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Claudia Bohner, MPH

Tobacco Prevention and Control Program (TPCP)

Utah Department of Health

A Partnership to Establish Tobacco‐free Mental Health and Substance Abuse Treatment Centers 

in Utah 

Background:

• Cigarettes smoked in the U.S. by individuals with a mental health disorder: 44%1

• Smoking prevalence among population groups with mental health issues: 36%2

• Smoking prevalence among individuals with alcohol and drug use disorders: 65%3

• New York has tobacco-free publicly funded SA treatment centers

1Lasser K, et al (2000). Journal of the American Medical Association, 284, 2606-2610.2Gfroerer J, et al (2013). MMWR, February 8, 2013/ 62(05); 81-87.3Guydish J, et al (2011). Nicotine & Tobacco Research, 2011 June; 13(6); 401-411

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11.3%

20.7%

68%

0%

20%

40%

60%

80%

100%

Total mental health 7+ days not good SA treatment center clients

Current Smoking Among Utah Adults, Total and by Impaired Mental Health, 2009‐2011 (Combined Data, Age‐adjusted); Current Smoking by Substance Abuse Treatment Center 

Clients, 2009

Sources: Utah BRFSS 2009‐2011; Utah Division of Substance Abuse and Mental Health, Treatment Episode Data Set (TEDS), 2009

Utah Data:

Substance Use at Intake, Utah Treatment Center Clients (1999‐2009)

Source: Utah Division of Substance Abuse and Mental Health, Treatment Episode Data Set (TEDS), 1999‐2009

Tobacco vs Other Drugs:

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Conclusions:

• Smoking rates among clients of Utah’s publicly funded SA and MH treatment centers are extremely high.

• Utah’s SA and MH treatment centers serve an estimated 15-20% of Utah’s smokers

• Population is underserved due to • tendency to ignore treatment for tobacco

addiction in SA and MH clinic settings • need for specialized tobacco treatment options

Planning Stage:

1. Partnership: Utah Division of Substance Abuse and Mental Health (DSAMH) and TPCP

2. ARRA funding (tobacco policy change): create tobacco-free policies for Utah’s public mental health and substance abuse treatment centers

3. Three key project objectives: • Integrate tobacco cessation into treatment protocols• Establish tobacco-free campus policies• Decrease tobacco use among clients and staff

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Recovery Plus Leadership Team (2010):

• Utah Division of Substance Abuse and Mental Health (DSAMH)• 15 Publicly Funded MH/SA Treatment Centers

• Utah Department of Health, TPCP• 12 Local Health Departments

• Treatment Center Clients• Advocacy Groups• Department of Corrections

Vision:Recovery Plus is an initiative to promote health and wellness in people with mental illness and/or substance abuse. With support, education, and treatment, people can and will recover from symptoms of mental illness and addictions, including tobacco dependency.

Rules:• No one will be denied treatment because of their

tobacco use.• Assessment, education, treatment planning and

NRT will be provided to all clients as appropriate.

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Implementation Phases (2010-13):

Phase 1 - Needs assessments at each of the facilities.

Phase 2 - Staff training; providing resources to address challenges

Phase 3 - Policy development and implementation

Phase 4 - Follow-up: tracking and supporting policyenforcement during annual site assessments

Phase 1: Needs AssessmentsObjectives: Assess -

o Current tobacco policieso Barriers to developing tobacco-free campus policieso Readiness to change policieso Client and staff attitudes about tobacco useo Need for training and technical assistance

Methods: o Client focus groups (select sites) – 10 completedo Key informant interviews (all sites) – 50 completed

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Phase 1: Needs Assessment Results

Clinic Assessments:

• Smoking rates: staff 4-17%; clients 60-68%

• Tobacco policy change means “culture change”

• Education needs are highest among staff members

• Staff concerns about enforcement; losing clients; funding for treatment and NRT

Clients:• High awareness of health benefits of quitting

• Fears about consequences of not quitting

Phase 2: Providing Resources and Staff Training• Outreach and education

• Training plan (Peer-to-Peer Tobacco Recovery Program)

• Changes to Utah Tobacco Quit Line protocols:o Track mental health and substance abuse at intakeo Ensure availability of NRT for treatment center

clientso Quit Line coach training to address tobacco

cessation in the MH and SA context

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Phase 2: Materials http://recoveryplus.utah.gov/

Phase 2: Materials - Fighting Myths

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Phase 3: Policy Development and Implementation• Adopt tobacco-free campus policies

• Integrate tobacco cessation into treatment protocolso Tobacco use assessed at intakeo NRT and counseling providedo Tobacco use addressed in discharge plan for

relapse preventiono Support offered through cessation classes

• Uniform signage

• Track policies in statewide policy matrix

Phase 4: Policy Enforcement

• Tobacco policy review is integrated in annual DSAMH site visits with local treatment centers

• Review of policy enforcement • Technical assistance

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OUTCOME (March 2013)

100% of Utah’s publicly funded SA and MH Treatment Centers have comprehensive tobacco-free policies that include -

• A tobacco-free campus • Tobacco addiction addressed in treatment protocols• Tobacco use tracked in data collection

Utah Tobacco Quit Line Data

Percent of Utah Tobacco Quit Line Users by Self‐reported Mental Health and Alcohol and Drug Use Problems, Utah, July 2011‐March 2013 

Source: Utah Tobacco Quit Line Intake Data, July 2011 – March 2013

mental health or substanceabuse issue

alcohol use drug use

FY12 Part 1 47.2% 4.7% 5.1%

FY12 Part 2 48.0% 5.8% 5.7%

FY13 49.5% 6.2% 7.3%

0%

20%

40%

60%

80%

100%

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Next Steps

Recovery Plus expansion to address other risk factors (obesity) and chronic diseases (cardiovascular disease, diabetes, asthma) through

o Assessmento Links to resourceso Follow-up

Recovery Plus Documentary

https://www.youtube.com/watch?v=IwiWrxEuOpc

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Thank you.

Claudia Bohner, MPH

Tobacco Prevention and Control Program Utah Department of Health

cbohner@utah.gov