Tobacco Dependence Project

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Tobacco Dependence Project
Ohio Department of Alcohol and Drug Addiction
Services Ohio Department of Mental Health

• Improving the Overall Health in the AOD MH
  System

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The Tobacco Issue in our population

• 55.5 of individuals who use tobacco have a
  comorbid psychiatric condition
  
• Grant et al., 2004
• Use rates as high as 90 among individuals with
  severe mental illness (SMI)
  
• Glassman, 1999
• Use rates of 70 - 90 among individuals with
  alcohol and other drug use disorders (AOD)
  

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The Tobacco Issue in our population

• People with SMI / AoD have significant
  non-psychiatric medical comorbidities
  
• Heart disease
• Pulmonary disease
• Diabetes
• Obesity
• High blood pressure
• ODMH comorbidity study
• Stuyt, Order-Conners, Zeidonis Psychiatric
  Annals July 2003
  

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Ohios AOD and MH Systems Impact

• About 354,000 consumers served in SFY 05
• Current staff have the skills necessary to treat
  an addictive substance like tobacco

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Tobacco Foundation Grant

• Aligns with ODMH ODADAS Goals
• Valued resource to address needs of our
  population
  
• Tool for defining a Best Practice approach
• Method for statewide integration for individuals
  in Ohios MH / AOD system

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How to address the Tobacco Issue

• Goal 1 of Presidents New Freedom Commission on
  Mental Health Mental Health is Essential to
  Overall Health
  
• Imbed services in a wellness / healthy lifestyle
  approach
  
• Three Goals we are working on
• Public Awareness
• Collaboration and Integration
• Technology and Best Practice
• Transformed system recovery focused and consumer
  / family driven

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Structure of Ohios Mental Health System
Ohio Department of Mental Health
ODMH Licensure Certification
Mental Health ADAMH Boards (50)
Mental Health Agencies (480)
ODMH BHOs (5 w/9 sites)
Operating responsibility Funding/contractual re
sponsibility
Certification responsibility
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ODMHs Leadership Role

• Provide care
• Fund services
• Regulate and oversee
• Coordinate and promote quality, best practices,
  recovery and workforce development
  
• Integrated Dual Disorder Treatment
• IDARP strategies for integrating new practices

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Structure of Ohios AOD System
ODADAS
7 County-level ADAS / MH Boards
50 County-level Combined ADAMH Boards
Local Provider Agency
Local Provider Agency
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ODADAS

• Remain at 70 - 90 among individuals with drug
  addiction, while smoking rates decrease in
  general population
  
• Richter, 2001 Glasserman et al., 1990 Hugh,
  1996 Sussman, 2002 Zickler, 2001 Berger, 1972
  Stark Campbell, 1993
  
• Substance abusers smoke more cigarettes, 40 per
  day, than average population
  
• Seidner et al., 1996

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ODADAS
Quitters are 3x as likely not to use cocaine as
their peers who smoke Frosch et al, 2000
the average length of sobriety of non-tobacco
users was almost twice that of tobacco users.
Stuyt, The American Academy of Addiction
Psychiatry 1997 Alcoholics who quit were less lik
ely to relapse to drinking MA Med Society 1997
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ODADAS

• alcoholics who quit smoking are more likely to
  succeed in alcoholism treatment
  
• (Shiffman Balabanis, 1996)
• We have found that our patients are much better
  able to focus on the issues central to their
  recovery when they are not using tobacco
  
• (Stuyt, presented at the 2/00 meeting of SRNT)

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An Ohio Partnership

• Taking on Tobacco

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An Ohio Partnership, Pilot Programs
?Ohio Mentor
?
Community Health Center
?
?Century Health
?
Central Ohio Mental Health Center
Upper Valley Medical Center
?
?
?Amethyst, Inc.
Wright State Consumer Advocacy Model
AOD Treatment Center ? MH Treatment Center
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An Ohio Partnership

• Tobacco Dependence Project
• 3 ODADAS sites 4 ODMH sites
• Assessment
• Treatment integration
• Policy change
• Training Education
• Statewide Advisory Committee
• Local Steering Committee

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Ohio Tobacco Use Prevention and Control Foundation
State-Level Advisory Committee
ODADAS ODMH Leadership Team
Project Evaluator
Statewide Coordinator
LSC
LSC
LSC
LSC
LSC
LSC
LSC
Pilot Site
Pilot Site
Pilot Site
Pilot Site
Pilot Site
Pilot Site
Pilot Site
Pilot Site
Note Solid lines show direct flow of
communication Dotted lines show secondary
communications
LSC Local Steering Committee
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An Ohio Partnership Achievements

• Developed and Maintain a Statewide Advisory
  Committee
  
• 39 Members
• 16 National, state and local organizations
  represented
  
• 2 Consumers
• Quarterly meetings
• Guidance, advice, expertise and information to
  overcome barriers, implementation and
  sustainability

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An Ohio Partnership Achievements

• Assess agencies
• Baseline evaluations on staff
• Develop Local Steering Committee
• Local leadership in pilot site areas
• Lung Association, Health Department, ADAMHS
  Boards, other TUPCF grantees, Regional directors
  and hospital officials
  
• Agency Kick-off
• Involve local media, boards and state
  representative

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An Ohio Partnership Achievements

• Training
• Staff general education
• Utilization of Ohio Quit Line
• 5 As Training
• State Coordinator on Statewide Advisory Committee
  of Wellness Management and Recovery CCOE
  
• Implementation of programming
• All clients assessed and diagnosed
• Modification of current forms for standardization
  
  
• All clients are receiving treatment

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A Vision for the Future

• Sustainability
• Recommendations from the Clinical Practices
  Guidelines state
  
• It is essential that clinicians and health care
  delivery systems institutionalize the consistent
  identification, documentation and treatment of
  every tobacco user seen in a health care
  setting.

U.S. Department of Health and Human Services
Clinical Practice Guideline, Treating Tobacco Use
and Dependence, 2000