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Tobacco Addiction Specialist Certification
  1. Martin Raw
  1. martinrawterra.com.br

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    The Tobacco Addiction Specialist Certification course, run from the University of Florida, is a “curriculum based NAADAC Certification Program designed to credential the professional tobacco addiction specialist”. It is online at http://www.smokerstreatmentcenter.com/ and is the only nationally certified course for tobacco cessation counsellors in the USA. It is endorsed by NAADAC (National Association of Alcohol and Drug Addiction Coordinators), the major professional group for chemical dependency counsellors in the USA.

    This web based course contains much fascinating and absorbing material and some good practical resources for trainers. However I think most mainstream tobacco cessation counsellors and researchers will find its approach somewhat unorthodox and will be concerned that significant amounts of its content are not based on scientific evidence.

    The course’s educational philosophy is summarised thus: “The course philosophy: foundational knowledge of tobacco addiction is essential; basic counseling techniques and strategies are the necessary skills; effective therapeutic interventions are the tools; the integrated addiction model is the framework for the recovery process; integration of the knowledge, skills, tools and framework for recovery is essential for preparing the student for counseling the smoker.”

    Course materials

    Some of the course materials are decidedly unusual for a tobacco dependence treatment training course and do not seem centrally related to the issue of helping tobacco users overcome their addiction. For example, a paper on “ancient tobacco – resource materials” contains a description of a traditional Indian game, whose relevance to nicotine addiction is neither explained nor obvious. A paper on “Centering prayer as recovery method” asserts “unless this person (the alcoholic) can experience an entire psychic change there is very little hope of recovery—the Big Book of Alcoholics Anonymous is an almost explicit injunction that the practice of the 12 Steps is a spiritual journey designed to produce a transformation of mind body and soul, and an implicit invitation to journey into the personal Interior to access a Higher Power that will in fact produce this transformation.”

    Thus the content of the course is drawn in large measure from the alcohol and drugs fields rather than from the tobacco field. It does not sufficiently acknowledge methods that have been shown to work in what is now a rather large tobacco cessation literature. Disturbingly, the two examples of course materials given above are from the section in the library called “Academic readings”. Other cited resources include Carl Jung’s collected works and Kellogg et al’s “Broken Toys, Broken Dreams, Understanding and Healing Boundaries, Codependence, Compulsion and Family Relationships, Brat Publishing” (their punctuation).

    Core issues

    The core issues that should underpin any evidence based course designed to train tobacco cessation counsellors include social coping skills and relapse, the nature of nicotine addiction, and a thorough account of the treatments which have been shown to work, including nicotine replacement therapy and bupropion. This course contains minimal content on evidence based treatments or on the research literature, including on nicotine replacement therapy and bupropion.

    This is why I would not recommend this course to those who want to train as tobacco cessation counsellors. In spite of its assertion that effective interventions are essential tools, the course as a whole is not centred on evidence based, effective interventions, something that may be clear from the examples I have quoted above. In the end we owe it to our clients and students and to the funders of our treatments and training courses to base interventions on what the scientific evidence shows to be effective. A basic training standard, like that developed by the Health Development Agency in the UK (http://www.hda-online.org.uk/documents/smoking_cessation_treatments.pdf), should mention the core effective treatments like brief interventions, intensive support (group and individual), and the proven medications. It should encourage students to familiarise themselves with the evidence base—for example, the Cochrane reviews (http://www.dphpc.ox.ac.uk/cochrane_tobacco/reviews.html) and the US and UK evidence based treatment guidelines. In the USA the Association for the Treatment of Tobacco Use and Dependence (www.attud.org) is developing training standards which, it is hoped, will lead eventually to national certification. In the meantime there are state courses based much more recognisably on the scientific evidence—for example, in Massachusetts, Maine, Oregon, and Arizona.

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