ADDRESSING

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• ADDRESSING
• NICOTINE DEPENDENCE
• Quarterly Provider Meeting
• 3/26/09

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History of Smoking Cessation Efforts in NJ

• NJ was a National Leader w/ Dr. John Slade, one
  of the nations pioneer advocates leading the
  way for tobacco control
• As early as 2000 The Department of Healths
  primary focus was Research, Education, and
  Surveillance
• Dr. Slade promoted the concept of viewing
  Nicotine as more costly in human life and as
  dangerous as any other drug of abuse/dependence

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WE NEED TO RESPOND

• The 1982 United States Surgeon General's report
  stated that "Cigarette smoking is the major
  single cause of cancer mortality (death) in the
  United States"
• This statement is as true today as it was in 1982
• Tobacco use remains the single most preventable
  cause of death causing about 440,000 deaths per
  year in the United States

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WE NEED TO RESPOND

• Almost half of tobacco related deaths are people
  with mental and substance use disorders
• Smoking cessation among people with mental and
  substance use disorders must become a top
  priority for our fields
• Nicotine addiction not only hinders recovery, it
  is literally killing the very people that we are
  dedicated to serving

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THE FACTS

• Between 80 and 95 percent of alcoholics smoke
  cigarettes, a rate that is three times higher
  than among the population as a whole
• Approximately 70 percent of alcoholics are heavy
  smokers (i.e., smoke more than one pack of
  cigarettes per day), compared with 10 percent of
  the general population

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THE FACTS

• A survey of persons treated for alcoholism and
  other drug addictions revealed that 222 of 845
  subjects had died over a 12-year period
  one-third of these deaths were attributed to
  alcohol-related causes, and one-half were related
  to smoking

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THE FACTS

• Between 80 and 95 percent of alcoholics smoke
  cigarettes, a rate that is three times higher
  than among the population as a whole
• Adolescents who begin smoking are 3 times more
  likely to begin using alcohol
• Smokers are 10 times more likely to develop
  alcoholism than are nonsmokers

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THE FACTS2007/2008 NJ High School Risk
Protective Factor Survey(pending publication)
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THE FACTS2003 Household SurveyFigure 4-11
Heavy Drinking and Illicit Drug Use Among
Smokers and Non-Smokers
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PROMISING FINDINGS

• Interventions to help individuals in drug
  addiction programs stop smoking are effective in
  the short-term and appear to enhance rather than
  compromise other treatment for addictions
• At follow-up substance abuse rates were roughly
  25 less in groups receiving smoking cessation
  interventions

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PROMISING FINDINGS

• Proven/Evidence Based Interventions to treat
  Nicotine Addiction are readily available and
  education, cognitive-behavioral therapy,
  motivational, and antidepressant medication used
  alone or in combination with nicotine replacement
  therapy

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DAS CONTRACT LANGUAGE

• Presently--- Treatment Annex As
• The contractee (subcontractee) shall provide
  all services under this contract(subcontract) in
  a smoke-free environment. All treatment planning
  shall include education on tobacco use. The
  contractee (subcontractee) shall work toward
  development of a tobacco-free program.

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DAS REGULATIONS

• Outpatient Regs (proposed)- The smoking of
  tobacco products and the use of spit or any form
  of tobacco is prohibited within all outpatient
  substance abuse treatment facilities.
• Inpatient Regs- (DRAFT) - The facility shall
  establish written policies precluding alcohol and
  nicotine use, or showing evidence of use (for
  example, paraphernalia, cigarette packs or other
  tobacco products) during working hours within the
  facility, on the grounds of the facility or when
  representing the facility. 

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PAC Feedback on Becoming Tobacco-Free

• Administration emphasis and staff commitment is
  necessary for success
• Smoking has been used as a behavior regulator at
  some programs, using it as a reward
• Tobacco must be addressed as part of a total
  recovery process
• Client-centered approach will get the best results

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The NY Experience

• Providers voiced concerns about the cost of
  retooling operations to go smoke free for clients
  and staffs
• They were concerned that a smoke free
  environment might create a disincentive for
  seeking and remaining in treatment
• Several provider agencies imposed a ban on staff
  smoking before imposing the ban on clients
• Gradual, non-punitive implementation w/ full
  program commitment has worked best for providers

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Questions

• What resources currently exist to support tobacco
  cessation?
• What is needed to address tobacco dependence in
  the context of addictions prevention, treatment,
  and recovery support?

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Citations

• Bobo, J.K., and Husten, C. Sociocultural
  influences on smoking and drinking. Alcohol
  Research Health 24(4)225232, 2000.
• http//www.athealth.com/Practitioner/ceduc/alc_tob
  .html
• Grucza, R.A., and Beirut, L.J. Co-occurring risk
  factors for alcohol dependence and habitual
  smoking Update on findings from the
  Collaborative Study on the Genetics of
  Alcoholism. Alcohol Research Health
  29(3)172177, 2007
• Hurt, R.D. Eberman, K.M. Croghan, I.T. et
  al.Nicotine dependence treatment during inpatient
  treatment for other addictions A prospective
  intervention trial. Alcohol Clin Exp Res
  18(4)867-872, 1994.
• Anthony, J.C., and Echeagaray-Wagner, F.
  Epidemiologic analysis of alcohol and tobacco
  use. Alcohol Research Health 24(4)201208,
  2000.
• http//www.athealth.com/Practitioner/ceduc/alc_tob
  .html