It sounds like a provocative idea for a health care practitioner: Frank Leone, MD, MS, and his team call themselves “pro-smoker.” That’s because smoking, he says, is a disease – one that should be treated with compassion and evidence-based therapies like any other.
“Getting people to quit is good for public health,” says Leone, director of the Comprehensive Smoking Treatment Programs at the Penn Lung Center. “But, we see our job as healthcare providers is to relieve the burden of the disease, not to apply additional pressure on smokers.”
The team engages smokers to understand why they smoke and in response, designs a cessation plan to meet the patient’s specific needs. Dr. Leone and his associate Sarah Evers-Casey, MPH, see patients both in their offices at Penn Presbyterian Medical Center and the Perelman Center for Advanced Medicine and meet with hospital inpatients suffering from illnesses in which smoking plays a role.
“What we hear from these patients is that they feel pressure to quit from their physician and caregivers, who often have a misunderstanding about smokers and an inherent bias toward them and their behavior,” says Evers-Casey.
Last week the Center launched its inaugural education program, Preparing for the Integration of Tobacco Use Treatment into Healthcare, an interactive training program for working healthcare professionals designed to help them develop skills in tobacco dependence treatment. The participants deepened their expertise through examination of accepted standards of care, analysis of current research findings, and hands‐on application of tobacco treatment principles.
The 5-day class drew about 15 participants from across the region in specialty areas including psychiatry, pulmonology, pharmacy and more, all now equipped with the tools needed to successfully address smoking cessation with their patients across their varied specialties. Patients may now be able to find help to quit smoking in places where they might not have before.
“We are training a new generation of practitioners with the ability to apply both a science-based knowledge to practice and future discoveries in the area of nicotine addiction and smoking cessation,” says Leone.
Day one gave the group a lesson in the biology of addiction, how the brain works and how its normal function is altered when flooded with tobacco or nicotine among other addictive substances, both on a macro and micro level.
“Nicotine acts like a stimulant to the brain. Neurons send messages by releasing neurotransmitters. Nicotine excites neurons to release neurotransmitters in the survival instinct structures of the brain, producing feelings of security and certainty,” Leone says. “After a person takes in nicotine a few times, the brain adjusts to the new levels of neurotransmitters. From then on, to sustain the ‘safety’ levels in the brain, the person must continue to take in nicotine, even if they know smoking is hurting them. They become stuck between two facets of the mind, it’s a viscous cycle.” Without it, the addicted brain feels uncomfortable and experiences withdrawal symptoms. The patient therefore adjusts his or her smoking or chewing to maintain the brain’s desired level of nicotine.
Robert Schnoll, PhD, associate professor of Psychology in the department of Psychiatry, spoke to the group about personalized treatment for nicotine addiction and how researchers are beginning to develop individualized treatment strategies for addiction that target a person’s specific genetic makeup.
Smoking involves more than biology; getting someone to quit also requires an understanding of the social influences on their behavior. “In order to successfully help patients quit, we need to understand the cultural and environmental influences they deal with every day and adjust our counseling approach to be responsive to the realities of life,” says Leone. “All the nicotine patches in the world won’t help a person quit if we don’t first understand how social and environmental variables impact a person’s smoking, before they even get to the point of putting on a patch.
The group also received education on counseling strategies to employ to overcome a patient’s reluctance to quit. “In treating dependence it is best to adopt a holistic view of the social influences, treatment misconceptions, to make a bigger impact, on both the individual and population levels,” says Evers-Casey.
Finally, Wharton marketing professor, Barbara Kahn, visited for a discussion on the science of persuasion. She discussed with the group how tobacco marketers appeal to their customers. A solid understanding of these concepts allows practitioners to re-evaluate how they traditionally attract people into treatment, and then helps them imagine new, more effective, messages that may be more appealing to the patients they are trying to help.
Participants who completed the program successfully will receive a Certificate of Professional Development from the Perelman School of Medicine, and will qualify for designation as Master Tobacco Treatment Specialist (CTTS‐M)by the Association for the Treatment of Tobacco Use and Dependence upon scoring 80 or above on a completion exam and fulfilling additional clinical requirements.
“We want to shift the burden of responsibility for fixing the problem of tobacco dependence onto the shoulders of ‘the system,’ and off the shoulders of the afflicted,” says Leone. “These new practitioners will help us make this leap.”