Tobacco-Free Treatment

As 2016 stretches before us, I am filled with anticipation and dread—anticipation of unlimited opportunities to provide treatment to those seeking a new way of life, and dread because way back in 2012, Skyway House committed to a five-year plan culminating in tobacco-free provision of services. That means no tobacco at any of our facilities! What seemed a long-term plan is now a short-term action item. As we draw nearer to 2017, my thoughts are turning to the challenges and rewards of tobacco-free treatment.

The research is clear; substance-addicted and mentally ill populations have higher rates of tobacco-related illnesses than the general population. And further, smoking cessation during treatment has been shown to enhance recovery and abstinence rates. It is heartbreaking to hear of folks who quit drinking and drugs just to die of tobacco-related illnesses later in recovery, and it is certainly a compelling argument for going tobacco free. Our leadership team agreed that it was important enough for us to focus on cessation resources for our staff, new policies supporting a tobacco-free environment, and protocols assisting clients in cessation if they chose.

Our first step was to restrict client and staff smoking together. That was fairly straightforward and everyone agreed it was a good idea. We also relegated smoking areas to a part of the facility that limits the effects of secondhand smoke on the other clients and staff, as well as the neighbors. The next step was to offer cessation resources for staff and clients who chose to quit. We offer the patch and a phone support network for staff. We also encouraged a weekly Nicotine Anonymous group on our campus and lower health care rates for tobacco-free employees. While there was general engagement at first, as can be the way with resolutions, the interest waned rather quickly. And of course we have staff who steadfastly cling to their right to smoke. 

We continue to offer clients assistance if they want to opt for a tobacco-free experience. 1-800-QUIT-NOW has been helpful for connecting clients with cessation resources. However, there is evidence that the tendency of staff to encourage smoking cessation among clients is directly related to their own smoking status. For example, current smokers are less likely to recommend clients consider cessation (Ratschen, Britton, Doody, Leonardi-Bee, & McNeill, 2009). So, our challenge lies in educating and supporting our staff. As I contemplate a tobacco-free agency, I can’t help but wonder, “If we do it, will they come?” When I was seeking treatment myself, my only qualifier was that I had to be able to smoke! How then, if I was seeking that freedom of choice years ago, can I create an environment where others won’t have it today? And the answer is, resoundingly, that I know better now. I know that tobacco limits our freedom and allows us to remain embedded in the disease of addiction far longer than we have to. But “Can I smoke there?” remains a qualifier for many when choosing treatment. 

The state of New Jersey has been successful in adopting the person-centered programming that utilizes craving management through counseling and medication in tobacco cessation. In 1999 that state passed licensure standards that required residential addiction treatment providers to assess and treat patients for tobacco dependence and maintain tobacco-free grounds at all residential treatment sites. There was a phased implementation and ultimately funding available for training, free nicotine replacement therapy (NRT), and implementation of the new standards. While I don’t seek state oversight in this area, program unity in our approach would be transformational. We as treatment leaders have been slow to address nicotine dependence despite evidence that while smoking has decreased in the general population, people with mental health and behavioral health issues are 70 percent more likely to smoke than their general counterparts and show little change over time (Weir, 2013).

As an industry how long will we tolerate tobacco use? As we transition to mainstream health care, will our tolerance level change? Will we treat tobacco as hospitals do, with a tobacco-free campus, no-evidence employee usage, and cessation resources available to all who request them? Will we support clients in their effort to be truly free of all substances?

And finally, as treatment leaders, should we not be having these conversations? Should we not be charting a new way forward for our clients? I welcome the discussion of health equity at our CCAPP conferences and hope to find partners willing to contemplate the impact of tobacco on SUD treatment.

2017 and its tobacco-free initiative looms large for our agency, but not nearly as large as the challenge facing our clients as they battle tobacco-related illnesses. In my own recovery journey, nicotine was the hardest drug to quit and the one I am most proud to remain free of, despite my counselor in treatment telling me that I’d never make it!

Ratschen, E., Britton, J., Doody, G. A., Leonardi-Bee, J., & McNeill, A. (2009). Tobacco dependence, treatment, and smoke-free policies: A survey of mental health professionals’ knowledge and attitudes. General Hospital Psychiatry, 31(6), 576–82.

Weir, K. (2013). Smoking and mental illness. Monitor on Psychology, 44(6), 36.