ADDRESSING ADDRESSING

NICOTINE DEPENDENCENICOTINE DEPENDENCE

Quarterly Provider MeetingQuarterly Provider Meeting3/26/093/26/09

History of Smoking History of Smoking Cessation Efforts in NJCessation Efforts in NJ

NJ was a National Leader w/ Dr. John NJ was a National Leader w/ Dr. John Slade, one of the nations’ pioneer Slade, one of the nations’ pioneer

advocates leading the way for tobacco advocates leading the way for tobacco control control

As early as 2000 The Department of As early as 2000 The Department of Health’s primary focus was Research, Health’s primary focus was Research,

Education, and SurveillanceEducation, and SurveillanceDr. Slade promoted the concept of Dr. Slade promoted the concept of

viewing Nicotine as more costly in human viewing Nicotine as more costly in human life and as dangerous as any other drug of life and as dangerous as any other drug of

abuse/dependenceabuse/dependence

WE NEED TO RESPONDWE NEED TO RESPOND

The 1982 United States Surgeon General's The 1982 United States Surgeon General's report stated that "Cigarette smoking is the report stated that "Cigarette smoking is the major single cause of cancer mortality major single cause of cancer mortality (death) in the United States" (death) in the United States"

This statement is as true today as it was in This statement is as true today as it was in 19821982

Tobacco use remains the single most Tobacco use remains the single most preventable cause of death – causing about preventable cause of death – causing about 440,000 deaths per year in the United States440,000 deaths per year in the United States

WE NEED TO RESPONDWE NEED TO RESPOND

Almost half of tobacco related deaths are Almost half of tobacco related deaths are people with mental and substance use people with mental and substance use disordersdisorders

Smoking cessation among people with Smoking cessation among people with mental and substance use disorders must mental and substance use disorders must become a top priority for our fieldsbecome a top priority for our fields

Nicotine addiction not only hinders Nicotine addiction not only hinders recovery, it is literally killing the very recovery, it is literally killing the very people that we are dedicated to servingpeople that we are dedicated to serving

THE FACTSTHE FACTS Between 80 and 95 percent of alcoholics Between 80 and 95 percent of alcoholics

smoke cigarettes, a rate that is three smoke cigarettes, a rate that is three times higher than among the population times higher than among the population as a wholeas a whole

Approximately 70 percent of alcoholics are Approximately 70 percent of alcoholics are heavy heavy smokers (i.e., smoke more than one smokers (i.e., smoke more than one pack of cigarettes per day), compared with pack of cigarettes per day), compared with 10 percent of the general population 10 percent of the general population

THE FACTSTHE FACTS

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

THE FACTSTHE FACTS

Between 80 and 95 percent of alcoholics Between 80 and 95 percent of alcoholics smoke cigarettes, a rate that is three smoke cigarettes, a rate that is three times higher than among the population times higher than among the population as a wholeas a whole

Adolescents who begin smoking are 3 Adolescents who begin smoking are 3 times more likely to begin using alcoholtimes more likely to begin using alcohol

Smokers are 10 times more likely to Smokers are 10 times more likely to develop alcoholism than are nonsmokersdevelop alcoholism than are nonsmokers

THE FACTSTHE FACTS2007/2008 NJ High School Risk & Protective Factor Survey2007/2008 NJ High School Risk & Protective Factor Survey

(pending publication)(pending publication)

96.1%

66.6%

24.6%

51.0%

10.8%

2.4%

0%

20%

40%

60%

80%

100%

Used Alcohol Used Marijuana Used Other Drug*

Past Year Substance Use

Smoked in Past Year

Did not Smoke

THE FACTSTHE FACTS2003 Household Survey2003 Household Survey

Figure 4-11: Heavy Drinking and Illicit Drug Use Among Figure 4-11: Heavy Drinking and Illicit Drug Use Among Smokers and Non-SmokersSmokers and Non-Smokers

47.9

12.5

28.8

5.6

14.5

2.30

10

20

30

40

50

60

Used Marijuana inLifetime

Used Drug Otherthan Marijuana in

Lifetime

Current HeavyDrinker

Current Smoker Never Smoked

PROMISING FINDINGSPROMISING FINDINGS

Interventions to help individuals in drug Interventions to help individuals in drug addiction programs stop smoking are addiction programs stop smoking are effective in the short-term and appear to effective in the short-term and appear to enhance rather than compromise other enhance rather than compromise other treatment for addictionstreatment for addictions

