Tobacco dependence among clients in residential substance abuse programs:Meeting the NYS mandate

Tobacco dependence is a leading cause of morbidity and mortality in addiction treatment programs. Recently, the NYS Office of Alcoholism and Substance Abuse Services (OASAS) announced regulations applicable to all OASAS programs to institute a policy of tobacco free premises starting July, 2008. As such, clients entering long-term residential treatment programs (6-18 months) will need to quit smoking during their treatment stay. Such programs will require clinical level change, better assessment of nicotine dependence and the inclusion of tobacco dependence in the client's treatment plan. The research division at Samaritan Village (SV) one of the largest residential treatment agencies in NY has developed and implemented a tobacco assessment which provides information on client's current, historical and intentional tobacco use. Data is reported on clients entering treatment from November 2007 (N=340), and clients having been in treatment between 1-12 months (N=513). Findings indicate that nearly 90% of clients smoke and 93% of those smoke every day. The majority score as having low to moderate nicotine dependence; about 60% of clients have attempted to stop using tobacco; many making at least 3 attempts; most reported using “cold turkey” to quit smoking followed by the nicotine patch; and the most common side effects included increased appetite, frustration, anger, anxiety and depression. Precontemplaters were significantly more nicotine dependent than those in the preparation stage (p=<.005) and higher levels of stress significantly predicted greater nicotine dependence (p<.001). Using information from a targeted tobacco assessment can better equip counselors to support clients in becoming tobacco free.