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Psychology homework helpPsychology-LMHC#1 DISCUSSION week 5 $10.00
Is treatment planning important and/or necessary in substance abuse counseling? Why or why not?Is it important for treatment plan goals to be measurable? Why or why not? Provide an example of a treatment plan goal that is in fact measurable.How do the stages of change relate to treatment planning?#2: Overview and Objectives $10.00
The following article was published in MD Health.� It discusses the harmful consequences of smokeless tobacco.� All too often addictions counselors do not address issues such as smokeless tobacco (or gambling, for example).� In addition to the discussion question noted on the syllabus, please discuss your understanding of smokeless tobacco as an addiction and ideas you have about how you would approach it clinically with a client.�
Smokeless tobacco poses a cardiovascular risk
October 6, 2004 By Doug Kaufman
1. LOUIS (MD Consult) – The cardiovascular risks of cigarette smoking are well known, as are the oral cancer risks of using smokeless tobacco. But a paper published in the September 27, 2004 Archives of Internal Medicine sheds new light on the cardiovascular risks of smokeless tobacco. “It’s not as harmless as it might seem,” said lead author Dr. Ritesh Gupta of the Cardiology Department at the University of Alabama School of Medicine. Dr. Gupta and colleagues Dr. Hitinder Gurm and Dr. John R. Bartholomew reviewed previously published studies about smokeless tobacco when all three were at the Cleveland Clinic in Ohio. The impetus was a case they saw at the clinic. “We got interested in the fact that there’s not much information out there looking at smokeless tobacco and cardiovascular risk,” he said. “We wanted to explore that in greater detail and see what’s actually been published and bring it out for everybody to share.”
They did an extensive case and literature review of all medical articles about smokeless tobacco published since 1965. “To our surprise, there’s quite a dearth of sound clinical research in this area of public importance,” he said. “So, we wanted to highlight that and bring out everything that had been done so far, so you could go to one source and get all the information to build on with further research.” Cigarette smoking has a well-established link to cardiovascular risk, with multiple studies finding “almost a causal relationship between cardiovascular mortality and smoking,” Dr. Gupta said. “Such has not been the case with smokeless tobacco.”
However, studies examining such cardiovascular risk factors as hypertension, diabetes and lipid levels have noted risks involving smokeless tobacco. For instance, smokeless tobacco increases blood pressure. “(Smokeless tobacco) increases systolic pressure by about 21 millimeters of mercury, which is quite significant, and increases diastolic blood pressure by up to 14 millimeters of mercury – again, quite significant. It can increase the heart rate up to 19 beats per minute. Again, quite significant.”
— Dr. Ritesh Gupta �
“It increases systolic pressure by about 21 millimeters of mercury, which is quite significant, and increases diastolic blood pressure by up to 14 millimeters of mercury – again, quite significant,” Dr. Gupta said. “It can increase the heart rate up to 19 beats per minute. Again, quite significant.” The long-term risks, particularly when the relationship between smokeless tobacco and hypertension is considered, haven’t been as consistent. “In healthy volunteers, it’s been seen that maybe it doesn’t affect blood pressure as much as it does in certain other patients who are more likely to develop blood pressure (problems),” he said. “Similarly, looking at the lipid profile, we have found there are conflicting reports in the literature. But overall, it seems that use of smokeless tobacco is associated with the worst lipid profile, including 2.5 times adjusted risk for hypercholesteremia, or total cholesterol greater than 240.” Studies have also found, Dr. Gupta said, that people using at least 150 grams of smokeless tobacco a week have a three-fold greater risk of developing diabetes.
“These are all studies that have been published elsewhere,” he said. “We were able to compile all this and present it in a fashion that would lead to further research and give anybody interested in the subject an avenue to look at, in totality.”
A Swedish study of approximately 135,000 patients, conducted between 1971 and 1974, reached some interesting conclusions. The study divided patients into three groups – ex-smokers currently using smokeless tobacco, cigarette smokers and non-tobacco users.
