Integrating Tobacco Interventions in Chemical Dependence

1. Module 1 - The Foundation:Integrating Tobacco Use Interventions into Chemical Dependence Services

2. Welcome Add Trainer Names

3. This training was developed by the Professional Development Program, under a contract with the NYS Department of Health, Tobacco Control Program. PDP developed five classroom-based curricula and seven online modules, which are available at www.tobaccorecovery.org

4. Housekeeping • Hours of Training • Breaks and Restrooms • Tobacco Use Policy • Cell Phones • Active Participation • Complete Training Evaluation

5. Introductions

6. Training Modules Module 1 - The Foundation Module 2 - Assessment, Diagnosis, Pharmacotherapy Module 3 - Behavioral Interventions Module 4 - Treatment Planning Module 5 - Co-occurring Disorders E-Learning - All Modules (www.tobaccorecovery.org)

7. Module 1 Agenda • Introductions • Attitudes and Beliefs Activity • A Brief History • Rationale • Tobacco Dependence • NYS OASAS Regulation Part 856

8. Module 1 Objectives Please refer to the list of objectives in your manual.

9. Unit 1Setting the Stage

10. Attitudes and Beliefs The purpose of this activity is to help you explore your attitudes and beliefs about: • Tobacco use • Integrating tobacco interventions into chemical dependence services • Tobacco use, dependence, and recovery

11. Attitudes and Beliefs, cont’d Debrief and Process

12. Timeline • 1798 – 1970s: Recognition of Tobacco Dependence - Lost and Found • 1980s - 1990s: Emerging Awareness • 2003 - 2008: A New Century

13. RECOGNITION OF TOBACCO DEPENDENCE Lost and Found 1798 1870s late1800s, early 1900s 1930s 1960s-1970s

14. 1798: Benjamin Rush, a physician and signer of the Declaration of Independence, identifies tobacco use as a harmful substance and observes that use supports excess alcohol consumption. RECOGNITION OF TOBACCO DEPENDENCE 1798 1870s late 1800s, early 1900s 1930s 1960s-1970s

15. 1870s: Tobacco is identified as both a harmful addictive substance and as contributing factor in relapse from alcoholism and drug dependence. RECOGNITION OF TOBACCO DEPENDENCE 1798 1870s late 1800s, early 1900s 1930s 1960s-1970s

16. Late 1800s and early 1900s: Tobacco dependence is routinely treated along with alcoholism and other drug dependence in inebriate clinics and asylums. RECOGNITION OF TOBACCO DEPENDENCE 1798 1870s late 1800s, early 1900s 1930s 1960s-1970s

17. 1930s - Oxford Group principles used to help support early recovery efforts; Oxford Group frowns on tobacco use. 1935: Beginning of Alcoholics Anonymous. Alcoholism counseling begins to evolve. Tobacco use becomes embedded in recovery practices and the recognition as a serious addiction and recovery issue is lost for many years. RECOGNITION OF TOBACCO DEPENDENCE 1798 1870s late 1800s, early 1900s 1930s 1960s-1970s

18. 1964: Surgeon General Report on Smoking and Health indentifies the adverse health effects of tobacco use. 1960s: Alcoholism counseling continues to evolve. 1970s: Many former drug users become drug abuse counselors. Most counselors in both groups use tobacco. RECOGNITION OF TOBACCO DEPENDENCE 1870s late 1800s, early 1900s 1930s 1960-1970s

19. EMERGINGAWARENESS 1985 1992 1996

20. 1985: Geraldine Delaney, founder of Little Hill-Alina Lodge in New Jersey, makes this the first tobacco-free chemical dependence treatment program. EMERGINGAWARENESS 1985 1992 1996

21. 1992: John Slade, M.D. begins the Addressing Tobacco in the Treatment of Other Addictions Project at the University of Medicine and Dentistry of New Jersey (UMDNJ) EMERGINGAWARENESS 1985 1992 1996

22. 1996: Van Dyke and Norris Addiction Treatment Centers (ATC) become the first tobacco-free chemical dependence inpatient treatment programs in New York State. Stutzman ATC follows in 1997. EMERGING AWARENESS 1985 1992 1996 -1997

23. A NEW CENTURY 2003 2004 2005 2006 2007 2008 2009

24. 2003: Passage of NYS Clean Indoor Air Act, which exempts substance abuse and mental health treatment programs. 2003: American Cancer Society and ASAP of NYS create a mission statement to promote tobacco-free chemical dependence programs. OASAS task force convenes to discuss tobacco regulations and resources. 2003: NYS Partnership for the Treatment and Prevention of Tobacco Dependence convenes. A NEW CENTURY 2003 2004 2005 2006 2007 2008 2009

