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Treating Tobacco in Substance Abuse Programs: Two States’ Successes National Conference on Tobacco or Health December PowerPoint Presentation
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Treating Tobacco in Substance Abuse Programs: Two States’ Successes National Conference on Tobacco or Health December 11, 2003. Presenters. Janet Smeltz, M.Ed., CADAC, M-CTTS, Institute for Health and Recovery Martha Dwyer, MA, CADAC, Tobacco Dependence Program of UMDNJ-School of Public Health

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Treating Tobacco in Substance Abuse Programs: Two States’ SuccessesNational Conference on Tobacco or HealthDecember 11, 2003

  • Janet Smeltz, M.Ed., CADAC, M-CTTS, Institute for Health and Recovery
  • Martha Dwyer, MA, CADAC, Tobacco Dependence Program of UMDNJ-School of Public Health
  • Paula Figueroa-Vega, BA, Casa Esperanza, Inc.
  • Thomas Stevens, CADAC, New England Aftercare Ministries, / Bridge House
presentation objectives
Presentation Objectives
  • Review rationale for addressing tobacco dependence with policy and integrated treatment in substance abuse treatment systems/programs
  • Describe challenges to addressing tobacco use in substance abuse systems and individual programs
  • Identify solutions: statewide, systemic, and individual program approaches
research rationale for treating tobacco in s a programs
Research: Rationale for Treating Tobacco In S.A. Programs
  • Mortality
  • Prevalence
  • Interest in quitting smoking
  • Effect of quitting smoking on relapse to alcohol/other drugs
challenges barriers
  • Historical norms and beliefs
  • Lack of integrated systems
  • Different treatment modalities, program cultures & client profiles
  • Timing of implementation
  • Funding
new jersey history
New Jersey: History
  • The Vision: Dr. John Slade
  • Addressing Tobacco in the Treatment & Prevention of Other Addictions
  • NJDHSS -Division of Addiction Services
  • Master Settlement Agreement
  • Associated Treatment Providers
  • Certification for Addictions Counselors
new jersey history8
New Jersey: History

Tobacco Dependence Program

  • Annual survey
  • Training, education, consultation and technical support
  • Annual conference
  • Resource development & publications
  • “For Smokers Only” Workshop
nj residential licensure standards november 1999
NJ Residential Licensure Standards, November 1999

“Chemical Dependence means chronic or habitual use of alcohol, tobacco, any kind of controlled substance, or other non-prescription drug…”


new jersey residential licensure standards
New JerseyResidential Licensure Standards


  • Policy
  • Education
  • Treatment
  • Staff NJAC8:42A-1
new jersey training and support
New JerseyTraining and Support
  • Executive and Clinical Directors
  • Clinical Staff
  • NRT
  • Individual program consultation, training, and technical assistance
  • Quitline, Quitnet, Quitcenters
new jersey nicotine replacement therapy
New JerseyNicotine Replacement Therapy
  • State-funded NRT for residential treatment programs
  • Clients and staff
  • Patch (21mg, 14mg, 7mg) Gum (4mg)
  • 8-week protocol
new jersey lessons learned
New JerseyLessons Learned
  • Systems-based approach
  • Comprehensive plan with flexible timetable
  • Address staff concerns
  • Full integration
  • On-going education & training
new jersey initiatives
New Jersey: Initiatives
  • Addictions Treatment Quality Standards Manual
  • Outpatient Licensure Standards
  • Certification for Tobacco Dependence Treatment Specialist under consideration
massachusetts history
Massachusetts History
  • Collaboration
  • Leadership
  • Targeted capacity building project
  • 1996 Smoke-Free (“Tobacco-Free”) Policy
massachusetts history17
Massachusetts History
  • Tie in with addictions treatment
  • Build buy-in of leadership, line staff
  • Changing norms and culture, mission
  • Provider involvement
provider involvement
Provider Involvement
  • Council to End Nicotine Addiction in Recovery: CENAR
  • Training and educational opportunities: BSAS, MTCP
  • System-wide/regional meetings
  • Mailings on issues, newsletter
  • Focus groups, formal / informal
staff training
Staff Training
  • Initial three session commitment
  • Assess / tailor to organization’s stage of change
  • Create non-threatening atmosphere
  • Address unique programmatic issues
massachusetts methods
Massachusetts: Methods
  • Program surveys (1996, 2000)
  • Focus groups (1996, 1998, 2000)
  • Involvement of provider system
  • NRT funding; NRT pilot study
  • Linkage with, referrals to MTCP
program surveys 1996 2000
Program Surveys: 1996, 2000
  • Snapshot of system: 65%, 54% responses
  • “Substantial progress” in organizational support, # reporting compliance
  • Significant change in availability / scope of resources for cessation
  • 1996: 38% did not address clients’ nicotine dependence; 2000, <20% did not
focus groups 2000 results
Focus Groups: 2000 Results
  • 89 clients; 8 staff focus group, 28 staff survey
  • “Good news”
  • “Not so good news”
focus groups 2000 results23
Focus Groups: 2000 Results
  • Continue consumer education, emphasizing key topics
  • Increase staff training: challenge distinctions, build skills
  • Explore program rules regarding tobacco use
bsas 2003 tobacco guidelines
BSAS 2003 Tobacco Guidelines
  • Developed by BSAS, CENAR, TAPE/IHR
  • Initial release; provider input; revisions
  • Top-level support
  • Mandatory FY 2004
  • Address policy, environment, treatment
bsas 2003 tobacco guidelines25
BSAS 2003 Tobacco Guidelines
  • Staff as role models
  • Incorporate assessment, treatment planning, education
  • Staff training and staff support component
  • Modality-specific
lessons learned
Lessons Learned
  • Maintain Stages of Change perspective
  • Build relationships over time
  • Take a long view: change = process
  • Promote systems-based approach
  • See staff as key; reframe resistance
  • Translate research, make it relevant, end scare tactics
massachusetts next steps
Massachusetts: Next Steps
  • Implementation, monitoring, evaluation of BSAS Tobacco Guidelines
  • Ongoing training, promotion, outreach, resources
  • Bring entire system to next phase of addressing/incorporating tobacco dependence issues
  • Support interest / leadership of programs
  • Prevent “relapse” of system
mission statement
Mission Statement

