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Don't let fear torpedo the effort to go smoke-free

August 27, 2014
by Gary A. Enos
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Tobacco's once-ubiquitous presence in addiction treatment settings has been challenged considerably in recent years, as evidence has mounted that smoking hampers recovery from other addictions. Four panelists on the final day of the National Conference on Addiction Disorders (NCAD) offered much reason to believe that treatment programs can rise above staff and patient fears about going smoke-free.

In perhaps the most surprising moment of the Aug. 26 panel session in St. Louis, fewer than half of the attendees in the conference's main ballroom raised their hands when asked if they worked in a treatment facility that still allowed on-site smoking.

Two of the four panelists have had recent firsthand experience in transitioning their residential treatment programs to a smoke-free environment. Brian Coon, director of clinical program services at Pavillon in North Carolina, said his facility endured some early failures before successfully implementing a smoke-free policy that takes a recovery-focused rather than punitive approach. Pavillon's use of nicotine replacement therapies extends to offering them to center employees as a staff benefit.

Laura F. Martin, MD, attending psychiatrist at the Center for Dependency, Addiction and Rehabilitation (CeDAR) in Colorado, said that before her center went tobacco-free, around half of its patients entered treatment as smokers and around one-third of those actually increased their tobacco use while they were in treatment.

“The number one thing any individual can do to promote his health is to quit smoking,” said Martin. “It is the number one preventable cause of death. We also know that patients can quit, and they want to quit.”

Regulatory action

The other panelists for the third of three panel events held at NCAD were John Coppola, executive director of Alcoholism & Substance Abuse Providers of New York State, and Phil McCabe, health educator at Rutgers University and president of NALGAP, The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies. Coppola outlined how New York state implemented regulatory action to create mandated smoke-free environments affecting the more than 100,000 individuals in treatment in the state on any given day.

Coppola emphasized that programs received much education prior to implementation, as well as some flexibility in how to roll out the policy. The effort showed that there are many facets to going smoke-free: For example, programs had to bar their smoking employees from using tobacco while at lunch off-site, because they would return to work with the odor of tobacco.

McCabe offered a slide presentation depicting tobacco companies' insidious pursuit of consumers, with the latest frontier being electronic cigarettes that early research is indicating do not benefit smoking cessation. He added that when New Jersey piloted a “Drug-Free Is Tobacco-Free” initiative, staff members of treatment centers usually posed a bigger obstacle than patients.

“It was usually the ones who had a pack of cigarettes in their pocket who said it couldn't be done,” said McCabe, once a two-pack-a-day smoker himself.

Coppola said New York providers, particularly those that operate detox settings where patients arrive under considerable discomfort, did experience an initial downturn in admissions after tobacco-free regulations were implemented. But this decline proved to be short-lived in New York, he said, and panelists agreed that this is usually the pattern.

Martin said that when CeDAR implemented its policy, it did so in almost a celebratory fashion, lighting a fire into which people could toss their “goodbye notes” to cigarettes. It also did so on Valentine's Day, she said, to commemorate doing something good for one's health and loving oneself.

She and Coon agreed that organizational fear often poses the greatest challenge to becoming a tobacco-free environment. Martin said staff members can be reassured that the same coping skills that patients can be taught to assist resistance to other behaviors can apply to smoking. Coon added that leadership can push the idea that a change to a smoke-free environment at least needs to be tried—it can always be adjusted if problems arise.

Careful implementation always produces the best results, said McCabe. “Saying, 'As of tomorrow, no one can smoke'—that's not treatment. That's punitive.”