Tobacco Harm Reduction Addiction Treatment and Recovery Project
The addiction treatment and recovery system in the United States is massive. The industry is comprised of approximately 15,000 public and private service units with more than 1.3 million persons in care at any point in time. Some 24 million people are in long term recovery having benefitted from treatment, recovery support and/or a variety of mutual aid organizations. Considerable innovation occurs regularly in the system including motivational/cognitive behavioral approaches, recovery community organizations and harm reduction strategies such as needle exchange and naloxone distribution.
The addiction and recovery field can justifiably point to the success of its evolution and the important outcomes that benefit so many Americans. Notwithstanding the above, however, there is a problem at the core of this enterprise that has been long-avoided and now requires systematic and focused attention.
Unaddressed addiction to cigarette smoking among treatment and recovery populations is responsible for disease and premature death among a substantial number of Americans who achieve long term recovery from their substance use disorder.
A report from the Substance Abuse and Mental Health Services Administration entitled, “Adults with Mental Health Illness or Substance Use Disorder Account for 40 Percent of All Cigarettes Smoked.”(1) The Centers for Disease Control also endorses the proposition that adults with mental illness or substance use disorders smoke cigarettes more than adults without these disorders.”(2) The National Co-morbidity Study data reports smoking prevalence of 56.1% among persons with past-month alcohol disorders and 67.9% among those with substance use disorders (SUD).(3) Current literature cites smoking prevalence among treatment clients as ranging between 49% and 98%.(4)
One research report in Nicotine & Tobacco Research concluded:
“The very high smoking rates reported in addiction treatment samples warrant significant, organized, and systemic response from addiction treatment systems, from agencies that fund and regulate those systems, and from agencies concerned with tobacco control.”
The award of a Tobacco Harm Reduction Scholarship from Knowledge-Action-Change in 2019, enabled research that concluded the following:
There exists widespread empirical evidence that persons with substance use disorder (SUD) both active and in treatment are also very heavy consumers of combustible cigarettes.
Similarly, there exists strong evidence that persons in recovery from a substance use disorder are also very heavy consumers of combustible cigarettes, and that their risk associated with tobacco use is greater than life-threatening sequelae from their addiction.
Organizations that treat SUD and those that provide support for persons in recovery from SUD are increasingly recognizing the need to address tobacco addiction, but to date largely rely on prohibitions and cessation strategies.
Persons in treatment or recovery who smoke are ambivalent about their addiction to tobacco and receive mixed messages from local programs and national leadership organizations about tobacco use concurrent with SUD.
Tobacco harm reduction practices and strategies continue to be hampered by the legacy of drug harm reduction in the U.S.
The award of an Enhanced THR Scholarship in 2020 resulted in the development of the Smoking and Recovery Toolkit created to assist addiction treatment and recovery programs as well as individuals to reduce or eliminate cigarette smoking. The Toolkit contains:
1. An assessment/audit instrument to determine the existing policies, practice and readiness of treatment and recovery programs seeking to improve their response to client/member smoking behavior.
2. Two training curricula for staff and clients focusing on THR practices.
3. SUD-specific smoking self-assessment strategies that including stages of change and motivational components to help individuals who wish to reduce or end their combustible tobacco use.
The website is available at www.smokingandrecoverytoolkit.com.
Sources:
(1) The NSDUH Report: Adults with Mental Illness or Substance Use Disorder Account for 40 Percent of All Cigarettes Smoked, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (March 20, 2013).
(2) Tobacco Use Among Adults with Mental Illness and Substance Use Disorders, Centers for Disease Control and Prevention, https//www.cdc.gov/tobacco/disparities/mental-illness-substence-use/index.htm.
(3) Guydish, Joseph, et al., Smoking prevalence in addiction treatment: a review, Nicotine & Tobacco Research, vol 13, 401-411.
(4) Schroeder, S.A. (2009) A 51-year-old woman with bipolar disorder who wants to quit smoking. Journal of the American Medical Association, 301, 522-531. Doi:10.1001/jama.2008.982
(5) Guydich, 401.