1. Al Bliss, Health Educator La Crosse County Health Department April 22, 2009 This project was funded by the American Legacy Foundation. The grantees information materials do not necessarily represent the views of the foundation staff or its board of directors. The Challenges of Tobacco Cessation Among Binge and Heavy Drinkers

2. Is it too much to ask those addicted to alcohol and other drugs to quit tobacco at the same time? Is it too much to ask those addicted to alcohol and other drugs to quit tobacco at the same time?

3. Myths Among Those in Substance Abuse Programs Quitting smoking is too difficult at the same time Quitting smoking is too difficult at the same time Quitting tobacco will interfere with recovery outcomes Quitting tobacco will interfere with recovery outcomes It costs too much to quit It costs too much to quit Those in recovery have no interest Those in recovery have no interest

5. Drinking Culture in Wisconsin Wisconsin has the highest binge drinking rate in the United States. Wisconsin has the highest binge drinking rate in the United States. Behavioral Risk Factor Surveillance System, 2007

6. World's largest six-pack La Crosse, WI

7. Social Costs of Alcohol Alcohol is the 3 rd leading actual cause of death in the U.S. (CDC, 2005) Alcohol is the 3 rd leading actual cause of death in the U.S. (CDC, 2005) 21,083 deaths annually (NVSR, 2008) 21,083 deaths annually (NVSR, 2008) 13,470 annual deaths in alcohol- impaired driving crashes (NIAAA 2002) 13,470 annual deaths in alcohol- impaired driving crashes (NIAAA 2002) $185 Billion in annual economic costs (NIAAA, 2002) $185 Billion in annual economic costs (NIAAA, 2002)

8. Drinking Culture of La Crosse, WI La Crosse County has one of the highest binge drinking rates in Wisconsin at 24.9% (combined 2000-2007 data), higher than the nationwide average of 15.7% (2007). Behavioral Risk Factor Surveillance System, 2007; www.cdc.gov/brfss; Wisconsin Dept. of Health Services, Division of Public Health, Bureau of Health Information and Policy. Wisconsin Interactive Statistics on Health (WISH) data query system, http://dhs.wisconsin.gov/wish/, BRFS Module, accessed 04/20/09;

9. Binge Alcohol Use in Past Month among Persons Aged 12 or Older Source: SAMSHA, Office of Applied Studies, National Survey on Drug Use and Health, 2005 and 2006.

10. http://www.no-smoke.org/goingsmokefree.php?id=519#maps

11. What Local Counties and Cities Can Do La Crosse County Health and Human Services The Mission of the Clinical Services section is to assure that residents of La Crosse County with problems of mental illness and substance abuse have equal access to an array of services which promote wellness and recovery, in a system which emphasizes optimism, eradicates stigma, involves consumers in meaningful ways, and is committed to a responsible stewardship in our human and financial resources. The Mission of the Clinical Services section is to assure that residents of La Crosse County with problems of mental illness and substance abuse have equal access to an array of services which promote wellness and recovery, in a system which emphasizes optimism, eradicates stigma, involves consumers in meaningful ways, and is committed to a responsible stewardship in our human and financial resources.

13. Complications of Smoking and Alcohol Approximately 30 years of life lost on average were attributable to excessive alcohol use in 2001. Approximately 30 years of life lost on average were attributable to excessive alcohol use in 2001. (Source: Alcohol Attributable Deaths (AAD) and Years of Potential Life Lost in the U.S. - 2001, CDC 2004) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5337a2.htm http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5337a2.htm Average years of life lost of smokers – 11.5 years for males and 12.0 years for females Average years of life lost of smokers – 11.5 years for males and 12.0 years for females (Source: CDC 2008)

14. American Legacy Foundation Priority Populations Initiative Grant La Crosse County Health Department received a grant from Legacy to address the dual challenges of smoker/drinker La Crosse County Health Department received a grant from Legacy to address the dual challenges of smoker/drinker Year One - $99,458 Year Two - $99,060

15. Target Population 320 individuals who self identify as binge drinkers, heavy drinkers or are enrolled in substance abuse programs (Individuals with 25 years of age) 320 individuals who self identify as binge drinkers, heavy drinkers or are enrolled in substance abuse programs (Individuals with 25 years of age) 50 AODA counselors / staff at recovery centers 50 AODA counselors / staff at recovery centers

