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Tobacco cessation - systems change: Embedding tobacco cessation services in substance abuse and mental health treatment
Tuesday, November 5, 2013
Behavioral healthcare programs serve the largest number of populations disparately impacted by tobacco, are positioned to align themselves with tobacco treatment and historically do not take advantage of this opportunity. Agency cultures should support tobacco free principles, make systemic commitments to change, and integrate tobacco treatment within routine care. Current literature supports more aggressive use of nicotine replacement therapy (NRT) for both motivation to quit and longer term cessation. CODAC Behavioral Healthcare identified a goal of embedding tobacco free policy' into existing services, setting the standard for tobacco treatment within other Rhode Island behavioral healthcare agencies. Seed money was awarded to CODAC by the Rhode Island Department of Health and Newport Coalition to train 7 staff as Tobacco Treatment Specialists, provide CO monitors, initiate a pilot study in medication assisted treatment, and move the Board to adopt a tobacco-free policy. Services were more effective when all staff interacted daily with patients identified as tobacco users. Enhanced treatment combined group and individual counseling, longer duration of treatment, and more aggressive use of pharmacotherapy. CODAC achieved a 13% quit rate at the end of the study, 10% of patients used NRT to reduce tobacco use. Behavioral interventions averaged 8 hours. Tobacco treatment services are more effective when provided by trained Tobacco Treatment Specialists and when agency culture has shifted to support comprehensive tobacco treatment. Quit lines are an invaluable resource for disparately-impacted populations, and providers need to advocate for both funding and comprehensive tobacco treatment reform under the Affordable Care Act.
Learning Areas:
Program planning
Social and behavioral sciences
Learning Objectives:
Discuss how more successful quit attempts and longer term cessation are realized when utlizing a more aggressive approach to pharmacotherapy
Identify findings that illustrate how patient outcomes reflect the impact of shifts in agency culture toward comprehehsive tobacco treatment within a tobacco free environment
Describe how longer term quit attempts provide evidence for the effectiveness of a comrehensive systems approach in providing evidence-based, best practice inteventions
Keyword(s): Tobacco, Treatment Efficacy
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I have worked in social services for 40 years, the last 10 as a clinician at CODAC Behavioral Healthcare. Since 2008, I have worked, concurrently, with James Prochaska at URI on a cancer prevention research project utilizing Motivational Interviewing and Stages of Change Theory. I am certified as a masters level Tobacco Treatment Specialist through the ATTUD program at UMass Medical and have been tasked with the development and implementation of CODACâs tobacco treatment program
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
