Tobacco Resources
The MaineHealth Center for Tobacco Independence provides a variety of tools for providers on addressing tobacco use and treatment.Provider Tobacco Toolkit
The following resources are free for providers to use; they are the same documents we provide at our outreach visits and trainings. The tools, including assessments, billing and coverage information, medication information, treatment resources and more have been vetted with behavioral health and clinical providers. To learn more or receive technical assistance for your organization, please contact [email protected] or contact (207)662-7154.
Please visit our Tobacco and ENDS & Vaping sections for targeted resources for clients and patients.
Assessment Tools:
- Assessment Questionnaire
- CAGE AID
- E-Cigarette/ENDS Assessment (Penn State)
- Fagerstrom Scale for Nicotine Dependence – Smoking; Smokeless Tobacco
- Hooked on Nicotine Checklist
- Patient Health Questionnaire
- Readiness to Quit Ladder
- Tobacco Treatment Note – Initial Visit; Visit
- Tobacco Use Assessment
Billing and Coverage:
- American Lung Association Billing Guide for Tobacco
- MaineCare Coverage of Tobacco Treatment Medications
- Tobacco Treatment Billing Guide (Updated December 2019)
Motivational Documents:
- Behavioral Health Client Handout
- CTI Readiness Ruler
- What To Tell Your Patients About Smoking
- Additional motivational tools for patients and clients available under the Tobacco Resources page.
Maine QuitLink:
- Maine QuitLink Referral Form
- Maine QuitLink: What You Need to Know Infographic
- Referring Patients to Tobacco Treatment Fact Sheet
- The Maine Tobacco HelpLine is now the Maine QuitLink, visit our Maine QuitLink page for additional information.
Tobacco Treatment Medications:
- FDA: Smoking Cessation Products 101
- Medication Dosing Guidelines
- Over the Counter Nicotine Replacement Therapy (NRT) Products
- Buproprion
- Nicotine Gum – Fact Sheet; Patient Information Card
- Nicotine Inhaler
- Nicotine Lozenge – Fact Sheet; Patient Information Card
- Nicotine Nasal Spray
- Nicotine Patch – Fact Sheet; Patient Information Card
- Varenicline
Tobacco Treatment:
- Back Talk
- Carbon Monoxide Monitor Handout
- Cigarette Log
- Components of a Simple Quit Plan
- Daily Coping Inventory Worksheet
- Dear Family and Friends Letter
- Drug Interactions with Tobacco Smoke
- HALT Chart
- Helpful Tips for Quitting Tobacco
- High Risk Situations Worksheet
- I Quit Smoking and Now I Feel
- Keeping Track
- My Medication Plan
- My Weekly Strategies and Goal
- PacksTracks
- Problem Solving Strategies
- Reframe Worksheet
- Sample Tobacco Treatment Plans
- Sample Treatment Goals with Headings
- The 4 Ds
- The 5 As
- The Three-Legged Stool
- Tobacco Treatment Services Guide
- Understanding Withdrawal Symptoms
- When Do I Use Tobacco
- You Can Quit Smoking Worksheet
Group Specific Treatment Materials:
- Sample Schedule (Time Limited) Tobacco Treatment Group
- Three Topics Integrating Tobacco Conversations into Existing Groups
- Tobacco Group Participant Questionnaire
- Tobacco Treatment Group Flow Sheet
Additional Resources:
- Maine Tobacco Treatment Services Guide (updated June 2020)
- Brochure: Addressing Tobacco Use in Behavioral Health Agencies – Resources from the Center for Tobacco Independence
- Provider Office Poster: When You’re Ready to Quit, We Are Here to Help
- Digital Display Poster: Full Color One Color
- Digital Display Posters – Quit Messages
- Digital Display Posters – Smoke-Free Home Messages
- Digital Display & Posters – Secondhand Smoke and Pets Messages
- Secondhand Smoke and Pets 1 – Poster, Digital Display
- Secondhand Smoke and Pets 2 – Poster, Digital Display
- Secondhand Smoke and Pets 3 – Poster, Digital Display