and maintain a healthy immune system. Gut health is promoted when we eat foods like garlic, onions, leeks, asparagus, bananas, beans, whole grains, cultured and fermented foods. Foods That Promote Inflammation Try to avoid or limit highly processed, overly greasy, super sweet foods. These promote inflammation and thus adversely affect our immune system. Other Stressors To Our Immune System Learning to cope effectively with stress in our lives helps to maintain a healthy immune system. We encourage you to utilize stress management techniques like deep breathing, moderate exercise, hobbies, comic relief, journaling and other strategies.
MultiCare Tobacco Cessation Workbook 31 Quitting Smoking Without Weight Gain When you become a nonsmoker, positive, healing changes take place in your body. Without nicotine, your metabolism may slow slightly which could contribute to minor weight gain. However, the benefits of quitting to your health and longevity, far out way a small amount of weight gain. Weight gain is not inevitable when you quit tobacco. Here are a few ways to prevent weight gain: • To learn more about healthy eating habits, go to: https://www.hsph.harvard.edu/nutritionsource/ Use the quitting process to move towards optimal lifetime nutrition. Optimal nutrition will decrease the chances of subsequent weight gain after quitting tobacco. • Build an exercise program into your life if you don’t already have one. Exercise will help indirectly increase your metabolism by helping to build more muscle which burns more calories! Exercise also burns off nervous energy. • Find alternatives for your mouth. Use the items you have added to your Quit Kit. • Learn to reward yourself with non-food treats like meeting up with a non-smoking friend, starting a new book, starting a new project involving your hands.
32 MultiCare Tobacco Cessation Workbook Get Physical To Improve Your Odds Of Quitting For Good Did you know that. . . • After ten minutes, of physical exercise, nicotine cravings are reduced. • Exercise may produce brain chemistry associated with positive moods. • Exercise does not have to be hard or long-lasting to have positive effects such as reduced cravings. • Exercise like yoga or Tai Chi can help emphasize breathing awareness and promote relaxation. • Exercise like walking, aerobics, dancing, pickleball and spinning can burn off jitters.
MultiCare Tobacco Cessation Workbook 33 Get Physical To Improve Your Odds Of Quitting For Good Successful exercise routines don’t have to last for hours and leave you drenched in sweat gasping for air. If exercising or engaging in physical activity is not a routine yet, don’t feel discouraged by starting off slow. The American College of Sports Medicine recommends 150 minutes of low to moderate aerobic activity per week. Knowing this, we can create a plan that meets this goal for each week. We can spread out exercise routines/moments of physical activity into increments of 10-60 minutes at a time. Some days you may be very busy and will only be able to fit 10 minutes into the day, however, the following day you may find you have 40 minutes you can set aside to exercise. This physical activity can range from walking outside, riding a bike, gardening, cleaning your house or apartment, to exercising in the gym, going on a run or jog, or even swimming. The goal is to keep your body in a constant state of movement for at least ten minutes. Doing so will improve your quality of life!
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MultiCare Tobacco Cessation Workbook 35 In Summary... You are making a great choice to quit tobacco. Keep it up! Eat healthy. Enjoy being physically active. Reach out to those you love and do things you enjoy. Get the most out of life! Enjoy your freedom from smoking!
36 MultiCare Tobacco Cessation Workbook
MultiCare Tobacco
Cessation Workbook
A guide towards quitting for good
www.multicare.org/tobacco-cessation
BROUGHT TO YOU BY
(Rev. 1/21)You can also read