At follow-up substance abuse rates were At follow-up substance abuse rates were roughly 25% less in groups receiving roughly 25% less in groups receiving smoking cessation interventionssmoking cessation interventions

PROMISING FINDINGSPROMISING FINDINGS

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

DAS CONTRACT LANGUAGEDAS CONTRACT LANGUAGE

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

DAS REGULATIONSDAS REGULATIONS

Outpatient Regs (proposed)-Outpatient Regs (proposed)- The smoking of The smoking of tobacco products and the use of spit or any form tobacco products and the use of spit or any form of tobacco is prohibited within all outpatient of tobacco is prohibited within all outpatient substance abuse treatment facilities. substance abuse treatment facilities.

Inpatient Regs- (DRAFT)Inpatient Regs- (DRAFT) - The facility shall - The facility shall establish written policies precluding alcohol and establish written policies precluding alcohol and nicotine use, or showing evidence of use (for nicotine use, or showing evidence of use (for example, paraphernalia, cigarette packs or example, paraphernalia, cigarette packs or other tobacco products) during working hours other tobacco products) during working hours within the facility, on the grounds of the facility within the facility, on the grounds of the facility or when representing the facility.  or when representing the facility. 

PAC Feedback on Becoming PAC Feedback on Becoming Tobacco-FreeTobacco-Free

Administration emphasis and staff Administration emphasis and staff commitment is necessary for successcommitment is necessary for success

Smoking has been used as a behavior Smoking has been used as a behavior regulator at some programs, using it regulator at some programs, using it as a rewardas a reward

Tobacco must be addressed as part of Tobacco must be addressed as part of a total recovery processa total recovery process

Client-centered approach will get the Client-centered approach will get the best resultsbest results

The NY ExperienceThe NY Experience

Providers voiced concerns about the cost of Providers voiced concerns about the cost of retooling operations to go smoke free for retooling operations to go smoke free for clients and staffsclients and staffs

They were concerned that a smoke –free They were concerned that a smoke –free environment might create a disincentive for environment might create a disincentive for seeking and remaining in treatmentseeking and remaining in treatment

Several provider agencies imposed a ban on Several provider agencies imposed a ban on staff smoking before imposing the ban on staff smoking before imposing the ban on clientsclients

Gradual, non-punitive implementation w/ full Gradual, non-punitive implementation w/ full program commitment has worked best for program commitment has worked best for providersproviders

Questions Questions

What resources currently exist to What resources currently exist to support tobacco cessation? support tobacco cessation?

What is needed to address tobacco What is needed to address tobacco dependence in the context of dependence in the context of addictions prevention, treatment, addictions prevention, treatment, and recovery support?and recovery support?

CitationsCitations

Bobo, J.K., and Husten, C. Sociocultural influences on smoking and drinking. Bobo, J.K., and Husten, C. Sociocultural influences on smoking and drinking. Alcohol Research & HealthAlcohol Research & Health 24(4):225–232, 2000. 24(4):225–232, 2000.

http://www.athealth.com/Practitioner/ceduc/alc_tob.htmlhttp://www.athealth.com/Practitioner/ceduc/alc_tob.html

Grucza, R.A., and Beirut, L.J. Co-occurring risk factors for alcohol dependence 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 and habitual smoking: Update on findings from the Collaborative Study on the Genetics of Alcoholism. Genetics of Alcoholism. Alcohol Research & HealthAlcohol Research & Health 29(3):172–177, 2007 29(3):172–177, 2007

Hurt, R.D.; Eberman, K.M.; Croghan, I.T.; et al.Nicotine dependence Hurt, R.D.; Eberman, K.M.; Croghan, I.T.; et al.Nicotine dependence treatment during inpatient treatment for other addictions: A treatment during inpatient treatment for other addictions: A prospective intervention trial. prospective intervention trial. Alcohol Clin Exp Res Alcohol Clin Exp Res 18(4):867-872, 18(4):867-872, 1994.1994.

Anthony, J.C., and Echeagaray-Wagner, F. Epidemiologic analysis of Anthony, J.C., and Echeagaray-Wagner, F. Epidemiologic analysis of alcohol and tobacco use. alcohol and tobacco use. Alcohol Research & HealthAlcohol Research & Health 24(4):201–208, 24(4):201–208, 2000. 2000.

http://www.athealth.com/Practitioner/ceduc/alc_tob.htmlhttp://www.athealth.com/Practitioner/ceduc/alc_tob.html