A New York State Initiative to Address Tobacco in Alcohol and Drug Treatment National Conference on Tobacco or Health Chicago, IL May 5, 2005 William J. Panepinto, LMSW, Columbia Memorial Hospital Patricia Bax, CASAC, MS, RN, Roswell Park Cancer Institute Anthony Klein, BS, CASAC, Unity Health System Brian Sands, MD, New York City Health and Hospitals Corporation Michael Seserman, MPH, American Cancer Society, Eastern Division

Seeds of a Tobacco Control-Addiction Services Partnership

3 Passage of the NYS Clean Indoor Air Act was a win for Tobacco Control advocates, but… New Yorkers still had limited tobacco dependence treatment options: –Medicaid coverage for bupropion and NRT –Telephone counseling through the NYS Smoker’s Quitline –Cessation services from various providers across NYS Tobacco dependence continued to exact a devastating toll on the addictions treatment and recovery community.

4 Passage of the NYS Clean Indoor Air Act was a win for Tobacco Control advocates, but… If tobacco dependence is drug addiction, shouldn’t it be treated by addiction professionals? If New Jersey can do it, why can’t we?

5 Potential Benefits of Successful Integration Providing chemical dependency treatment for tobacco dependence further de- normalizes tobacco use. People whose tobacco dependence does not respond to minimal counseling and pharmacotherapy will get the treatment they need.

6 Potential Benefits of Successful Integration Chemical dependency providers can make a significant contribution to public health by preventing tobacco-related illnesses and deaths. Tobacco dependence treatment can be recognized as a medically-valuable service by physicians, insurers, and politicians.

7 Champions for Tobacco Dependence Treatment & Prevention NYS Tobacco Control Program (TCP) –New York State Smoker’s Quitline –Cessation Centers American Cancer Society, Eastern Division (ACS) –Center for a Tobacco-Free New York –Healthcare Tobacco Initiative

8 Champions for Tobacco Dependence Treatment & Prevention NYS Office of Alcoholism and Substance Abuse Services (OASAS) –Nicotine Work Group Alcoholism and Substance Abuse Providers of NYS (ASAP)

9 From a Conversation to a Plan June 2003: –ACS and ASAP first discuss collaboration to address tobacco in the addiction field. –OASAS Nicotine Work Group convenes July-December 2003: –ACS-ASAP and OASAS develop draft plans to integrate tobacco dependence services into addictions treatment and prevention.

10 From a Conversation to a Plan January 2004: –ACS, ASAP and OASAS meet, consolidate their draft plan, and establish a Partnership. –TCP and provider agencies join the Partnership. March 2004: –Tobacco Dependence Program shares the New Jersey experience with the Partnership, inspiring Partners to promote full parity of tobacco with other drugs of abuse.

11 NYS Partnership for the Treatment and Prevention of Tobacco Dependence Alcoholism and Substance Abuse Providers of New York State American Cancer Society, Eastern Division Columbia Memorial Hospital New York City Health and Hospitals Corporation New York State Office of Alcoholism and Substance Abuse Services New York State Tobacco Control Program Roswell Park Cancer Institute Unity Health System

12 The Partnership’s Mission The New York State Partnership for the Treatment and Prevention of Tobacco Dependence is dedicated to the belief that all tobacco dependent people deserve access to the support and evidence-based treatment and prevention necessary to overcome their tobacco addiction. Using education, advocacy, and the strengthening of linkages among organizations, the Partnership works to develop high quality, well-coordinated tobacco dependence treatment throughout the state. (Panepinto, 2004)

13 The Partnership’s Goal is to… … establish a model for reducing the incidence of tobacco use, tobacco dependence, and tobacco-related disease among adults in chemical dependency treatment by fully integrating tobacco dependence services into New York State’s chemical dependency services infrastructure – from provider education and service delivery evaluation to regulation and funding. (Panepinto, 2004)

Partnership Activities

15 Partnership Activities, January 2004 – April 2005 Coalition-building Public statements of support for tobacco-free chemical dependency programming Provider education and consciousness- raising

16 Partnership Activities, January 2004 – April 2005 Surveillance on provider knowledge, attitudes, and experiences related to tobacco Development of recommendations for OASAS regulations and guidance for OASAS-licensed programs

17 Building Provider Coalitions Recruited several provider agencies as Partnership members Facilitated the founding of a regional coalition of tobacco control and addictions professionals to integrate tobacco dependence treatment and tobacco control policies into chemical dependency treatment programs in a coordinated manner

18 Public Statements of Support for Tobacco-Free Programming Letter from OASAS Commissioner to all 1400 licensed chemical dependency treatment programs and 600 chemical dependency prevention provider agencies publicizes Partnership and urges providers to begin to address tobacco dependence in their programs

19 Public Statements of Support for Tobacco-Free Programming Letter from NYS Department of Health Commissioner follows up OASAS Commissioner letter supporting Partnership and Tobacco Control Program efforts to help chemical dependency providers to address tobacco dependence

20 Provider Education and Consciousness-Raising Sponsored 3 workshops by Terry Rustin on integrating tobacco dependence into chemical dependency programs at January 2004 ASAP Annual Meeting in NYC Delivered regional educations and focus groups for providers in five regions across NYS, October 2004 – January 2005

21 Provider Education and Consciousness-Raising Sponsored Regional Coalition’s Tobacco Dependence Conference in Albany, March 2005 Developed, sponsored, and delivered a Tobacco Dependence Institute at April 2005 ASAP Annual Meeting in Rochester, NY

22 Surveillance on provider knowledge, attitudes, and experiences Regional focus groups for providers in five regions across NYS, October 2004 – January 2005 captured perceptions of barriers, benefits, and recommended strategies for implementing tobacco-free chemical dependency programming

23 Surveillance on provider knowledge, attitudes, and experiences Key informant survey administered by TCP and Research Triangle Institute captured program administrator knowledge, attitudes, and experiences in addressing tobacco dependence in their OASAS-licensed chemical dependency treatment programs

24 Recommendations for Chemical Dependency Programs Adapted New Jersey Licensure Standards to develop recommendations for integrating requirements for tobacco dependence training for Credentialed Alcoholism and Substance Abuse Counselors and tobacco- free environment and tobacco dependence treatment policies into OASAS program licensure standards

25 Recommendations for Chemical Dependency Programs Adapted Tobacco Dependence Program (Hoffman and Slade)’s 12 Steps for Addressing Tobacco in Addictions to Develop guidance for training, policy development, and service delivery for OASAS-licensed chemical dependency treatment programs

Next Steps

27 Future Partnership Activities Secure funding to support the Partnership’s educational, advocacy, and coalition-building activities Building regional tobacco dependence coalitions from regional chemical dependency provider coalitions to coordinate ongoing educational and advocacy activities

28 Future Partnership Activities Building OASAS capacity to monitor tobacco dependence prevalence and treatment delivery Development of a website to deliver educational materials and coordinate statewide and regional educational and advocacy activities

Any Questions?

For more information, please contact: William J. Panepinto, LMSW