Using tobacco products is prevalent among people with substance use disorder (SUD).
“Persons with mental or substance use disorders or both are more than twice as likely to smoke cigarettes as persons without such disorders and are more likely to die from smoking-related illness than from their behavioral health conditions,” wrote Marynak, VanFrank, et al. in their 2018 study “Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities.”
The good news is that “many persons with behavioral health conditions want to and are able to quit smoking, although they might require more intensive treatment. Smoking cessation reduces smoking-related disease risk and could improve mental health and drug and alcohol recovery outcomes.”
Many modern, evidence-based addiction treatment centers are fully aware of these data and have made their programs nicotine-free. One of them is Harmony Foundation. In a recent webinar hosted by the National Association of Addiction Treatment Providers (NAATP), Harmony CEO James Geckler and Harmony’s medical director, Michael Rountree, talked about their experience with introducing a tobacco-free campus.
After exploring options during 2019, Harmony became tobacco-free in January 2020. “We knew that it supported people’s wellness, it made for better options for long-term recovery, and it spoke to our mission of being foundational,” said Geckler. “it had all the right pieces to it.”
Dr. Rountree explained the basic science. Many people in recovery want to quit smoking. ”Clients find treatment to be the appropriate place for quitting,” Dr. Rountree said. “And smoking cessation does not impair outcomes in patients presenting with substance use disorder.”
Not only does smoking cessation not impair outcomes, there is a “25 percent improvement in long-term abstinence for people with SUD.”
Some organizations fear a smoke-free campus will have a negative impact on the census. As the Harmony experience demonstrates, there is no real reason for concern. “We now have about one patient a month who is not admitted because of the smoking ban,” Geckler said. “If people object to the tobacco-free setup, we refer them to another treatment center.” Overall, the transition to a smoke-free campus “was easier than expected.” Dr. Rountree added that he was “stunned at the lack of complaints.”
Harmony Foundation prepared for the transition well. The team started having conversations with clients, staff were trained and supported with studies to promote tobacco cessation, and the campus itself had to be prepared. “We used to have smoking gazebos for cigarette breaks and smoke breaks were actually built into the schedule,” explained Geckler.
Before going smoke-free, Harmony had offered smoking cessation groups to clients interested in quitting. Now, all nicotine products are off-limits with the exception of patches and gums. Sometimes, clients bring e-cigarettes or nicotine pouches only to learn they are not permitted on campus. However, most clients understand why such products are not helpful when explained to them.
“Flexibility and patience are important,” said Geckler. “Appropriate training and good communication is key. We had to learn to look out for mail deliveries of tobacco and how to check clients’ baggage for tobacco products. We ended up with a cleaner campus—no more cigarette butts on the ground, and have better group attendance, as nobody has to finish a cigarette.”
Nicotine addiction is very similar to other substance use disorders. Like other drugs, nicotine engages the reward cycle of the brain. “A transient surge of endorphins in the reward circuits of the brain causes a slight, brief euphoria when nicotine is administered. This surge is much briefer than the ‘high’ associated with other drugs,” explains a webpage from the National Institute on Drug Abuse. Nicotine works like other psychoactive substances; consequently, cessation tends to support recovery from substance use disorders. Since addiction is a biopsychosocial and spiritual disease, Harmony’s treatment program promotes physical, emotional, and spiritual healing, empowering patients to embark upon a lifelong journey of recovery. All our services are provided in a safe, culturally sensitive, tobacco-free environment and in a trauma-informed manner.
If you or a loved one are struggling with alcohol or drug addiction, or you have questions about our programs and workshops, call us today at (970) 432-8075 to get the help needed as soon as possible. Our experienced staff is available 24 hours a day, seven days a week.