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Treating Tobacco in Substance Abuse Programs: Two States’ Successes National Conference on Tobacco or Health December 1

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’ Successes National Conference on Tobacco or Health December 1

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

  2. 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 • Paula Figueroa-Vega, BA, Casa Esperanza, Inc. • Thomas Stevens, CADAC, New England Aftercare Ministries, / Bridge House

  3. 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

  4. 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

  5. Challenges/Barriers • Historical norms and beliefs • Lack of integrated systems • Different treatment modalities, program cultures & client profiles • Timing of implementation • Funding

  6. Tobacco Dependence Program of UMDNJ – School of Public HealthMartha Dwyer, MA, CADAC

  7. 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

  8. New Jersey: History Tobacco Dependence Program • Annual survey • Training, education, consultation and technical support • Annual conference • Resource development & publications • “For Smokers Only” Workshop

  9. 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…” NJAC8:42A-1.3

  10. New JerseyResidential Licensure Standards Integration • Policy • Education • Treatment • Staff NJAC8:42A-1

  11. New JerseyTraining and Support • Executive and Clinical Directors • Clinical Staff • NRT • Individual program consultation, training, and technical assistance • Quitline, Quitnet, Quitcenters

  12. New JerseyNicotine Replacement Therapy • State-funded NRT for residential treatment programs • Clients and staff • Patch (21mg, 14mg, 7mg) Gum (4mg) • 8-week protocol

  13. New JerseyLessons Learned • Systems-based approach • Comprehensive plan with flexible timetable • Address staff concerns • Full integration • On-going education & training

  14. New Jersey: Initiatives • Addictions Treatment Quality Standards Manual • Outpatient Licensure Standards • Certification for Tobacco Dependence Treatment Specialist under consideration

  15. Institute for Health & RecoveryJanet Smeltz, M.Ed., CADAC, M-CTTS

  16. Massachusetts History • Collaboration • Leadership • Targeted capacity building project • 1996 Smoke-Free (“Tobacco-Free”) Policy

  17. Massachusetts History • Tie in with addictions treatment • Build buy-in of leadership, line staff • Changing norms and culture, mission • Provider involvement

  18. 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

  19. Staff Training • Initial three session commitment • Assess / tailor to organization’s stage of change • Create non-threatening atmosphere • Address unique programmatic issues

  20. 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

  21. 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

  22. Focus Groups: 2000 Results • 89 clients; 8 staff focus group, 28 staff survey • “Good news” • “Not so good news”

  23. Focus Groups: 2000 Results • Continue consumer education, emphasizing key topics • Increase staff training: challenge distinctions, build skills • Explore program rules regarding tobacco use

  24. 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

  25. BSAS 2003 Tobacco Guidelines • Staff as role models • Incorporate assessment, treatment planning, education • Staff training and staff support component • Modality-specific

  26. 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

  27. 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

  28. Tobacco Education & Treatment ServicesCasa Esperanza, Inc.Paula Figueroa-Vega, BA

  29. 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.

  30. 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

  31. 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

  32. 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

  33. 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

  34. 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

  35. 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

  36. 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

  37. 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

  38. 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

  39. 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

  40. Challenges • 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 . . .

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

  42. Introduction • 1992: NEAM Licensed by DPH/BSAS • Bridge House Mission: “To provide treatment for criminal justice involved men with ATOD abuse/dependence”

  43. 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

  44. History • 1996: BSAS introduced Tobacco-Free Guidelines • Bridge House adopted BSAS Guidelines • Board of Directors intervenes • Staff begin to attend CENAR Conferences

  45. History • 1998: Tobacco-Free Policy modified • Staff are not to “model” addiction • Begin to provide tobacco dependence education • Begin to provide NRT

  46. History • 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

  47. 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

  48. Current Plans • All Clinical Staff complete “Core Course” by June 2005 • All Clinical Staff complete CTTS by December 2006

  49. Resources • TAPE Project • CENAR • NRT Program • Basic Skills course • Core Course • Janet, Janet, Janet…

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