Pubdate: Mon, 19 Nov 2007
Source: Rochester Democrat and Chronicle (NY)
Copyright: 2007 Rochester Democrat and Chronicle
Contact:  http://www.democratandchronicle.com/
Details: http://www.mapinc.org/media/614
Author: Cara Matthews
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

STATE TO END SMOKING IN ALL ADDICTION PROGRAMS

ALBANY -- For decades,  addiction-treatment programs have focused on 
drug and  alcohol abuse and shrugged at patients' near-universal  use 
of tobacco.

But faced with growing awareness of the power of  nicotine addiction 
and that smoking kills more people  than all other addictive drugs 
combined, New York  officials have decided the state can no longer 
afford  to ignore smoking.

"The entire field has struggled with the really  incorrect notion 
that treating nicotine addiction would  be really a hardship on the 
chemically addicted," said  Karen Carpenter-Palumbo, commissioner of 
the state  Office of Alcoholism and Substance Abuse Services.

In July, New York will become the first state in the  nation to ban 
smoking at all its chemical dependence  prevention and treatment 
programs, including those that  treat gambling addiction.

The 1,400 providers treat some 110,000 people on any  given day. 
About 10,000 of them are in 13  state-operated addiction-treatment 
centers, which  already are smoke-free. The policy also applies 
to  employees, visitors and volunteers.

"If we truly care about people's health and wellness,  we have to 
care about their addiction to tobacco," the  commissioner said last week.

In New York, up to 92 percent of the chemically  dependent population 
smokes, compared with 18.2 percent  of smokers in the general 
population, Carpenter-Palumbo  said. An estimated 25,000 deaths each 
year in New York  are tobacco-related, according to the agency.

The move is a progressive one and will save many lives,  said Richard 
Hurt, director of the Mayo Clinic Nicotine  Dependence Center in 
Rochester, Minn.

An 11-year study conducted by Hurt and colleagues found  that 51 
percent of deaths of addiction-treatment  patients were due to 
tobacco-related disease.

"To me, the ultimate outcome is whether or not the  patient lived or 
died," he said.

But there is fear that patients finding out that they  have to tackle 
their tobacco addiction in addition to  their drug and/or alcohol 
abuse "could be the straw  that breaks the camel's back and they 
leave treatment,"  said Keith Stack, director of development and 
grass-roots advocacy for the state Association of  Alcoholism and 
Substance Abuse Providers.

Stack said he received addiction treatment and is in  recovery, but 
he wasn't a smoker.

"You don't think of tobacco causing a problem in your  life," said 
Stack, a member of Faces and Voices, a  group whose 10,000 members 
nationwide are in recovery  from addiction.

The association is supportive of the initiative, which  is designed 
to reduce death from tobacco-related  illness among people in 
recovery, said John Coppola,  executive director of the group.

"I think, in part, the assertion is that it makes not a  lot of sense 
to help people stop drinking and stop  using other drugs only to see 
them die from their  addiction to nicotine," he said.

Smoking can be a hard habit to break because cigarettes  are legal 
and there is a lot more social acceptance of  them than hard drugs 
and alcohol abuse, said Russ  Sciandra, tobacco-policy specialist for 
the American  Cancer Society.

"I think it's important that people sort of be forced  to confront 
what they're doing to their body by smoking  cigarettes," he said.

Providers have voiced concerns about getting staff  training and 
having appropriate smoking-cessation  medication on hand.

The state is providing $8 million to fund  nicotine-replacement 
therapy for patients who do not  have coverage for that service and 
to teach staff about  medications and smoking-cessation techniques. 
Most insurance companies pay for nicotine-replacement  therapy.

By implementing the change statewide, the Office of  Alcoholism and 
Substance Abuse Services is making sure  that one facility won't lose 
patients to another, said  Thomas Nightingale, an associate 
commissioner with the  agency.

The idea of going smoke-free is not a new one at OASAS.  Three of its 
upstate addiction treatment centers --  John L. Norris in Rochester; 
Dick Van Dyke in Ovid,  Seneca County; and Margaret A. Stutzman in 
Buffalo --  were the first to do so 11 years ago. The rest of the  13 
state facilities joined later, and all have been  tobacco-free for at 
least two years, Nightingale said.  At the first three, there was a 
small dip in patient  numbers during the first few months of the 
change, but  ultimately the population went up, he said.

Joseph LaCoppola, program director of the Whitney M.  Young Jr. 
Health Center methadone program in Albany,  said 13 treatment centers 
in the region have already  gone smoke-free and are having success.

Overall, the response to the statewide regulation has  been 
favorable, Nightingale said.

"It's a significant change for the field. It's an area  that our 
field has struggled with and been very  hesitant to address for the 
better part of the last 30  years," he said.

Tobacco is a trigger, and by eliminating it, treatment  centers will 
help improve patients' overall sobriety  and prevent relapses, 
Carpenter-Palumbo said.

The commissioner said other states are calling New York  to learn 
about the initiative. "They want to go that  way. They're not ready 
yet," she said.
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MAP posted-by: Jay Bergstrom