Table 3.

Behavioral skills strengths and deficits

Definition/ Code	Strength/ Deficit	Total na	Clients na	Client Examples	Counselors na	Counselor Examples
Coping skills
Replacing smoking (“smoking is all I have”)	Strength	4	4	“It seems like I can pick it up…I can do without. I can take it or leave it.”	0
	Deficit	16	8	“I feel like if I quit smoking, what am I going to replace that [with]? I don’t want to replace it with eating because I don’t want to get fat. I don’t know what else I would replace it with.”	8	“…if you are going to take something away, you have to give something in its place.”
Coping with emotions/ stress	Strength	4	4	“It’s always weirded me out that when people are nervous, they chain smoke. I cannot do that because if I am nervous and I start chain smoking, I get more nervous.”	0
	Deficit	21	13	“When I am stressed out or emotional, or something is upsetting me, I tend to smoke a lot more. A whole lot more.”	8	“Smoking may just be another coping method and another way to deal with the stress, anxiety, unpleasant feelings…”
Coping with cravings	Strength	10	10	“I went for a walk. I exercised to get my endorphins going that way and eventually the cravings went away.”	0
	Deficit	13	11	“The craving. The tobacco companies are geniuses. Like a mixture that they have is so addictive and it is so strong and you do not even have power over it. It controls you.”	2	“They have to know what to do with the cravings.”
Coping with fatigue	Strength	0	0		0
	Deficit	13	11	“I have to chain smoke to keep myself awake.”	2	“[They think] ‘it [the methadone] makes me sleepy, so I’ll just smoke.’”
Social skills
Developing supportive social networks	Strength	13	10	“You find ways to get away from people that smoke. The more you want it, the more you’ll find people on your level.”	3	“…his wife bugged him enough and he [the client] quit.”
	Deficit	27	18	“Well, everybody, my boyfriend smokes, my brother smokes, my mom, my dad, like everybody smokes. I feel like smokers cling together.”	9	“I think that most of the people in their lives probably smoke as well.”
Saying “no” to offered cigarettes	Strength	0	0		0
	Deficit	4	2	“Sometimes, somebody is like, ‘Oh, you want to come and smoke a cigarette?’ Even if, like, I just went out and smoked a cigarette 20 minutes ago, ‘Alright, let’s go smoke a cigarette again.’”	2	“…the more you are around it, the more acceptable, the less likely you will say ‘no’.”
Negotiating clinic culture	Strength	11	11	“It [clinic culture] doesn’t affect me because I come in, get my dose, get back in my car, and I split.”	0
	Deficit	21	13	“Instead of saying we’re taking a 5-minute break, the counselor would be like ‘We’re taking a 10-minute smoke break. Basically because everybody except maybe one person gets up and smokes.”	8	“I think among the patients it is a big culture. The second there is a break for group they all rush out and smoke cigarettes.”
Breaking links and changing routine
Breaking smoking links with alcohol and coffee	Strength	1	1	“Some people smoke a lot when they go to a bar or drink. If I ever drink, I would, like, have 18 cigarettes left in my pack.”	0
	Deficit	15	13	“Coffee and cigarettes is, like, the best match…I smoke another cigarette when the coffee is still hot and then I will warm my coffee up and smoke another cigarette. At least five cigarettes with my one coffee.”	2	“…she relapsed on alcohol and the relapse to alcohol led her back to cigarette smoking.”
Breaking link with methadone dosing	Strength	9	6	“When I take methadone, I can go with or without the cigarette afterwards.”	3	“I have heard, you know, people saying that once they started methadone they just don’t have a taste for cigarettes.”
	Deficit	21	17	“I think it is more of a Pavlovian response that, okay, I got my meth, now I am having a cigarette.”	4	“Methadone clients smoke a cigarette after taking a dose.”
Breaking link with drug use	Strength	1	1	“When I did drugs, I definitely didn’t smoke…cigarettes definitely weren’t in the picture.”	0
	Deficit	19	13	“Every time I go back to using, I start smoking again.”	6	“I just believe that tobacco is just part of the whole culture of drug use. We know we have removed the drugs, the culture remains and tobacco continues.”
Changing routine	Strength	2	2	“I found out what worked for me is by me not having that cigarette to take the dogs out or the minute I wake up. I smoke less.”	0
	Deficit	13	8	“It’s like routine…you’re so used to eating something then smoking a cigarette…you get your dose and then you smoke a cigarette…You’re just so used to doing the same thing every day…it takes a while to break a routine that you have had for so long.”	5	“I find that in speaking with smokers, I find that they do it at certain times. It is habitual in that way, and I think it is the same for clients. ‘I smoke when I get up in the morning, or I smoke when I do this. If I take a break from work, I will do this.”
Pharmacotherapy
Obtaining pharmaco- therapy and taking correctly	Strength	15	9	“I tried the inhaler and that works good. And even now, I still have some more, and if I do not have cigarettes, and I need nicotine, I’ll do the inhaler.”	6	“I think once they have it [pharmacotherapy], they will take it properly.”
	Deficit	16	6	“It’s easier to get $20 a day to get a pack of cigarettes…it is not so secure in a lot of people’s heads that ‘I can put $100 aside for the quit smoking things.’”	10	“…some of them will have difficulty following through and taking the medications as prescribed.”
Existing skills
Skills used to quit drugs	Strength	8	6	“It’s the same thing with drugs. You’ve got to change people, places, and things. If you don’t want to smoke anymore, you are not going to hang out at bars. You are not going to hang out with people that smoke. You’ve got to separate yourself. It is just like, if you want to quit getting high, you are not going to hang out with people that are getting high.”	2	“They have to develop a concrete plan with people, places, and things.”
	Deficit	1	0		1	“It’s a little different [from quitting drugs], they change their phone numbers so the dealers cannot call them anymore.”

^aNumber of participants who provided comments.