Campaign puts muscle behind effort to elevate smoking cessation in treatment

A group of heavy hitters, ranging from the addiction field's historian to the leader who ran New York's state substance abuse agency when publicly funded providers were mandated to go smoke-free, are asking other field influencers to make the integration of treatment for tobacco use a priority.

“No more ignoring the facts. No more castaway casualties,” reads the conclusion of a report issued by the National Tobacco Integration Project, Inc. “No more pretending that it is somehow acceptable to ignore the mandates of competency and due care in health care delivery, pretending they do not apply to those addicted to nicotine.”

The project's advocacy council, with ranks that include William White, William Cope Moyers, former New York state substance abuse director Karen Carpenter Palumbo, American Society of Addiction Medicine (ASAM) past president Michael Miller, MD, and others, helped to craft the report, A Time to Lead, as a call to action and a summary of the case for including tobacco use treatment in addiction and mental health services.

Forty-eight national associations, treatment providers, accrediting agencies, foundations and other key players in the behavioral health field have been sent a letter from the campaign, urging them to do their part to make this a front-burner issue. For addiction treatment organizations, fulfilling the request will require shedding the traditional mindset of looking the other way regarding patient smoking, understanding that smoking poses a trigger to other substance use, a barrier to long-term recovery, and a serious health hazard.

“We want them to include this as a recovery issue, not as some rule,” David Macmaster, co-founder of the Wisconsin Nicotine Treatment Integration Project and a main organizer of the latest campaign, tells Addiction Professional.

Macmaster acknowledges that direct responses from the letter recipients have been scarce to this point (the campaign intends to survey the organizations periodically in order to report on their progress). But like many developments in the behavioral health treatment community, changing attitudes on smoking has been an evolutionary, not revolutionary, process.

Emphasize health

Carpenter Palumbo doesn't sound daunted by the task at hand. As commissioner of the influential New York State Office of Alcoholism and Substance Abuse Services (OASAS), she overcame doubts expressed about the future of state-funded providers in bringing forth what would become the toughest smoke-free requirements for addiction treatment facilities.

She still recalls the words of former patients who railed against the smoke-free mandate when entering treatment, only to say weeks later that they had never felt better physically as a result of the requirement. A focus on “health, health, health,” Carpenter Palumbo suggests, is what can help overcome skepticism or downright opposition. “The goal hasn't changed,” she tells Addiction Professional.

She wants the new campaign's approach to be one of partnering with the targeted organizations, not dictating to them. She prefers that her group ask these organizations, “How can we help you?”

Carpenter Palumbo believes that most treatment administrators want to address this barrier to recovery in their programs, but tend to get caught up in the myriad everyday challenges associated with their job. Now directing a nonprofit in child welfare in New York state, she uses her own latest work crises to explain what a typical day might look like for any CEO: assisting a wronged contractor one minute, responding to a utility problem in the facility the next, and then rushing off in hot pursuit of a critical grant.

“People need the courage,” she says. “We're a field about courage.”

Report's recommendations

“There are no more excuses for preventing the integration of tobacco and nicotine into our intervention, treatment and recovery services,” A Time to Lead report states. “With relatively minor adaptations, providers of these services already have the core knowledge and clinical expertise to do the job. Their boards and administrators need only the willingness.”

The report includes these among its numerous recommendations:

• For insurance companies, they should require their networks' providers to include formal protocols for treating nicotine dependence. They also should adequately reimburse providers for these services.

• Treatment programs should adopt policies leading to a completely smoke-free environment for patients and staff. They should employ evidence-based medication and counseling treatments for smoking cessation.

• Mutual-help groups such as Alcoholics Anonymous (AA) should furnish members with literature on the dangers of smoking, and should cite data demonstrating that recovering people who continue to smoke are at greater risk for relapse and numerous other health problems.

The full report is available online.

Macmaster laments past difficulties in seeing this issue gain traction, and wonders whether it might eventually take something of the magnitude of a class-action lawsuit to effect real change.

“The problem with that is there has not been enough standing,” he says. “There has never been an association of family members of the innocent victims of tobacco deaths.”