“There was no follow-up done on these patients, so there’s always the possibility of some crossover,” Dr. Gupta said. “But what they found from this study was there was a 1.4 times (greater) risk of cardiovascular mortality in patients who used smokeless tobacco, compared to non-users. That’s a very important finding in itself. The study is limited in its methodology, but it does give us a very important insight into some of the adverse cardiovascular profile that can be associated with just smokeless tobacco use.” Smokeless tobacco has a well-established causative link to oral cancer, cancer of the larynx, cancer of the esophagus and many other body organs, Dr. Gupta said. “That’s a known fact,” he said. “The 1986 U.S. Department of Health and Human Services report indicated there was a 50-fold increase in the relative risk of oral cancers in smokeless tobacco users compared to controls – people who did not use any form of tobacco product. Those are really telling figures. We need to bring to the forefront that use of smokeless tobacco is not as harmless as some people think it might be. It may be a little less risky to use smokeless tobacco compared to cigarette smoking, but definitely it’s much more than people who do not use any form of tobacco products.”
Doctors should be aware of the risks represented by smokeless tobacco. “We physicians are very good at taking the history of smoking, of cigarette intake, very seriously,” Dr. Gupta said. “But when it comes to other tobacco products, I think what’s lacking is mainly awareness in terms of the use, in terms of quantifying the use, and also in terms of what kind of risk factors it (involves). We also found certain research showing that use of smokeless tobacco may be an indication for use of cigarettes in later years.”
There is a “disturbing trend” of marketing smokeless tobacco to the youth of our country.
— Dr. Ritesh Gupta��
There is also a “disturbing trend” of marketing smokeless tobacco to the youth of our country, he said. “People are starting to use smokeless tobacco at earlier ages,” he said.One study of about 400 teenagers between the ages of 12 and 18 found that 12.7 percent of them had used smokeless tobacco in the last month, and four percent of them became regular users over a four-year follow-up period, Dr.Gupta said. “So that is a very telling statistic,” he said. “It brings to point … that people who are using smokeless tobacco at a very early age are more likely to start using smokeless tobacco on a regular basis. We know for a fact that it’s harmful, and some of these people may end up using cigarette smoking as another form of tobacco intake.” Physicians need to encourage patients who use smokeless tobacco to quit. Nicotine replacement therapy, behavioral interventions such as telephone counseling and self-help manuals, group therapy and sustained-release bupropion have all proven effective in helping people stop a smokeless tobacco habit, he said. “We just need to counsel patients more aggressively to seek these therapies,” Dr. Gupta said.
Related Information Story List Core Collection Journal Articles
Reducing tobacco use among youth. Heyman RB – Pediatr Clin North Am – 01-APR-2002; 49(2): 377-87
Treating tobacco use and dependence: an evidence-based clinical practice guideline for tobacco cessation. Anderson JE – Chest – 01-MAR-2002; 121(3): 932-41
Health effects associated with smokeless tobacco: a systematic review.
Critchley JA – Thorax – 01-MAY-2003; 58(5): 435-43
Smokeless tobacco and cardiovascular disease. Asplund K – Prog Cardiovasc Dis – 01-MAR-2003; 45(5): 383-94
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PLEASE PLEASE follow Professors comments, it is a Men and Women Groups no specific topic. Or Women only.
This is not a theoretical paper, no references. It is the application of your experience at your site. Write from the “I” perspective. Notice the prompts include “What will you do when…” “What are your site’s specific…” and “What are your responsibilities…” notice the prompts are about you not theoretical. It appears you were not able to clearly cover the prompts due to writing from a theoretical perspective instead of an applied “I” perspective. Remember it is 3-4 full content page paper. Content closely related to the prompts. At times the writing is unclear. The Writing Center is available to you, information in syllabus.
#3 Crisis Intervention & Workplace Violence Prevention $10.00
What types of crisis intervention do you (or will you) perform at your site?
What will you do when a client expresses suicidal ideation? Homicidal ideation? Child abuse? Elder abuse?
What are your site’s specific safety plans/protocols in case of various crises (ie. suicidal/homicidal ideation, etc.)?
What are your responsibilities when those safety plan/protocols are initiated?
#4 Clinical Documentation $10.00
What are your various documentation responsibilities at your site? What are some of the easiest aspects of documentation?
What are some of the difficult aspects of documentation?
Include a de-identified example of your documentation in this week’s paper (e.g., progress note, treatment plan


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