Tobacco treatment counselors offer practical help along with encouragement, emotional support

July 07, 2023
a man holds a small device with a straw up to his mouth to blow into it
Alex Humphreys breathes into a carbon monoxide detector. Getting to a green, or healthy, reading is often the first goal for new patients because they can achieve this level after 48 hours of stopping smoking. Photos by Clif Rhodes

It goes without saying that smoking is bad for you.

And so, the trained tobacco treatment counselors at MUSC Hollings Cancer Center mostly don’t say it.

Instead, when working with people who’ve come to them for help to stop smoking, the counselors focus on the positive changes their clients are making, providing nurturing support that’s centered on evidence-based strategies.

“The biggest thing for me is meeting the patient where they’re at,” said Bridget Harris, a certified tobacco treatment specialist.

The MUSC Health Tobacco Treatment Program started in Charleston in 2014. It expanded to hospitals in the Regional Health Network in 2021, but because the counselors can meet with people in person or by video or telephone calls, they can help people across the state, regardless of whether they live near an MUSC Health location.

Most of their clients are referred to the program by treating physicians, many of whom are surgeons or cancer doctors. If people can quit smoking before surgery, they’re more likely to get through surgery without complications and will have a smoother recovery. Similarly, quitting smoking during cancer treatment can help to make the treatments more effective and to reduce some of the side effects.

Alex Humphreys was referred to the program when he was diagnosed with prostate cancer. He had smoked for years – so long that he can’t say exactly when he started, but probably when he was about 16.

With the help of Emily Ware, Pharm.D., a clinical pharmacy specialist, he was able to stop smoking five years ago. But a few months ago, with some stress in his life, he turned to cigarettes again. When he came to Hollings for an appointment, he saw the tobacco treatment office and decided to drop in.

“I said, ‘Hold up now. Emily got me to stop smoking one time. I’m going back in there.’ I told my wife, ‘I’m going back in there so I can stop again,’” he said.

At a recent appointment with Ware, she pulled out a device that measures levels of carbon monoxide in the lungs.

“Oh, I’m in the green!” Humphrey declared.

Patients breathe into the device, which then reports their carbon monoxide levels along with a color-coded red, orange or green label.

a small device displays numbers in green showing carbon monoxide readings for a patient's lungs 
Emily Ware, Pharm.D., shows how the carbon monoxide reader displays its results.

“A lot of people, when they come back at a scary red color, we talk about getting to the green, healthy area,” Ware explained. “The amazing thing about our bodies and how quickly they heal is that it just takes two full days. Just 48 hours without smoking, and then they would be in that green area. So I think it gives a lot of encouragement to people because they just have to make it two days. That's our first goal – let's just make it two days; let's get you in the green.”

When people come to the Tobacco Treatment Program, they’ll be assigned to a counselor who they’ll meet with regularly, depending on need, until they feel confident on their own. The sessions review treatment-oriented action items like pharmacotherapy, which can be nicotine gum, the nicotine patch, or prescription medication, and cognitive behavioral changes that the patient can make. These are mental “tricks,” like having a plan to distract yourself when a cigarette craving comes on or giving yourself something to do with your hands, which can help to delay picking up a cigarette until the urge passes. The counselor will then check in with follow-up calls, helping the patient to stay on track.

During one such call, Harris checked in on a patient who was undergoing chemotherapy. He felt lousy from the chemo, and he was still smoking, although he’d reduced the number of cigarettes.

“I really appreciate, because I have a sports background, being a teammate with the patient, along with coaching and sharing knowledge and problem solving to win the game – to win the championship! That draws me to this work, day in and day out.”

Demetress Adams-Ludd
tobacco treatment specialist

Harris didn’t scold or lecture. He was dealing with a lot, she told him, between work and family and cancer treatment. She asked whether he was sleeping at night and whether he’d tried any of the nutritional shakes. Chemotherapy can affect people’s taste buds and their appetites, making it hard to eat enough to get the necessary nutrition. After talking over everything that was going on, Harris offered one piece of advice – change up the morning routine a bit by first going into a different room, instead of the room where he usually smokes. And she ended with words of encouragement.

“I’m super proud,” she told him. “Because every time you do something, it’s a difference. Every small victory deserves praise. Every time, even though you might not feel good or like you’re doing the best, you are. Because you’re doing something different that you didn’t do the day before.”

Similarly, tobacco treatment specialist Demetress Adams-Ludd praised a client who explained how he distracted himself whenever he felt tempted to smoke.

“I’m over here cheering in my seat because those are all the coping skills we talked about!” she said.

Like Harris, Adams-Ludd offered a patient encouraging support while also gently offering a few pieces of advice. She noted that cravings can come on even years after someone has stopped smoking, so it’s good to keep practicing the skills that he honed while quitting with the help of the program.

She said she loves helping people and knowing that she’s making a difference for people in her community.

“I really appreciate, because I have a sports background, being a teammate with the patient, along with coaching and sharing knowledge and problem solving to win the game – to win the championship!” she said. “That draws me to this work, day in and day out.”

Humphreys, Ware’s patient, uses both nicotine lozenges and the “delay and distract” techniques that Ware taught him to keep from smoking. Sometimes that means reading a passage from the Bible; sometimes it means using a toothpick or straw to keep his hands busy, and sometimes it means popping a Jolly Rancher in his mouth.

He’s committed to keeping his smoke-free life. He can feel the difference that being smoke free makes, he said. For example, helping his brother out in his yard used to take all day because he would have to take so many breaks. Now, he can get the work done in an afternoon.

He knows he can go five years without cigarettes – now, his new goal is to stay smoke free for the rest of his life.