Another stated, ��Here��everyone had things in common, but in school�� people might think you��re different or strange�� (18-year-old male). For delivering tobacco treatment, eight youth emphasized the value of in-person contacts preferable to phone or selleck chem Internet-delivered interventions. Treatment recommendations did not differ by gender. Treatment Recommendations: Provider Interviews Nearly all the clinicians stated that the risk of tobacco is minimized relative to other drugs of abuse and mental health symptoms, documented in the medical record but rarely addressed (6 clinicians, 15 quotes). An academia-based psychiatrist summarized, ��The tendency is to minimize it and document it as happening but not to actively address it or consider changing that behavior.
We focus more on illicit street drug issues or the alcohol use�� [and] feel that if they��re only smoking tobacco, that��s okay, there are worse things that they can be doing.�� A community-based case manager stated, smoking is ��treated as a fact of life that we work with. We know they��re going to be out front smoking and we put up smoking areas for them.�� At the same time, the clinicians viewed mental health settings as uniquely placed for addressing youth tobacco use. An academia-based psychiatrist asserted, ��In the mental health community, we have the greater awareness of substance use disorders and a better understanding of the psychological underpinnings of substance use and addictions, so I think the milieu would be supportive.
�� The top clinician recommended strategies for treating tobacco dependence in youth were cessation medication, specifically bupropion, nicotine patch, and nicotine gum (7 clinicians, 9 quotes); cessation groups (7 clinicians, 8 quotes); psychoeducation (6 clinicians, 13 quotes); and referrals to community smoking cessation programs (6 clinicians, 8 quotes) (Figure 2b). Additionally, recommended strategies were targeting triggers for smoking, including other substance use (5 clinicians, 10 quotes), providing support (5 clinicians, 6 quotes), cognitive-behavioral strategies (distraction, mindfulness, daily monitoring; 4 clinicians, 10 quotes), parental involvement (4 clinicians, 5 quotes), referrals to primary care (4 clinicians, 4 quotes), encouraging smoking reduction (3 clinicians, 5 quotes), and use of dramatic imagery, such as exposing the youth to smokers with serious tobacco-related health problems (3 clinicians, 4 quotes).
A community-based psychologist summarized, ��Teach them how to manage their anxiety, anger, or their feelings without needing to smoke.�� With regard to parental involvement, a college-based mental health program coordinator emphasized engagement to ��encourage their son or daughter�� providing information to them, maybe attending a Brefeldin_A group with them�� give them tools.