UF Online Program Could Help Fill Need For Tobacco Counselors
GAINESVILLE, Fla. — The American Cancer Society’s Great American Smokeout on Thursday will challenge the nation’s smokers to give up cigarettes for at least a day, but University of Florida medical experts say quitting permanently may require more than just encouragement.
In many cases, long-term success could depend on whether smokers receive treatment from trained counselors -specialists who are in short supply. Now a unique Internet-based program formally launched today will train and certify tobacco counselors nationwide, said Timothy VanSusteren, associate dean for continuing medical education and faculty development at UF’s College of Medicine and one of several UF researchers who helped develop the program.
“We believe this is the first online tobacco counseling certification program offered anywhere,” VanSusteren said. “Tobacco smoking is the No. 1 health problem in the United States, and we need to promote efforts to help people stop.”
Tobacco-related illnesses such as cancer, heart disease and emphysema kill almost one in five Americans, with more than 430,000 deaths expected in 2002, according to the American Cancer Society. In 1999, 47 million U.S. adults smoked.
Studies show that 25 percent to 30 percent of adult smokers will need professional help to have a realistic chance of quitting, said Murray Kelly, president and founder of the private tobacco treatment provider Patient Support International in Pinehurst, N.C. A former smoker, Kelly began counseling tobacco users in 1987 and developed therapeutic techniques emphasized in the online program, known as Tobacco Addiction Specialist. A study by Queens University in Ottawa found that 40 percent of patients in one of Kelly’s earlier programs remained smoke-free one year after completing treatment.
The Tobacco Addiction Specialist program is expected to produce 900 to 1,000 certified counselors within its first six to eight months, Kelly said. Thousands of noncertified tobacco counselors are employed today throughout the world, but professional credentialing could help promote tobacco treatment.
“There are more than 5,000 alcohol treatment centers in North America serving about 20 million alcoholics,” he said. “We currently have about 10 tobacco treatment centers and at least 50 million tobacco-addicted people who need help. The reason we have so few tobacco counselors is that without certification they can’t be reimbursed by insurance companies and HMOs.”
The new program is a collaborative effort involving UF, Patient Support International and NAADAC, The Association for Addiction Professionals. It covers the history of tobacco use, causes of addiction, nicotine’s physical effects, skills and strategies for counseling, and the challenges of living tobacco free. The program is available in English, with Spanish and French versions scheduled to debut in 2003.
Because tobacco contains a powerful addictive drug – nicotine – chronic use of cigarettes or other tobacco products should be treated as a form of drug addiction, said Dr. William Jacobs, a UF assistant professor of psychiatry and the program’s associate medical director. Many lay people consider smoking simply a bad habit, and health-care professionals who know better may not address patients’ needs adequately.
“A lot of primary-care providers work on a sort of ‘don’t ask, don’t tell’ situation because if they identify the problem, they feel obligated to treat it,” Jacobs said. “If they don’t have the time or adequate training to treat it, they may feel threatened.”
The program should be especially useful to physician assistants, nurses, substance-abuse counselors and other professionals who work with primary-care providers, said Shirley Beckett, certification education manager with NAADAC in Alexandria, Va.
To obtain certification, candidates must complete at least 85 hours of online course work and pass a 150-question test and an oral examination, she said. Candidates’ total cost for the program is $1,500, which includes membership in NAADAC.
Nicotine, a poisonous alkaloid used in some insecticides, doesn’t produce strong intoxication, but acts as a stimulant in small doses and is powerfully addictive, Jacobs said. Along with medical director Dr. Mark Gold, a UF distinguished professor of psychiatry and chief of addiction medicine, Jacobs is responsible for reviewing and monitoring the curriculum’s scientific foundation.
“One thing that makes treating nicotine addiction difficult is that people want to think it’s different from treating other drug addictions, but it probably has more similarities than differences,” Jacobs said. “All recreational drugs work in the same pathways in the brain, so treatment must be comprehensive and aggressive and ongoing.
“We don’t anticipate that a heroin addict will no longer need maintenance therapy after 28 days (in rehab), yet many people tend to think that a person who is nicotine dependent doesn’t need maintenance therapy.”
Jacobs also is the medical director for the Stewart Marchman Center in Daytona Beach, a private, nonprofit drug-and-alcohol treatment center that was one of the first sites to test the tobacco-counseling program. The center now has 20 counselors awaiting certification.
Major Canadian universities will offer the program beginning in early 2003, said Kelly, a visiting lecturer at Algonquin College in Ottawa.
Tobacco counseling is one of the most cost-effective types of health treatment because the impact of tobacco-related illness is so great, said Lirio Covey, director of Columbia University’s Smoking Cessation Clinic in New York.
“It can reduce the need for much more costly procedures like lung cancer surgery,” said Covey, who estimates that she has treated more than 1,000 smokers in her 10 years with the clinic.
- Tom Nordlie