Articles

By Janice Boafo

As a recipient of the Tobacco Free Champions mini-grant from the Los Angeles County Department of Public Health, Tarzana Treatment Centers, Inc. (TTC) is once again at the forefront of changes in the behavioral health field. On August 1st our Reseda (Baird) site became a tobacco-free facility along with one of our transitional homes. As of that Friday, tobacco products including electronic nicotine delivery systems (such as e-cigarettes) will be prohibited for staff, clients and visitors to use on the grounds at both facilities. In a world where 90% of people with mental illness and substance use disorders smoke, there is no way that we in the field can continue to ignore this serious health epidemic without negatively impacting the health and recovery of the clients that we serve. Thankfully TTC is forging ahead with a multifaceted approach that is building greater congruence between our stated mission and values and our treatment approaches.

Nicotine dependency is a chronic relapsing disorder often requiring multiple attempts before individuals quit for good. Despite the high prevalence of tobacco use among people with substance use disorders, tobacco treatment is often overlooked in behavioral health settings. Many staff feel they lack adequate training, have limited knowledge of treatment resources and still others cling to the belief that addressing tobacco use will threaten clients’ sobriety. While it is a daunting task and often involves shifts in both organizational culture and challenges to long-held beliefs tobacco treatment is well worth the effort. There is no reason that our clients, peers and ourselves should confront and overcome drug addiction and mental illness only to later succumb to smoking related diseases.
Let’s start by addressing some of the long held beliefs so that we can get to the business of treating tobacco dependence.

MYTH #1: With our clients’ many competing needs, addressing tobacco use is just not that important.

According to the American Psychiatric Association, tobacco dependence is one of the most common substance use disorders and a leading cause of death and disability among those in treatment for mental illness and substance use. Individuals with substance use disorders are heavy smokers and more often die from tobacco related causes than from other drug or alcohol-related causes. In fact, persons with chronic mental illness die 25 years earlier than the general public and smoking is a major contributor to their premature mortality. Although persons with mental illness and/or substance abuse disorders only account for 22% of the population, they consume 44% of all cigarettes sold in the United States. Research shows that 50% or more of adults with mental illness want to quit smoking, can quit and do benefit from treatment.

MYTH #2: I do not know how to treat tobacco use.

Tobacco dependence is tough to treat because it is a two part problem – physiological and psychological. On average it takes 12 quit attempts to stop smoking. It is hard to quit but it is possible. In fact, 63% of people who have ever smoked have quit. The good news is that you are already treating smokers. The same skill set that is used for other types of addiction have been shown to be effective with tobacco cessation. You have likely been counseling to address ambivalence, create accountability, share knowledge and facilitate planning. All of those skills are what is needed for your clients to begin to see themselves as non-smokers. In addition to individual and group counseling, motivational interviewing and cognitive-behavioral strategies have been proven effective in addressing tobacco use.

MYTH #3: Quitting smoking will threaten recovery for persons with substance use disorders.

Treating tobacco dependence at the same time as other substances increases long-term recovery by 25% for persons with substance use disorders. Nearly half of all smoking related deaths in the United States are people with a history of substance abuse and or mental illness. As providers, our silence on this issue poses a barrier to treatment and robs our clients of the opportunity to receive the best care. Being “interested” in quitting is enough. Don’t rule out some type of intervention even if motivation to quit is low.

Now that the truth is out there, both addiction counselors and their patients can look forward to a sober and healthy lifestyle without the threat of issues that are caused by tobacco dependence.