Quit Insights Clinical Series podcast with Beige and David, Quitline Counsellors on Quitline Explained.
This podcast and article are intended for health professionals and are for educational and informational purposes only. The content discussed does not constitute medical, legal or professional advice and should not replace your own clinical judgement.
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In this episode, called Quitline Explained, we were joined by two Quitline counsellors, David and Beige, who gave us their insights into Quitline: how it works, what happens when health professionals refer their patients, and why they should refer their patients.
Can I ask you to each tell us about your background and your experience at Quitline?
David: I spent many years in the hospitality industry owning and operating little cafes. I got pretty tired of that after a few years. I was wondering what to do, and I thought I might do a Bachelor of Counselling degree. I was interested in that area, and while doing that degree, I had an opportunity to apply for the job at Quitline. I've been here for nearly nine years and in that time at Quitline, I've seen it grow and develop in many positive ways.
Beige: See, I have a Bachelor in Health Science and also a Masters in Public Health. When I went to university, I did some units surrounding addiction, so when I saw the advertisement for the Aboriginal counsellor at Quitline, I thought it would be a perfect position for me to pursue a career in health with especially helping my Aboriginal community. I've been working with Quitline now for about five years. The first four and a half years I worked as an Aboriginal counsellor and recently I have transitioned into being Aboriginal Quitline team leader. So that's been a new role for me. I think at Quitline we understand each person's situation is very subjective and each person has a unique experience. So taking the time to understand the client's situation is critical to tailoring a plan that suits the client.
What's the benefit to health professionals of referring patients to Quitline?
David: We understand that health professionals are typically time-poor. They have very little time to discuss the client's smoking or vaping in depth. So I think that the Quitline service can be used as an extension to that Brief Advice model that is used by GPs and others in the allied health industry. So in the Ask, Advise, Help framework, in the typical five minutes or less, a referral could be made to us.
Beige: Definitely referrals can be made from health professionals. We do see a lot of referrals on a day-to-day basis. And it's worth noting as well that the telephone counselling that we do provide is actually free, so that's a really great thing about our service, and we also do provide health professional feedback to the referring health professional.
David: The research also suggests that the telephone counselling service is a very cost-effective in a way of helping people. The studies definitely show that when the (Quitline) service is used, along with a quitting medication, the person's chances of stopping can rise significantly.
Do clients have to be ready to quit before being referred to Quitline?
David: A potential client doesn't have to be ready. If you're talking about smoking or vaping, it's very common that most people who smoke and or vape are not sure about stopping.
Beige: I think to add to that, ambivalence to change is very common. I think a lot of people think that they have to be ready to quit, even if that's not where they're at the moment. But I think the most important thing is that they're ready to have a conversation and to maybe try and understand their smoking or their vaping. Quitline has the time to build a rapport with clients, especially in those initial calls where they do the assessment. Health professionals may not have the time to kind of go into that in detail.
Can Quitline also help people to plan to quit?
Beige: Definitely. When the client makes first contact with the counsellor, they will go through the assessment and then they will tailor a plan depending on the needs and the goals of the client. Whether it is vaping, whether it's smoking, and what their overall goals are, we help them to put a plan in place, including strategies to reach those goals.
Some clients have commented that they're really relieved that Quitline is non-judgmental. Have you found that as well?
Beige: Yes, that's true. The counsellors we have at Quitline, they do provide a safe and empathetic, accepting environment. We definitely offer that non-judgmental service to clients to make them feel comfortable with re-engaging with Quitline.
What happens when someone is referred to Quitline? Can you walk us through the process?
Beige: Definitely. The Quitline referral will usually be received from the health professional, either through fax or a web request. You can go online and there's a specific section for health professionals to put their patient's details into. Once we receive the referral it's logged in our system, and we usually try to provide a callback from the counsellor within 24 to 48 hours, two business days, depending on the date that the health professional has requested. Once the referral is received, the counsellor will make contact with the client, providing the full assessment, tailoring that plan and then going from there depending on the client's goals with smoking and vaping.
