1. Enhancing Recovery: Addressing Nicotine Dependence in Treatment Programs Janet Smeltz, M.Ed., CADAC, M-CTTS Institute for Health & Recovery Cambridge, MA Melanie Thornton, MSW, GSW Jefferson Addictive Disorders Dually Diagnosed Clinic Metairie, Louisiana

2. Rationale for Addressing Tobacco Dependence  Morbidity / mortality  Prevalence  Interest in quitting  Continued smoking as relapse factor to A/OD

3. Rationale for Addressing Tobacco Dependence (2)  Similar relapse prevention techniques  Tobacco use negatively impacts other psycho-social & recovery issues:  Finances  Health, HIV, Hepatitis C status  Pregnancy, children’s health  Treatment compliance  Medications  Dealing with feelings, developing coping skills  Increased risk for other health problems through multiple substance dependence

4. The Challenges  High prevalence  Historical view of smoking  Change requires multiple approaches, systems change, paradigm shift  Policy concerns

5. Tobacco, Addictions, Policy & Education (TAPE) Project  Funded through Mass. DPH, Bureau of Substance Abuse Services (BSAS), 1994  Statewide Targeted Capacity Building Grant  Serves all BSAS prevention & treatment programs by providing:  Consultation / TA  On-site staff training  “Thinking About Change?” workshops for staff who smoke  Resources, referrals & information  Annual conference & statewide trainings

6. Collaborations  Provider advisory group, CENAR (Council to End Nicotine Addiction in Recovery)  Massachusetts Tobacco Control Program (MTCP)  NJ Tobacco Dependence Program  MTCP / U. Mass. Medical School TTS Core Certification Training

7. Stages of Change Framework  Organizational process of change  Tailor approaches  Acknowledge & work with ambivalence  Importance of education & training

8. Tie-In With Addictions Treatment  Chronic, relapsing condition; complex addiction  Bio-psycho-social model  Build buy-in of leadership & line staff  Changing norms & culture, mission

9. Methods  Focus groups  Program surveys  Outreach to providers  Linkage with / referral to MTCP  NRT: pilot study; integration

10. Progress: BSAS Tobacco Guidelines (2004)  Process: development, review, final product  Leadership of state agency based on accumulation of research, US P.H.S. evidence- based clinical practice guidelines  Wider view of addiction, treatment, recovery: whole person  Implementation: systems-based, individualized  Ongoing follow-up, training, TA  Consistent message throughout system

11. Lessons Learned  Maintain Stages of Change perspective  Build relationships over time  Take the long view: change is a process  Promote systems-based approach  Build a cadre of trained, committed professionals

12. Lessons Learned (II)  See staff as key: reframe resistance  Use inclusive, treatment-oriented language: put the “T” in ATOD  Translate research into meaningful, relevant terms  End scare tactics: educate, involve

13. Next Steps  Continue to build buy-in  Implement, follow-up & enforce new guidelines  Build capacity of system through ongoing provision of training, TA, & resources  Support interest & leadership of programs  Prevent “relapse” of system