25. 2004: Founding of Tobacco Recovery Coalition of the Capital District, Albany, NY. 2004: OASAS Commissioner William GormanPolicy Statement that stated: • Prevention and treatment providers should address all addictions including nicotine. A NEW CENTURY 2003 2004 2005 2006 2007 2008 2009

26. 2005: All 13 OASAS-operated Addiction Treatment Centers (ATCs) in transition to be tobacco-free programs. August 2005: OASAS Medical Director letter to all OASAS certified providers: “Addiction providers are best positioned to help patients become tobacco free to increase the quality of their lives in recovery.” 2005: Some NYS chemical dependence providers begin implementing similar policies, becoming tobacco-free agencies A NEW CENTURY 2003 2004 2005 2006 2007 2008 2009

27. May 2006: ASAP opens NYS Tobacco Dependence Resource Center. November 2006: ASAP launches www.tobaccodependence.org. December 2006: OASAS releases Local Services Bulletin No. 2006 – 10:  Tobacco Dependence Practice Guidelines. A NEW CENTURY 2003 2004 2005 2006 2007 2008 2009

28. July 2007: OASAS Commissioner, Karen Carpenter-Palumbo - Announcement of Regulation Part 856 Tobacco-Free Services, to be effective by July 24, 2008. ASAP Questions and Answers about Tobacco-Free Chemical Dependence Services teleconference series begins. August 2007: NY Tobacco Control Program issues RFP to provide statewide training and technical assistance to integrate tobacco interventions into services. September 2007: TCP starts providing $4M in Over-the-Counter Nicotine Replacement Therapy (OTC NRT) products to Patients and Staff of OASAS programs. A NEW CENTURY 2003 2004 2005 2006 2007 2008 2009

29. March - July 2008: PDP begins training and technical assistance, launches www.tobaccorecovery.org website, selects Regional Training Centers, designs Modules 1 and 2, and begins statewide training. October - December 2008: PDP launches Module 3 and Online Modules 1 and 2. July 24, 2008: OASAS Regulation Part 856 Tobacco-Free Services goes into effect. January 2008: TCP awards training and technical assistance contract to Professional Development Program, University at Albany. A NEW CENTURY 2003 2004 2005 2006 2007 2008 2009

30. January – December 2009: PDP launches Modules 4 – 5, Online Modules 3 – 7, and completes statewide classroom training. 2009: Family Smoking Prevention and Tobacco Control Act enacted. The FDA is finally given the legal authority to regulate tobacco, nicotine levels, and tobacco additives, excluding menthol. States of Washington and Texas: decide to implement tobacco-free addiction treatment services. A NEW CENTURY 2003 2004 2005 2006 2007 2008 2009

31. Rationale

32. Mission and Purpose • Treating tobacco dependence is consistent with the mission and purpose of chemical dependence services

33. Mission Statement Example “We provide quality, cost-effective care to those suffering from alcoholism and chemical dependency and to the many whose lives are affected by the diseases of addiction.”

34. Mission Statement Example 2 “Our mission is to provide a quality continuum of comprehensive treatment and related services, in a caring atmosphere and at a reasonable price, for all people experiencing problems with alcohol or other drug use.”

35. Skills and Knowledge • Treating tobacco dependence requires the same skills and knowledge that addiction professionals already have to treat chemical dependence

36. Tobacco’s Relationship to Alcohol and Other Drugs Prevalence of Tobacco Use (National Data) • General Population 19.8% • Addiction Treatment 60 – 95% • Serious Mental Illness 75 – 80% • HIV and AIDS 50 – 70%

37. Tobacco Use 7 Days Prior To Admission in 2006 Data: 2006, OASAS Certified Programs

41. Tobacco Industry Practices • Knowingly sells a product that when used as intended causes serious disease and death • Targets youth and denies doing so • Lots of money and no morals • Continues to lobby against further tobacco regulation • Uses massive advertising campaigns, plus insidious and deceptive marketing

42. Toll of Tobacco UseGeneral Population - Annually Deaths over 438,000 Health care and productivity cost $194.3 billion

43. Toll of Tobacco Use Tobacco-Related Deaths are greater than Alcohol or Drug-Related Deaths among people treated for chemical dependence

44. Toll of Tobacco Use • Bill W. • Dr. Bob • Marty Mann

45. Toll of Tobacco Use • For every person who dies from their tobacco use, there are twenty people living with serious health problems caused by their tobacco use.

46. Toll of Tobacco Use Tobacco-Related Health Consequences: • Commonly known • Less commonly known

47. Integrated Tobacco Dependence Treatment • Efficacy • Improved Outcomes

48. Unit Two Tobacco Dependence

49. Tobacco Dependence Why do people use tobacco?

50. Tobacco Dependence (cont’d) Nicotine Dependence vs. Tobacco Dependence DSM III / III-R used the term “tobacco dependence.” Why did this change to “nicotine dependence” in the DSM-IV / DSM IV-TR?