Tobacco Dependence Project Improving the Overall Health in the AOD

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Tobacco 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
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Tobacco Dependence Project

• Overview of the Problem
• Tobacco Dependence Project
• Implementation Plan

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Per Capita in United States Cigarette Consumption
and Major Smoking and Health Events U.S. 1990-
1998
CDC Office of Smoking and Health, 1999
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Epidemiology 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

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R. J. Reynolds (Camel) Sub Culture Urban
Marketing Whos SCUM? Alternative Life Styles
(Castro/Gay), International Influence, Rebellious
/ Generation X Street People.
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Death Rate Comparison
ETS stands for Environmental Tobacco Smoke also
known as Second-Hand Smoke.
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Daily 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
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The Smoking Death Epidemic

• Smoking Death in the United States is equivalent
  to one Sept. 11th occurring once every three
  days, 365 days a year.

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The Smoking Death Epidemic

• Smoking death in the United States is the
  equivalent of a 757 crashing every 6 hrs, 365
  days a year.

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How does it kill you

• Cardiovascular effects
• Pulmonary damage
• Vascular damage
• Vasoconstriction and endothelial damage
• Carcinogenesis
• DNA damage

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Overview 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

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Overview 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

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Overview 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

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Overview 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

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Overview 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.

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Overview 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.

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Community Health Center

• The Plan

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Implementation Plan

• Consumers
• Assessment
• Education
• Treatment
• Quit Line

• Staff
• Training
• Provisions
• Policy

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Consumers

• Assessment
• Diagnosis
• Nicotine Use Disorder
• 305.10 Nicotine Dependence
• Nicotine-Induced Disorder
• 292.0 Nicotine Withdrawal
• 292.9 Nicotine-Related Disorder Not Otherwise
  Specified

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Consumers

• Assessment
• Desire to quit
• Stage of Change
• Pre-contemplative
• Contemplative
• Preparation
• Action
• Maintenance

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Assessment
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
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Consumers

• 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

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5 As Algorithm
Smoker Relapses
Ask
Current Smoker
Advise
Assess
Yes
No
Assist
Promote Motivation
Arrange
Willing to Quit
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Consumers

• Pharmacotherapy
• Buproprion
• Nicotine Replacement Therapy (NRT)
• Offered to all quitters
• Appropriate dosing methods

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Staff

• 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

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Staff

• Training
• Nicotine Replacement Treatment
• Proper dosing
• Client specific treatment
• Educating consumers on use

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Staff

• Provisions
• Assist staff who want to quit
• Provide smoke-out days

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Staff

• 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.

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Staff

• Policy
• Tobacco-free is a process
• Tobacco-free is supportive of staff consumers

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Next Steps

• Training
• General Education
• Assessment
• NRT
• Meeting with internal committee
• Evaluate current treatment policies
• Strategize for implementation
• Assessment of clients

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Questions
Aimee Maychack amaychack_at_greenehealth.org 937-352-
2915