David: At the end of a counselling service, a client may have stopped smoking or vaping. Sometimes a client we find quite often can be very exhausted or they just can't seem to break the addiction completely. We would be fine with that. It's up to the person to figure out when they can do it. What we do is we provide feedback via a letter to the referrer. And in this letter we would say where the client is at, or whether they've stopped (smoking or vaping), or whether they want to rest and leave it to the referrer to maybe engage again.
Can you tell us about how Quitline supports people who vape, as well as those who smoke, or those who both smoke and vape?
David: Health professionals may not be aware that Quitline supports people that are vaping or are dual users, which means that they are using tobacco and vapes. We can offer support for both vaping or dual users and counsel these people. We've been trained to support these clients even though it is a recent and emerging issue. So you can refer people to us that are either vaping or dual using.
We receive research on a regular basis regarding vaping and the health harms, these are coming in quite regularly. Even though the research is still low on the ground, there are similarities between smoking and vaping. For instance, some of the behavioural aspects like the hand-to-mouth action and inhaling the toxic substances, even though they are different, it is the same action. So we're here to discuss those addictions with the client.
Beige: There are also some differences between smoking and vaping as well. With smoking, usually there's a beginning and an end, there seems to be more of an embedded ritual with smoking tobacco. For example, the act of rolling a smoke, which can be a trigger or a strong ritual. Whereas vaping, however, doesn't have a start or finish, it's very convenient and a lot easier to use. So because of the fact that it doesn't smell as bad as tobacco, people who vape usually tend to vape more often in more places. This increases the risk of consuming more nicotine that is used more often. The other difference with vaping, compared to smoking, is how sudden and recent (it’s increase) has been. This means that there has been no time to gather long-term health effects and harms that come along with vaping. So even though they are a bit different, the referral pathway for vaping is still the same as smoking.
So the bottom line is that health professionals can be reassured that you can refer people who are vaping to Quitline?
Beige: Health professionals definitely can refer people who are vaping as well.
What sort of personalisation or tailoring is available for different clients? For example, people who identify as Aboriginal and or Torres Strait Islander, pregnant people, young people or those with mental health conditions?
Beige: All Quitline services do tailor calls to the different priority populations, and depending on each state it could be slightly different. Usually we do tailor calls to different groups – people with mental health conditions, people who identify as Aboriginal and or Torres Strait Islander and people who are pregnant.
For example, if we do have a client who is pregnant, we can tailor their needs and have more calls over a longer period of time, and this can also include having calls after birth as well. It's great to have that service to ensure that those changes are also being followed after birth.
There is also a Quitline service run by Aboriginal and or Torres Strait Islander counsellors, who provide tailored support to Aboriginal and or Torres Strait Islander clients. This is usually done through a yarning-based counselling approach, more talking one-on-one, building a relationship between the counsellor and the client to make sure that the client is trusting of the counsellor. Usually the Aboriginal and or Torres Strait Islander clients will have the same counsellor so that they're able to build that relationship over time.
Some states have different names for their Quitline service for Aboriginal and Torres Strait Islander people?
Beige: That's right.
Can you tell us how Quitline supports youth clients?
Beige: We support youth clients usually that are under 18. What happens? The youth clients that come through, they'll either give us a call on their own or while they're in the presence of a school counsellor, or their parents might influence them to call in. They will receive what we call an ongoing key worker. That counsellor will work one-on-one with the client, developing a really good relationship, and also aiming to give the young person a positive counselling experience. We also try to weave in that plan for the youth client as well, with their vaping and smoking. The number of calls that we give for youth clients just depends on the client’s needs.
What about for clients who experience mental health conditions?
David: We have a tailored support service for those with mental health conditions. Initially the calls may be extended in an assessment over a period of time. That's just assessed on each call, each call is unique, and we assess that as we go. We provide psychoeducation on the mental health benefits of quitting. We try and work with a client when they're ready to set up a plan, or prepare to try and help them with things like relaxation strategies, other ways to self-soothe, so to speak. It's really important to try and separate that idea that smoking relieves and relaxes as the only mechanism available, so that can take some time. We do a mood monitoring tool, which is a series of questions we ask on each call about how they've been feeling and their moods and experiences for the last day or so before the call. This really helps to track emotions and discuss any concerns they might have and that can really, really be of help.
