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Section 4
Approach for Tobacco Abstinence

Question 4 | Answer Booklet | Table of Contents

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In the last section, we discussed preparing to quit.  There are three basic steps that can help a client attempt to successfully overcome tobacco dependence.  These three steps are self-monitoring smoking habits, devising a quitting plan, and committing to a quit date. 

In this section, we will discuss the S.A.L.E.S. approach to overcoming tobacco dependency.  As you know, many tobacco dependent clients associate with other tobacco users.  Statistics show that over seventy percent of smokers want to quit.  Therefore, I have found that it can sometimes be easy and usually helpful for a client to enlist a quitting partner

The S.AL.E.S. approach is a technique that attempts to maximize the effectiveness of your client’s quitting partner regarding breaking smoking patterns.  You might consider playing this section during your next session with a tobacco dependent client.  Clearly, S.A.L.E.S. is an acronym for speak, abstain, link, empathize and solve, which are the five elements of the S.A.L.E.S. approach. 

Let’s examine each of the five elements of the S.A.L.E.S. approach as they relate to Darcy. We will also take a look at a three step problem solving process regarding smoking cessation.

Darcy, age 42, had struggled with tobacco dependency for eight years.  Darcy stated, "I quit smoking when I was pregnant nine years ago.  I didn’t have any trouble quitting for my baby, but after she was born I started right back up.  It was a dumb thing to do, I know!"  Do you have a client like Darcy who has resumed smoking after a short but successful quit attempt?  Do you find that previous quit attempts can sometimes benefit clients regarding finding out what works and what doesn’t? 

Darcy continued by stating, "We had a cancer awareness meeting at the office last week.  Afterward, my girlfriends and I went out back to smoke and found ourselves talking about how smoking was going to kill us!"  Because Darcy had peers that were obviously motivated to quit as well, I decided to ask her to try the S.A.L.E.S. approach to overcoming tobacco dependency.

The Five Elements of the S.A.L.E.S. Technique

♦ #1  Speak
I explained to Darcy that ‘S.A.L.E.S.’ was an acronym that she could implement with her coworkers along with other techniques to increase her chances of quitting successfully.  I stated, "The first ‘S’ in the S.A.L.E.S. approach stands for speak.  Let this remind you to ‘speak to each other every day.’  Frequent, daily contact with a support source is an integral part of kicking the habit, particularly in the early stages of quitting. 

Of course, these contacts don’t have to be face to face.  Phone contact is fine.  Some clients have even used email.  The goal is brief, frequent contact rather than one long conversation each day.  Then, after you and your partner quit smoking, make an agreement to talk to one another, no matter what, before either of you has a cigarette."  Darcy asked, "Do you mean like in a twelve step program?"  I responded, "Yes.  The strategy of calling your partner before relapsing is used extensively in twelve step programs, and it may be one of the most effective strategies these programs use."  Would you agree?

♦ #2  Abstain
The letter ‘A’ in the S.A.L.E.S. approach stands for abstain.  Darcy asked, "You mean abstain from smoking, right?"  I responded, "I’d like you to abstain from smoking, but to meet that goal, abstain from complaining about quitting smoking."  Think of your Darcy.  Could your client benefit from avoiding turning conversations into gripe sessions about how awful it is to quit smoking?  I explained to Darcy that it was fine, of course, to talk about difficulties, but that the focus of the conversation should be on problem solving.  Would you agree?  We’ll discuss problem solving later on this section. 

♦ #3  Link
In addition to speaking to your partner and abstain from complaining about not smoking, the third part of the S.A.L.E.S. approach is the letter ‘L.’  ‘L’ stands for link.  I stated to Darcy, "A buddy system is only as good as its weakest link.  Try to support your partner’s efforts even if you are having a tough time.  Most quitting partners are helpful, but they can also bring you down."  Darcy acknowledged the importance of linking together as a team.  For clients that can benefit from an example of how a quitting partner can bring them down, I relate Susan’s story. 

Susan, a 51 year old client, had partnered up with Linda, age 49.  Susan stated, "Everything was going really well, until Friday.  I called Linda.  She was having an awful day!  She wanted a cigarette real bad.  While my day had been alright, Linda suggested we meet for a drink and a cigarette!  She was kidding, but I said ‘Sure!’  At eight o’clock that night, I was half way through a pack of Kool’s and well on my way through my third martini!"  Do you have a client like Darcy who could benefit from hearing about Linda’s experience with her stop smoking partner? 

