IRETA staff member Lisa Howard shares her insight on the role of tobacco in recovery

Despite having worked in the addiction field for more than two decades, it was not until recently that I had my tobacco “ah-ha” moment.  Certainly, in my years working in prevention, we delivered “the facts” about smoking to students, warning of the dangers of starting and promoting healthy lifestyle choices. But in 2008, I began work on New York State’s first-in-the-nation initiative to implement tobacco-free policies and integrate tobacco dependence treatment in their programs and for the first time, I really considered tobacco’s role on the other side of the addiction services continuum, treatment and recovery.

Learning that smoking rates for minority, immigrant and low-income populations, as well as people who have other substance use disorders and/or serious mental illness, are far greater than the nation’s general population prevalence of 19.3% (Centers for Disease Control 2010) was revelatory.  It is well documented that 77% -93% of people in addiction treatment settings use tobacco, more than triple the national average.[1] The toll tobacco takes on patients who have co-occurring substance use and/or mental health disorders is also disproportionate to that of the general population: nearly 50 percent of tobacco-related deaths in the US each year are among people with mental illness. It is a staggering truth that people who receive treatment for chemical dependence die as a result of their tobacco dependence more often than as a consequence of the chemical dependencies for which they were treated.

Why, for decades, had we accepted these high rates of tobacco use and the morbidity and mortality that it brings? Had we as a field imposed our own attitudes, values and beliefs that this patient population does not want to stop, or that they can’t stop or that their other problems will get worse if they stop using tobacco?  Well supported by research, New York’s bold tobacco-free initiative, along with several others across the country, has refuted these false beliefs and has led to system changes to address this serious healthcare disparity.  And although barriers to tobacco dependence treatment and recovery services in behavioral health settings remain (Morris et al., 2009), integration of tobacco treatment into the mainstream of addiction and mental health treatment is rapidly becoming a nationwide best practice (Schroeder, 2007).  Accordingly, there are a growing number of promising approaches for programs and systems looking to address co-occurring tobacco dependence and offer patients tobacco-free recovery.

One of the most comprehensive resources for addiction and mental health professionals who want to offer their patients tobacco interventions can be found at the Smoking Cessation Leadership Center  (SCLC). In addition to publications, toolkits, and training, the staff at SCLC provides technical assistance and strategic advice on implementation of effective smoking cessation strategies. If you are not familiar with SCLC or if it has been some time since you last visited their website, you won’t be disappointed with the expansive array of resources they have compiled!

The past ten years has seen increased interest in peer services with the emergence of a body of knowledge around Recovery-Oriented Systems of Care (ROSC) and the major role that peers play in this model of service delivery. If your program has a peer services component, another excellent resource to explore is The Peer-to-Peer Tobacco Dependence Recovery Program at the University of Colorado Denver, which trains peers to offer emotional and informational support for tobacco dependence recovery through motivational engagement strategies, peer-led support groups, community referrals, and educational activities. The program uses an “embedded” model of training that works to integrate tobacco recovery and wellness services into peer specialists’ existing roles and responsibilities and is currently active in six states (including Pennsylvania) and a wide variety of settings including mental health and addictions treatment, advocacy groups, and the Veterans Administration.

Treatment norms are changing and offering patients tobacco dependence treatment is certainly consistent with the mission of addiction and mental health services. Fortunately, clinicians working in these service areas possess many of the skills and much of the knowledge necessary to provide hope and empower people to be tobacco-free.

For more information, check out these highly recommend resources: 

1. Tobacco Recovery Resource Exchange http://www.tobaccorecovery.org/

2.  Tobacco Treatment for Persons With Substance Use Disorders: A Toolkit for Substance Abuse Treatment Providers  ttp://www.bhwellness.org/wp-content/uploads/2009/07/2-STEPP-Sub-Abuse-Toolkit.pdf

3. Treating Tobacco Use and Dependence: 2008 Update http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=hsahcpr&part=A28163

4. AA and NA Members Dying from Tobacco, By David Macmaster, CSAC, PTTS AAandNAMortalityDyingfromTobacco


[1] Ziedonis, D., Williams, J.M.,Smelson, D. (2003).“Serious mental illness and tobacco addiction: A model program to address this common but neglected Issue.”  The American Journal of Medical Sciences Volume 326, Issue 4: 223-230.

Lisa Howard supports the work of the Northeast ATTC in New York by providing both classroom and web-based training. With more than 25 years experience in the fields of human and addiction services, Ms. Howard recently completed work on a grant-funded, multifaceted training project for the Impaired Driver Services Initiative at the NYS Office of Alcoholism and Substance Abuse Services (OASAS). Prior to joining OASAS, Ms. Howard served as a Training Specialist at the Tobacco Recovery Resource Exchange a training curricula for both classroom and web-based delivery to support the multidisciplinary New York State addiction workforce in the integration of tobacco use interventions into the continuum of addiction services. Ms. Howard is currently an instructor for the New England ATTC Distance Learning Program and has in the past served as the NYS Northeast ATTC Information Specialist and Assistant Director of the Institute for Professional Development in the Addictions.