We encourage the client to see their health professionals and get them involved. We're aware that there is some chance of medication side effects when they're changing their smoking. We also tell them that we're not medically trained. That's really important to have that disclaimer, so it’s important to try and just encourage them, if they can, to get their GP or their health professional involved.
Could you both give us some examples about how Quitline has helped someone to quit?
David: I can remember speaking with a single dad recently. He was raising his son by himself, and he just didn't think it was possible to stop smoking tobacco. He had a terrible stigma. He felt really guilty about being that negative role model, especially for his son. He was really stuck and he was really grateful for the assistance in just trying to unpack the behaviour that he was doing. We just helped him to plan and prepare towards trying to give it a go to stop smoking. He was really grateful for the support in that first month, just after stopping and adjusting to being tobacco-free. He just couldn't believe the significant difference that he experienced with his breathing and his stamina, he felt great.
The other example I can remember, was a young adult female who had recently decided to stop vaping. She had used vaping to stop (cigarette) smoking about three years ago. But what she found was that she couldn't stop vaping. It was out of control, so to speak. She used (vaping) much more than she used to do with her cigarettes. It was easier to use, and it seemed to be cleaner. And she suddenly felt recently that she was not quite right with her health.
She rang the Quitline presenting with severe withdrawals after stopping vaping for two days. She didn't know what to do, so we managed to help her understand what the withdrawals were and went through that and normalised that experience. Sometimes just having that little chat and normalising things can help a little bit. We tried to explain that if she can get through the next few days, these (withdrawal effects) are going to weaken a little bit. She mentioned that her hand-to-mouth impulse was really strong. So we tried to figure out some replacements, and we discussed some ideas and strategies around that. Having something else in her hand, she really thought that was a good idea, so she tried that, especially when the cravings were strong. She also downloaded the My QuitBuddy app, and she found that the daily positive affirmations really boosted her resolve, and her confidence grew gradually over that first few weeks. She kept a goal in clear focus each day and the app helped too with doing that, and she found that the withdrawals did weaken. After a week, her confidence grew and grew, and she started to feel that her health improved and hasn't looked back since.
Could you tell us a little bit about the My QuitBuddy app?
David: It's on the App Store. It's a free application that you can download. You set it up and tailor it for your own needs, and it will give you little tools, and little positive affirmations, daily or hourly. It'll also track how much you've saved. Once you've stopped. It'll track how your body's going, what improvements you might be feeling or what looking ahead, what improvements might be there.
Beige: Working on the Aboriginal Quitline, a young Aboriginal client called in for support, wanting to make some changes with her vaping and smoking. This particular client saw her older family members around her who were smoking for many years, who were getting sick and passing away from smoking-related illness. This wasn't something that she wanted for herself. She wanted to break those barriers of influences from around her. And so she engaged with Quitline for support and I think we spoke to her for about two months. During that time we supported her with the use of nicotine replacement therapy, NRT, and the client was successfully able to quit from both smoking and vaping, which was amazing to see. The client was very proud of her progress and she did notice benefits with her breathing. She felt free from the burden of feeling the need to constantly have either a vape or smoke with her.
So NRT being nicotine replacement therapy?
Beige: That's right, it can include patches, mouth spray or lozenges.
Another client that I've worked with at Quitline that stuck with me is an older gentleman who had been smoking for about 30 years, and he thought it was impossible to stop because he had been smoking for so long, and he did let us know when we first had the initial assessment that he didn't think he could do it. An upcoming surgery and some underlying health conditions were made worse by smoking. He was referred to Quitline by his doctor and when Quitline spoke to him, I think for about 6 to 8 weeks, he was actually able to stop smoking completely. He kept in contact with his doctor as well, who had also helped him with some medication. Quitline did help with monitoring that medication as well as providing strategies that were tailored for him and his specific lifestyle. And so we were able to kind of help manage his cravings and he was able to successfully quit.
Our thanks to guests David and Beige, Quitline counsellors, for this inside information about Quitline, and your expert insights.
Further information:
Research
Tobacco in Australia: Facts & Issues