♦ #4  Empathize
After linking together with her quitting partner, Darcy implemented the ‘E’ in the S.A.L.E.S. approach.  I stated, "Empathize, but don’t sympathize with your quitting partner.  Overcoming tobacco dependency is more productive when you give and get empathic support.  What I’m referring to is listening, encouraging, understanding and problem solving.  Be careful not to offer instrumental support, like favors.  Also, it doesn’t help to give sympathy and say, ‘Oh the withdrawal must be terrible!’ 

Instead, consider giving encouragement and help your partner solve the problem by saying something like, ‘Those withdrawal symptoms are tough; let’s think about how we can get through this."  Darcy stated, "I’m still not sure I understand the difference between empathy and sympathy."  How would you clarify for Darcy?  I stated, "Offer sympathy when you can do nothing or little about the outcome.  For example, a friend grieving the death of a loved one needs sympathy.  Give empathy when you can actively help with a solution." 

♦ #5  Solve
In addition to speak, abstain, link and empathize, the fifth letter in the S.A.L.E.S. approach stands for solve.  I stated to Darcy, "Once you and your quitting partner start working together to solve the problems, you can help each other stay positive.  Problems lead to relapse.  By solving your problems together, you can avoid relapse together."  Darcy stated, "I’m not very good at problem solving." 

3 Steps to Problem Solving

First, define the problem as specifically as you can.  An example might be getting a terrible craving for a cigarette.  Can you think of questions you could ask to help define the craving?"  Darcy responded, "Well…, the basics, I guess.  Who, what, when, where."  I continued, "Exactly.  So, for example, let’s say the problem is defined more specifically as, ‘I have a terrible craving for a cigarette whenever I go out for a drink with my friends.’ 

Then the second step in the problem solving process is to brainstorm alternatives.  What alternatives can you think of for craving a cigarette when drinking with friends?"  After some thought, Darcy replied, "You could not drink for a couple days, avoid the bar, or ask your friends not to smoke or offer you a cigarette."  I stated, "Good.  Those are great alternatives, which brings us to the third step in the problem solving process.

In the third step, you can choose the best alternative from step two and act on it."  Would consistently adopting a problem solving approach to overcoming tobacco dependency help your client?  Would playing this section in a session be productive?

In this section, we have discussed the S.A.L.E.S. approach to overcoming tobacco dependency.  The S.A.L.E.S. approach is a technique that attempts to maximize the effectiveness of a client’s quitting partner.  Clearly, S.A.L.E.S. is an acronym for speak, abstain, link, empathize and solve.  We also looked at a three step problem solving process regarding smoking cessation.  Do you have a tobacco dependent client that would benefit from listening to this section during your next session?

In the next section, we will discuss smoking triggers.  The four smoking triggers we will look at in this section are places, people, time, and feelings.

Peer-Reviewed Journal Article References:
McCarthy, D. E., Ebssa, L., Witkiewitz, K., & Shiffman, S. (2015). Paths to tobacco abstinence: A repeated-measures latent class analysis. Journal of Consulting and Clinical Psychology, 83(4), 696–708. 

Merritt, P. S., Cobb, A. R., & Cook, G. I. (2012). Sex differences in the cognitive effects of tobacco abstinence: A pilot study. Experimental and Clinical Psychopharmacology, 20(4), 258–263.

Ozga, J. E., Romm, K. F., Turiano, N. A., Douglas, A., Dino, G., Alexander, L., & Blank, M. D. (2021). Cumulative disadvantage as a framework for understanding rural tobacco use disparities. Experimental and Clinical Psychopharmacology, 29(5), 429–439.

Palmer, A. M., & Brandon, T. H. (2018). How do electronic cigarettes affect cravings to smoke or vape? Parsing the influences of nicotine and expectancies using the balanced-placebo design. Journal of Consulting and Clinical Psychology, 86(5), 486–491.

Perkins, K. A., Karelitz, J. L., & Michael, V. C. (2017). Effects of nicotine versus placebo e-cigarette use on symptom relief during initial tobacco abstinence. Experimental and Clinical Psychopharmacology, 25(4), 249–254.

What are the five elements of the S.A.L.E.S. approach? To select and enter your answer go to Answer Booklet.

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Section 5
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