Enhancing Recovery: Addressing Nicotine Dependence in Treatment Programs

1. Enhancing Recovery: Addressing Nicotine Dependence in Treatment Programs Janet Smeltz, M.Ed., CADAC, M-CTTS Institute for Health & Recovery Cambridge, MA Melanie Thornton, MSW, GSW Jefferson Addictive Disorders Dually Diagnosed Clinic Metairie, Louisiana

2. Rationale for Addressing Tobacco Dependence • Morbidity / mortality • Prevalence • Interest in quitting • Continued smoking as relapse factor to A/OD

3. Rationale for Addressing Tobacco Dependence (2) • Similar relapse prevention techniques • Tobacco use negatively impacts other psycho-social & recovery issues: • Finances • Health, HIV, Hepatitis C status • Pregnancy, children’s health • Treatment compliance • Medications • Dealing with feelings, developing coping skills • Increased risk for other health problems through multiple substance dependence

4. The Challenges • High prevalence • Historical view of smoking • Change requires multiple approaches, systems change, paradigm shift • Policy concerns

5. Tobacco, Addictions, Policy & Education (TAPE) Project • Funded through Mass. DPH, Bureau of Substance Abuse Services (BSAS), 1994 • Statewide Targeted Capacity Building Grant • Serves all BSAS prevention & treatment programs by providing: • Consultation / TA • On-site staff training • “Thinking About Change?” workshops for staff who smoke • Resources, referrals & information • Annual conference & statewide trainings

6. Collaborations • Provider advisory group, CENAR (Council to End Nicotine Addiction in Recovery) • Massachusetts Tobacco Control Program (MTCP) • NJ Tobacco Dependence Program • MTCP / U. Mass. Medical School TTS Core Certification Training

7. Stages of Change Framework • Organizational process of change • Tailor approaches • Acknowledge & work with ambivalence • Importance of education & training

8. Tie-In With Addictions Treatment • Chronic, relapsing condition; complex addiction • Bio-psycho-social model • Build buy-in of leadership & line staff • Changing norms & culture, mission

9. Methods • Focus groups • Program surveys • Outreach to providers • Linkage with / referral to MTCP • NRT: pilot study; integration

10. Progress: BSAS Tobacco Guidelines (2004) • Process: development, review, final product • Leadership of state agency based on accumulation of research, US P.H.S. evidence-based clinical practice guidelines • Wider view of addiction, treatment, recovery: whole person • Implementation: systems-based, individualized • Ongoing follow-up, training, TA • Consistent message throughout system

11. Lessons Learned • Maintain Stages of Change perspective • Build relationships over time • Take the long view: change is a process • Promote systems-based approach • Build a cadre of trained, committed professionals

12. Lessons Learned (II) • See staff as key: reframe resistance • Use inclusive, treatment-oriented language: put the “T” in ATOD • Translate research into meaningful, relevant terms • End scare tactics: educate, involve

13. Next Steps • Continue to build buy-in • Implement, follow-up & enforce new guidelines • Build capacity of system through ongoing provision of training, TA, & resources • Support interest & leadership of programs • Prevent “relapse” of system