Tobacco cessation - systems change: Embedding tobacco cessation services in substance abuse and mental health treatment

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.