Casa Esperanza, Inc’s mission is to help Latino men and women recover from alcoholism and drug addiction and to re-unite with their families. Our priorities are to help people gain the skills to be self-sufficient, contributing members of society and to strengthen families that have been torn apart through substance abuse. Casa Esperanza, Inc. believes in AA’s 12-step philosophy of self-help.

programs of casa esperanza inc
Programs of Casa Esperanza, Inc.
  • 1987: Casa Esperanza, men’s program
  • 1991: Nueva Vida, transitional housing for graduates
  • 1995: Latinas y Niños Center, residential treatment program for Latina women and their children
  • 2003: Dunmore Place, affordable housing for women and children
  • Coming in 2005 – Family Stabilization Center
services provided
Services Provided
  • Individual and group counseling
  • Mental health services
  • Parenting services and coordination of child services
  • Case management to address legal, medical, housing, income and employment needs
  • HIV/AIDS counseling, case management
  • Career counseling
  • Tobacco education and treatment services
tobacco free policy
Tobacco-Free Policy
  • Adopted in 2000, established an environment free of tobacco use
  • The program recognizes through the policy that nicotine is an addictive drug and that it poses a substantial risk to the life and health of individuals who use tobacco and who are exposed to tobacco smoke
  • No in-house services in place, occasional outside providers offered education and treatment
tobacco education and treatment services
Tobacco Education and Treatment Services
  • The American Legacy Foundation funded a pilot program that began on September 1, 2002
  • Received 2 year continuation beginning September 1, 2003 through August 30, 2005
  • Began integrating the tobacco treatment services into the existing services
tobacco education and treatment services34
Tobacco Education and Treatment Services
  • One full-time staff to provide services to all programs
  • All clients receive an assessment of tobacco dependency – 5 A’s
  • If client reports smoking they are referred to the Tobacco Treatment Coordinator
  • Clients that report smoking are given 8 individual sessions
  • All clients participate in 8 education groups
  • Nicotine replacement therapy is offered in the form of nicotine patches and gum
goals clients
Goals - Clients
  • To educate clients about the effects of tobacco and the benefits of quitting
  • To motivate clients through Motivational Interviewing counseling techniques to start moving along the Stages of Change towards preparation or action stage
goals staff
Goals - Staff
  • Reinforce already Tobacco-Free Policy (no staff smoke at the facility while at work or around premises)
  • Staff receive on-going training to integrate tobacco education and treatment in the program
goals community
Goals - Community
  • To disseminate information about tobacco to other agencies and to the community
  • Activities
    • Participate in CENAR meeting
    • Provide information in community events
    • Provide information for clients to take to families
activities to reinforce tobacco free lives
Activities to Reinforce Tobacco-Free Lives
  • Exercise with the women at the residential treatment program Latinas y Niños
  • Meditation groups at the men’s residential program – Casa Esperanza
  • Teach relaxation techniques in every group
what has helped
What has Helped?
  • Funding from the American Legacy Foundation
  • Receiving training from the University of Massachusetts - Tobacco Treatment Specialist Program
  • Participating in the Council to End Nicotine in Recovery
  • Motivational Interviewing Techniques
  • Stages of Change Model
  • Staff involvement, creative staff, supportive administrators
  • Nicotine dependence is a strong addiction
  • Clients are challenging and dealing with other dependencies
  • Relapse to tobacco
  • Continuous education needed – not only with clients but with staff, doctors, outside providers . . .

Integrating Tobacco Treatment into The Bridge House Substance Abuse Treatment Program New England Aftercare Ministries Bridge HouseThomas Stevens, CADAC

  • 1992: NEAM Licensed by DPH/BSAS
  • Bridge House Mission:

“To provide treatment for criminal justice involved men with ATOD abuse/dependence”

history of the integration of tobacco dependence treatment into the bridge house program
History of The Integration of Tobacco Dependence Treatment into The Bridge House Program
  • 1992 – 1994: No treatment for tobacco dependence
  • 1994: Staff smoked with residents
    • Staff made cigarette runs
  • 1996: BSAS introduced Tobacco-Free Guidelines
  • Bridge House adopted BSAS Guidelines
    • Board of Directors intervenes
    • Staff begin to attend CENAR Conferences
  • 1998: Tobacco-Free Policy modified
    • Staff are not to “model” addiction
    • Begin to provide tobacco dependence education
    • Begin to provide NRT
  • 2000: Selected for BSAS NRT Program

Continuing education for staff & residents

  • 2001: NRT continues
  • 2002: NRT continues
  • 2003: Board of Directors responds to education presentation
current plans
Current Plans
  • 2003: Plans for taking the Bridge House tobacco-free with a target date of June 2005
  • Executive Director completes CTTS by February 2004
  • All staff complete “Basic Skills” by December 2004
  • At least 2 Clinical Staff complete “Core Course” by December 2004
current plans48
Current Plans
  • All Clinical Staff complete “Core Course” by June 2005
  • All Clinical Staff complete CTTS by December 2006
  • TAPE Project
  • NRT Program
  • Basic Skills course
  • Core Course
  • Janet, Janet, Janet…