Title: Tobacco Dependence Project Improving the Overall Health in the AOD
1Tobacco Dependence ProjectImproving the Overall
Health in the AOD MH System
The Ohio Department of Alcohol and Drug Addiction
Services The Ohio Department of Mental Health
- Community Health Center
- Akron, Ohio
- Summit County
Funded By The Ohio Tobacco Use Prevention and
Control Foundation
2Tobacco Dependence Project
- Overview of the Problem
- Tobacco Dependence Project
- Implementation Plan
3Per Capita in United States Cigarette Consumption
and Major Smoking and Health Events U.S. 1990-
1998
CDC Office of Smoking and Health, 1999
4Epidemiology of Tobacco Use
- Where are smokers over-represented?
- Low education
- Low Income
- Blue collar
- Separated/divorced
- Psychiatric population
- Addiction population
- Cognitively impaired populations
- UMDNJ Tobacco Program
5R. J. Reynolds (Camel) Sub Culture Urban
Marketing Whos SCUM? Alternative Life Styles
(Castro/Gay), International Influence, Rebellious
/ Generation X Street People.
6Death Rate Comparison
ETS stands for Environmental Tobacco Smoke also
known as Second-Hand Smoke.
7Daily Death Rate
- 2,480 people die each year from heroin or
morphine overdose - 7 per day
- 3,308 die from their cocaine use each year
- 9 per day
- 127,750 people die each year from alcohol abuse
- 350 per day
- 400,000 people die each year from tobacco use
- 1,200 per day
Bernice Order-Conners UMDNJ
8The Smoking Death Epidemic
- Smoking Death in the United States is equivalent
to one Sept. 11th occurring once every three
days, 365 days a year.
9The Smoking Death Epidemic
- Smoking death in the United States is the
equivalent of a 757 crashing every 6 hrs, 365
days a year.
10How does it kill you
- Cardiovascular effects
- Pulmonary damage
- Vascular damage
- Vasoconstriction and endothelial damage
- Carcinogenesis
- DNA damage
11Overview of the Problem
- 85 of addicts and alcoholics are smokers
- 100 of methadone users are smokers
- 44 of all cigarettes smoke are smoked by DSM
diagnosed patients - 25 to 17 smoking rate for average population
12(No Transcript)
13Overview of Problem (cont.)
- Individuals with mental illness and AOD disorders
have higher rates of chronic health problems and
premature death compared to general population
due to long-term tobacco use. - Joukamaa et al., 2001 Stuyt, Order-Conners,
Ziedonis, 2004
14Overview of the Problem
- Effects on severe and persistent mental illness
- 32 years of life lost
- Most common cause is heart disease
- Smoking increases chances of heart disease by 200
15Overview of Problem (cont.)
- Pancreatitis is increased 10x among alcoholics
who smoke compared to those who do not
Pitchumoni et al. 1988 - Smokers require higher doses of antipsychotic
medications than non-smokers, although a direct
link to increased kidney excretion has not been
found yet. - (Surviving Schizophrenia., 3rd edt., pp. 250-53,
95) -(NAMI, 2004) - Alcoholic patients are heavier smokers than their
non-alcoholic counterparts Maletzky and Kottler
1974 - Cirrhosis is three times more likely in people
who smoke - Klatsky and Armstong, 1992
16Overview of the Problem
- Maternal smoking during and after pregnancy is
linked to asthma. - SIDS rate is highest in infants of smokers.
- Breathing difficulty is the 1 cause for cardiac
arrest in children.
17Overview of the Problem
- Teen Smoking
- The rates of smoking among teenagers are as high
as or higher than those of adults - 28 of teens smoke in 2001
- Adolescent tobacco users are more likely to use
alcohol and illegal drugs than are nonusers - Each day, more than 4,000 teens try their first
cigarette - 2,000 become regular, daily smokers
- 1 out of 3 will eventually die from
smoking-related disease.
18Community Health Center
19Implementation Plan
- Consumers
- Assessment
- Education
- Treatment
- Quit Line
- Staff
- Training
- Provisions
- Policy
20Consumers
- Assessment
- Diagnosis
- Nicotine Use Disorder
- 305.10 Nicotine Dependence
- Nicotine-Induced Disorder
- 292.0 Nicotine Withdrawal
- 292.9 Nicotine-Related Disorder Not Otherwise
Specified
21Consumers
- Assessment
- Desire to quit
- Stage of Change
- Pre-contemplative
- Contemplative
- Preparation
- Action
- Maintenance
22Assessment
I dont want to quit
I think I may
Pre-contemplative
Im ready
Contemplative
I quitfocus of everyday
Preparation
Action
Maintenance
Ive quit for 1 month
23Consumers
- Treatment
- Brief Intervention / 5 As
- Ask, Advise, Assess, Assist Arrange
- Completed by medical staff
- Integration
- Tobacco education
- Integration of transtheoretical model into
treatment - Provide treatment materials
245 As Algorithm
Smoker Relapses
Ask
Current Smoker
Advise
Assess
Yes
No
Assist
Promote Motivation
Arrange
Willing to Quit
25Consumers
- Pharmacotherapy
- Buproprion
- Nicotine Replacement Therapy (NRT)
- Offered to all quitters
- Appropriate dosing methods
26Staff
- Training
- General Education
- Latest research practices for population
- Tobacco Treatment Specialist Training
- One staff member to be certified
- 5 As
- Medical staff
- Integrating into current treatment
- Adaptation to treatment planning
- Adaptation to assessment
- Adaptation to education curriculm
27Staff
- Training
- Nicotine Replacement Treatment
- Proper dosing
- Client specific treatment
- Educating consumers on use
28Staff
- Provisions
- Assist staff who want to quit
- Provide smoke-out days
29Staff
- Policy
- Tobacco-free agency
- For Womens Recovery Program Campus
- Tobacco-free refers to those facilities that
prohibit the use of tobacco products on the
grounds of the facility. Tobacco-free also
denotes that you have integrated tobacco
dependency into treatment.
30Staff
- Policy
- Tobacco-free is a process
- Tobacco-free is supportive of staff consumers
31Next Steps
- Training
- General Education
- Assessment
- NRT
- Meeting with internal committee
- Evaluate current treatment policies
- Strategize for implementation
- Assessment of clients
32Questions
Aimee Maychack amaychack_at_greenehealth.org 937-352-
2915