1. ADDRESSING NICOTINE DEPENDENCE Quarterly Provider Meeting 3/26/09

2. 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 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 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 Dr. Slade promoted the concept of viewing Nicotine as more costly in human life and as dangerous as any other drug of abuse/dependence

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

4. WE NEED TO RESPOND Almost half of tobacco related deaths are people with mental and substance use disorders 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 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 Nicotine addiction not only hinders recovery, it is literally killing the very people that we are dedicated to serving

5. 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 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 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

6. 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 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

7. 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 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 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 Smokers are 10 times more likely to develop alcoholism than are nonsmokers

8. THE FACTS 2007/2008 NJ High School Risk & Protective Factor Survey (pending publication)

9. THE FACTS 2003 Household Survey Figure 4-11: Heavy Drinking and Illicit Drug Use Among Smokers and Non-Smokers

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

11. 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 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

12. DAS CONTRACT LANGUAGE Presently--- Treatment Annex As 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.

13. 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. 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. 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.

14. PAC Feedback on Becoming Tobacco-Free Administration emphasis and staff commitment is necessary for success 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 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 Tobacco must be addressed as part of a total recovery process Client-centered approach will get the best results Client-centered approach will get the best results

15. The NY Experience Providers voiced concerns about the cost of retooling operations to go smoke free for clients and staffs 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 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 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 Gradual, non-punitive implementation w/ full program commitment has worked best for providers

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

17. Citations Bobo, J.K., and Husten, C. Sociocultural influences on smoking and drinking. Alcohol Research & Health 24(4):225–232, 2000. Bobo, J.K., and Husten, C. Sociocultural influences on smoking and drinking. Alcohol Research & Health 24(4):225–232, 2000. http://www.athealth.com/Practitioner/ceduc/alc_tob.html http://www.athealth.com/Practitioner/ceduc/alc_tob.html 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):172–177, 2007 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):172–177, 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. 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):201–208, 2000. Anthony, J.C., and Echeagaray-Wagner, F. Epidemiologic analysis of alcohol and tobacco use. Alcohol Research & Health 24(4):201–208, 2000. http://www.athealth.com/Practitioner/ceduc/alc_tob.html http://www.athealth.com/Practitioner/ceduc/alc_tob.html