Replacing cigarette butts with candy wrappers

As part of the 2008 smoking ban legislation, a statewide ban of smoking at all addiction recovery centers in New Jersey will go into effect on Dec. 12, 2012.  Private, non-profit Seabrook House(Seabrook, NJ) decided to lunge ahead and make their facility truly drug-free in September. 

Stephanie Loebs, Vice President of Treatment Services at Seabrook House, said that there was no shortage of reasoning for the implementation.  She explained that the average daily census is anywhere between 80-100 well-insured, middle-class, working clients.  “We noticed that 40% of the daily admissions told us that they had tried to quit nicotine, wanted to quit nicotine, but were unsuccessful,” she recalled.

Another frequent comment was coming from the families of patients in the family satisfaction surveys.  Loebs said, “Always present was the question of ‘why aren’t you doing something about their smoking?’”

Another reason Loebs said they decided to implement the ban at their treatment facility three months before the statewide ban, was the environment and weather.  “Right now,” she said in September, “the athletic fields are green and the gardens are open.  Wouldn’t this be the time, rather than the two or three feet of snow that Southern New Jersey gets in December?  This way we can allow our patients to embrace nicotine sobriety and learn to socialize without using nicotine.”

The administration also wanted to make sure they were well-prepared for the state’s changes.  “We didn’t want to implement it on 12/12, and not have all the glitches worked out. We wanted to have it all ironed out by the time the state mandated it,” she said.

Treatment for nicotine sobriety

Loebs explained that Seabrook treats two kinds of people around the issue of nicotine:

·        Those who want to quit and stay quit

·        Those who don’t want to quit

How do they treat these two groups differently?  “Not at all,” she says.  “Both groups receive nicotine replacement therapy if they choose that, lozenges, hard candies, and they are all required to attend Nicotine Anonymous 12-step meetings.”

She explained that those in violation of the tobacco-free policy by verbalizing cravings constantly or acting out must attend a nicotine recovery program.  This group then takes the place of their daily gym time.

“We see that as an incentive,” Loebs commented. “We try not to shame them and try to help them, but we want to be clear that we have a zero tolerance policy.”

Zero tolerance at Seabrook House

“Programs that have been successful at this, have all said the same thing, ‘it is as dangerous and as important as alcohol or opiates or any other substance.’ And so we have an alternative to discipline process where they enter into a series of interventions, then we will suggest that they transfer to a program and continue their treatment,” Loebs said of the disciplinary process.  

However, she said that they don’t simply discharge clients with no resources.  “Even if they are therapeutically discharged for whatever reason, at the very minimum, they walk out of Seabrook House with a meeting list, and aftercare providers in their area.”

At the 40-acre campus, Loebs remarked that they rarely have walk-ins.  Most clients have scheduled admissions so the staff is able to prepare.  “In the preadmission phase of treatment, we tell the families and the patients that no tobacco products are allowed at Seabrook House.”

One week later

A week into the smoking ban in September, Loebs reported that there had been a distinctive split in the opinions and reactions to the ban.  “It’s been about a third, and a third, and a third,” she said.  She went on to explain that:

1/3 of the clients were saying “thank you,” “this was long overdue,” “not as bad as I thought,” etc.

1/3 of the clients “weren’t sure.”  They were “conflicted internally and looking for an excuse” according to Loebs.  They were saying things like “Why are you doing this to me?”  Loebs commented that the staff sees this group as an opportunity.  They can then ask the clients, “How will this affect your recovery?”

1/3 of the clients were “this interesting middle group that is not saying anything.”  They were relatively focused on what they need to be doing, said Loebs.  She observed that this group seems to be comprised of “the people who may have relapsed, hit bottom.”  These people are “mature and maybe a little older.”

Overall, she said that the younger patients react more negatively.

The key behavioral issue that Loebs and other staff members were witnessing is that “socializing in a clean air environment just appears after these short six days to just be healthier.”

“Today, they rallied and got a softball game together, whereas normally, at 3:30 in the afternoon after the lecture is done, they probably would’ve smoked for a half hour,” she explained.

“There’s a lot of Jolly Rancher wrappers,” she said with a chuckle, “but we don’t have cigarette butts.”

Nicotine replacement therapies

Loebs commented on clients coming in and wanting to quit alcohol or hard drugs, and nicotine at the same time.  Their policy, she said, is abstinence based so they will never discourage a client from wanting to tackle it all together. 

She reported that “national data says there is a 25% greater chance of maintaining long-term abstinence from alcohol and drugs if you stop being under the influence of nicotine right out of the gate.  With nicotine replacement therapies, there is a 28% quit rate right out of the gate if you use it like it’s supposed to be used.  It is a 6-8 week medical intervention, while constantly stepping down and stepping down on the dosage.” 

“These statistics were all on an outpatient basis, so imagine the improved outcomes in a therapeutic community and positive peer culture that Seabrook provides,” she continued. 

The only downside to this type of therapy, she said is the dependence on it from this point forward.  However, “It’s less expensive and there’s no exposure to carcinogens. Even if they stayed on nicotine replacement therapy for the rest of their adult life, that is still an outcome that we would be proud of.”

Help from the state

Loebs disclosed that all nicotine replacement therapy is being supplied to Seabrook House for the first two weeks of each client’s medical intervention, by the state of New Jersey, free of charge. “After the two week period-- when they sometimes will be stepping down to another patch-- we consider it a detox medication and our third-party payers love the fact that we’ve done this,” she explained.

Speaking to the credit of New Jersey, Loebs made it known that they were on board and glad to help.   “They didn’t mind that we started early,” she said.

On funding the program, Loebs said that she was “pleasantly surprised that we were prepared and budgeted x amount of funds to make sure that no patient who wanted nicotine replacement therapy starting in September would go without it.”

Adjusting to changes

Coming from a person who remembers smoking with her counselor when she was in treatment, Loebs said that she doesn’t think this is a huge assault on patients like it would have been in the 90s because there are already smoking bans at restaurants and various other places.

“When you implement a huge paradigm shift within a residential treatment program, the community that is most resistant or reactive to implementation of a new direction, is the community you have currently.  By the time the next new community rolls over, it’s the norm that people don’t smoke at Seabrook House.  But in that transitional community, where they came in and were allowed to use nicotine under the guidelines, and then on 9/4, they could no longer use nicotine, we had that to deal with,” she explained.

Loebs expressed her excitement and energy for the ban and said, “The thing that made me the saddest, having been in addiction treatment 18 years, a nonsmoker would come into treatment, and guess what would happen?  They would start smoking.  It disturbed me on a core level.  And it happened more often because that’s how they socialized.”

Support of the staff is key

The planning for this initiative began early in April, when they began quality development and conducted research.  She says they went to places such as the Colorado state prison system when they went smoke-free, talked to colleagues in New York who had gone through the smoking ban process already, attended trainings provided by the Addiction Smoking Program and Resource for Cessation (ASPARC), and held monthly meetings.

The most important piece of the puzzle, according to Loebs, is the backing from the staff.  She said that Seabrook House has always had a smoke-free policy in place regarding the employees.  “Employees of Seabrook House are not allowed to smoke on campus, smell of smoke, or even have a hint that they’ve been smoking when they arrive from being off of campus,” she explained.

When they came around to making it smoke-free for patients as well, the staff was enthusiastic and willing to go through the training, and that made the initiative move forward smoothly.