Substance abuse

From Tobacco Info No. 1 - June 2010
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Addressing tobacco addiction while in treatment helps prevent relapse

In the past, substance abuse programs have been reluctant to address smoking addiction, fearing it would interfere with other interventions. However, at the Horizon Health Network (HHN) in New Brunswick, smoking cessation efforts and substance abuse rehabilitation go hand in hand, and quitting smoking may help clients quit other drugs as well.

In May 2008, the HHN in Saint John implemented a tobacco free property policy: no smoking rooms on the property and no smoking outside anywhere on the premises. Although this initiative was met with some reservations, Kelly Evans, the former Zone Manager for the Addiction and Mental Health Program for the HHN, believes the outcomes have been mostly positive.

“People with addictions need help with all aspects of their addictive personalities,” said Evans as part of her presentation at the Second Annual Ottawa Conference: State of the Art Clinical Approaches to Smoking Cessation on January 22–23, 2010. “If we ignore the addiction to nicotine, then we leave the patients even more vulnerable to relapse [to other drugs] than they already are.”

Opponents of addressing a person’s tobacco dependence while in treatment for substance abuse argue that addiction clients don’t want to address their tobacco use, that doing so adds stress to their initial desire to quit drinking or doing drugs, and that tobacco free policies are ‘making miserable people more miserable.’ Other challenges include commitment by staff, scheduling conflicts and low motivation among patients.

Also, cigarettes have been used in the past as rewards at rehabilitation centres, in order to calm patients down.

Studies support co-cessation treatments

According to a 2008 Swiss study published in the Harm Reduction Journal, smoking rates in methadone-maintained patients are almost three times higher than in the general population and remain elevated and stable. The study entitled Barriers to smoking cessation in Swiss methadone and buprenorphine-maintained patients, conducted by Victoria Wapf et al. at the Zurich Psychiatric University Hospital, demonstrated that four out of five patients (78.6%) suffered from co-dependencies.

This rate of co-dependency is common in all types of addiction treatment programs. Given the many negative health effects of smoking, tobacco dependence contributes to the high mortality rates in this patient group, and thus needs to be addressed.

In Quebec, following a suggestion by Health Canada to incorporate smoking cessation interventions in substance abuse rehabilitation centres, the Maison l’Alcove in St. Hyacinthe instituted an intervention policy. A book published by Laval University entitled Tabac, alcool, drogues, jeux de hasard et d’argent (Tobacco, alcohol, drugs, gambling and money), outlines the intervention initiated in 2003.

“The importance of integrating a smoking cessation policy rests on three objectives,” said Marc Caya, program director at Maison l’Alcove. “The first is to help our patients quit smoking, the second is to educate them on the ill effects of smoking and the most important is to inform them of the negative relationship between smoking and other psychotropic substances.”

As a result of the smoking cessation policies, clients receiving some smoking interventions were more likely to abstain from alcohol use six to 12 months after their treatment.

These findings are supported by a systematic review of the effectiveness of smoking cessation policies in substance abuse programs undertaken by Prochaska, Delucchi, and Hall, and published in the Journal of Consulting and Clinical Psychology in 2004. They conducted an extensive literature research study from 1999–2003, identifying 19 trials for review. The researchers found that, among individuals in addiction treatment, smoking cessation interventions were associated with a significant increase in long-term sobriety compared to those who were allowed to continue smoking.

Seeing is believing

Clients from all around New Brunswick are now seeking out the facility in Saint John, specifically for its tobacco-free services. Further, they are requesting tobacco addiction treatments and feel safer because they no longer go outside at night to smoke a cigarette alone in the dark, or in a secluded smoking room.

“The key here is the effective use of NRT. Our clients are all addicted to nicotine, so it is safer and easier to wean them off of nicotine as opposed to forcing them to quit cold turkey,” said Evans during her presentation entitled Smoking Cessation and Policy Linkage in Challenging Situations. “We need leadership and commitment from all involved in the process to make it successful.”

– by Joe Strizzi