16. Project Outcomes Reduce tobacco use among heavy drinkers, binge drinkers and those in recovery programs (total to enroll = 320) Reduce tobacco use among heavy drinkers, binge drinkers and those in recovery programs (total to enroll = 320) Train AODA counselors in treating tobacco dependence Train AODA counselors in treating tobacco dependence Recovery centers will sustain tobacco cessation programs when funding ends Recovery centers will sustain tobacco cessation programs when funding ends

17. Program Protocol / Details Clients received 1 month supply of nicotine replacement therapy (patches, gum or lozenges) Clients received 1 month supply of nicotine replacement therapy (patches, gum or lozenges) Recovery clients received a $40 cash incentive for enrolling Recovery clients received a $40 cash incentive for enrolling All clients received initial 1:1 counseling and follow up at 1,3, and 6 months. All clients received initial 1:1 counseling and follow up at 1,3, and 6 months. All clients will receive quarterly follow up after 6 months All clients will receive quarterly follow up after 6 months

18. La Crosse County Health Department Tobacco Cessation Program Quit Rates Among Adults with Less than a 4-Year College Degree American Legacy Grant October 1, 2007 – April 17, 2009

19. Improved Recovery Rates Alcoholics who quit smoking were more likely to maintain long term abstinence (Bobo et al., Cigarette Smoking Cessation Attempts by Alcoholics, Addict Behav. 1987;12(3):209-15;) Alcoholics who quit smoking were more likely to maintain long term abstinence (Bobo et al., Cigarette Smoking Cessation Attempts by Alcoholics, Addict Behav. 1987;12(3):209-15;) …research shows that smoking cessation does not disrupt alcohol abstinence and may actually enhance the likelihood of longer term sobriety Gulliver et al, Smoking Cessation and Alcohol Abstinence: What Do the Data Tell Us?, NIAAA Publications …research shows that smoking cessation does not disrupt alcohol abstinence and may actually enhance the likelihood of longer term sobriety Gulliver et al, Smoking Cessation and Alcohol Abstinence: What Do the Data Tell Us?, NIAAA Publications

20. Its Safe to Treat Both can be treated simultaneously without endangering alcoholism treatment Both can be treated simultaneously without endangering alcoholism treatment NIAA, 1998; http://pubs.niaaa.nih.gov/publications/arh293/208-212.pdf http://pubs.niaaa.nih.gov/publications/arh293/208-212.pdf

21. Whats Going on Statewide? (WINTIP) Wisconsin Nicotine Treatment Integration Project Saving Wisconsin lives by integrating evidence-based nicotine dependence treatment into alcohol and other drug dependence and mental health services Saving Wisconsin lives by integrating evidence-based nicotine dependence treatment into alcohol and other drug dependence and mental health services www.wisconsinwintip.com www.wisconsinwintip.com www.wisconsinwintip.com

22. WINTIP Overview One year (2008) planning project for integration One year (2008) planning project for integration Funded by WI Division of Public Health Tobacco Prevention and Control Programs Funded by WI Division of Public Health Tobacco Prevention and Control Programs Brings together tobacco control, mental health/substance use systems, and government Brings together tobacco control, mental health/substance use systems, and government

23. The Challenge To treat and de-normalize smoking and tobacco use in the recovery community

24. Contact: Al Bliss, Health Educator La Crosse County Health Department 608 789-4820 Bliss.al@co.la-crosse.wi.us This project is funded by the American Legacy Foundation. The grantees information materials do not necessarily represent the views of the Foundation, Foundation staff, or its board of directors.

25. Acknowledgements WINTIP Steering Committee 2009 Rob Adsit, M.Ed., UW-Center for Tobacco Research and Intervention (UW-CTRI) Bruce Christenson, PhD, UW-CTRI Carlos Edge, UW-CTRI Randal Glysch, MS., Tobacco Prevention Program, Bureau of Community Health Promotion Eric Heilgenstein, MD., Clinical Director, Psychiatry, University Health Services, University of Wisconsin-Madison David Mac Macmaster, CSAC, CTTS, WINTIP Managing Consultant Gary Nelson, Section Chief, Bureau of Prevention Treatment and Recovery, Division of Mental Health and Substance Abuse Services, Madison, WI Jennifer Recoy Gombar BS, RRT, WINTIP Project Coordinator Agencies: American Legacy Foundation (Funded) Coulee Council on Addictions La Crosse County Health Department Western Technical College University of Wisconsin Center for Tobacco Research and Intervention Wisconsin Tobacco Quit Line La Crosse County Health Department