Integrating Tobacco Treatment into Substance Abuse Treatment Agencies

1
Integrating Tobacco Treatment into Substance
Abuse Treatment Agencies

• Erik Stone, MS, CAC III
• Director of Compliance and Quality Improvement
• Signal Behavioral Health Network
• September 13, 2007

2
The Elevator Speech

• 80 of Coloradoans in treatment for substance
  use disorders use tobacco.
• Tobacco is the single largest cause of death for
  people with substance use disorders.
• Tobacco is currently not consistently or
  adequately addressed by substance abuse treatment
  providers.
• Tobacco Use Recovery Now! (TURN), a Signal
  project funded by STEPP, is trying to get all
  Signal providers to assess and treat the tobacco
  addiction of all clients.

3
Who is Signal?

• A Colorado non-profit corporation created in 1996
• A managed services organization (MSO) that
  receives funds from the state, counties, and
  other sources to deliver substance abuse
  treatment and detoxification services
• A MSO that contracts with a network of providers
  to deliver substance abuse treatment services
• An organization with 9 FTEs disbursing 25
  million annually to its providers for services

4
(No Transcript)
5
Who Are The Providers?

• 19 providers in Signals three regions
• All are agencies licensed by ADAD to treat
  substance abuse many are also licensed for other
  services such as mental health or domestic
  violence counseling
• Range in size ? 162 admissions to 19,894
  admissions 1 location to 24 locations
• Range in treatment services offered ? outpatient,
  residential, or detox programs

6
Metro Denver Providers

• Arapahoe/Douglas MHN
• Arapahoe House
• ARTS
• CADREC
• Denver Health

• IDEA
• Jeffco SACP
• Jeffco Mental Health
• Sobriety House
• The Council

7
What Services Are Offered?

• Detoxification (Non-medical)
• 5 providers 40,542 admissions
• Residential
• 6 providers 2,721 admissions
• Outpatient
• 17 providers 8,983 admissions

• Opioid Replacement Therapy
• 4 providers 627 admissions
• DUI Education and Treatment
• 15 providers 4,122 admissions

Source Signal 06-07 contract year
8
Who are the Clients in Treatment?

• 66 males (National average is 70)
• 89 adults (National average is 91.5)
• 64 white, 23 Hispanic, 8 African American
• 51 single
• Median annual income 4800
• 76 admitted to outpatient modalities
• Source - ADAD Report to Committees of Health and
  Human Services, 2006

9
Who are the Clients? (2)

• 38 report alcohol as primary substance, 22
  marijuana, 20 methamphetamine, 12 cocaine
• Typical client uses multiple substances
• Typical client has multiple problems
• Typical client has external pressure to enter
  treatment

10
TURN Phase IJanuary 2006 September 2006

• Reviewed the literature on tobacco cessation in
  SA treatment settings
• Surveyed staff and clients at Signal providers to
  identify barriers and facilitators to integration
  of tobacco treatment
• Conducted an environmental scan assessing the
  current state of tobacco cessation programs
• Created a change plan outlining the steps
  necessary to increase the SA treatment
  communitys capacity to provide tobacco treatment

11
TURN Survey - 2006

• Self-administered, anonymous survey of staff and
  treatment clients at 9 Signal providers
• 6 providers in metro Denver 1 each in Greeley,
  Lamar, and Pueblo
• 86 of clients and 82 of staff participated
• 810 clients 261 staff completed surveys

12
Regular Tobacco Use
13
Intention to Quit Tobacco Use
14
If I were to stop using tobacco, it is likely or
certain that I would
CLIENTS 1 Be more irritable 2 Gain
weight 3 Be less calm 4 Have intense
cravings 5 Miss pleasure of using
tobacco STAFF 1 Have intense cravings 2
Be more irritable 3 Miss pleasure of using
tobacco 4 Be less calm 5 Be less able to
deal with stress
15
Attitudes Toward Tobacco Use(Agree or Strongly
Agree with Item
16
Clients Getting Help to Quit

• 75 of clients believed tobacco treatment should
  be offered to people while in treatment.
• 36 of clients reported wanting assistance to
  quit tobacco. Of these, only 11 asked for help.
• Cold turkey, NRT, gradually reduction in use were
  preferred quit methods less than 30 said they
  wanted help from classes, QuitLine, or counseling
• Tobacco cessation may be a good idea for someone
  else.

17
What would it take for your agency to provide
tobacco dependence treatment to clients?
18
TURN Phase IIOctober 2006 September 2008

• Educate staff at Signal providers on tobacco and
  role of tobacco treatment in supporting recovery
• Train Signal providers on delivery of tobacco
  treatment
• Promote policy interventions to facilitate
  integration of tobacco treatment
• Create a change plan for integrating tobacco
  control and treatment into all substance abuse
  treatment providers in Colorado

19
Educate

• Create materials for Signal providers
• Fact sheets on Why Should Counselors Care? and
  How Do Substance Abuse Clients Benefit?
• Adaptation of 5 As
• Resource list on tobacco control treatment
• Identify existing educational materials relevant
  to tobacco treatment in SA treatment agencies
• Nicotine cessation articles from Northwest
  Frontier Addiction Technology Transfer Center
• You Can Quit Smoking consumer guide

20
Educate

• Create posters on tobacco relevant to SA
  treatment agencies
• Adapted Cigarettes Are My Greatest Enemy
  campaign images in posters and post cards
• Disseminate educational materials
• Distributed to all Signal providers
• Posted on Signal website (in process)
• Presented at ADAD Research Forum in July
• 178 attendees 48 via video cast in Durango,
  Grand Junction, and Pueblo

21
Train

• Offered free online tobacco course through
  Northeast ATTC 25 incentive to staff who
  complete
• Sessions in January, May, July
• 66 completed from 12 providers
• Offered free face to face training on August 20
• 74 completed from 16 providers
• Attendees received credit towards certification
  as addictions counselor
• Staff from 17/19 Signal providers have completed
  either online or face to face training

22
Promote Policy Changes

• Created provider workgroup to review and analyze
  existing provider policies
• Created Key Elements of Model Tobacco Policies
  for Substance Abuse Treatment Providers in April
  2007
• Distributed Key Elements to all Signal
  providers
• Began discussion with ADAD of adding tobacco
  education to mandated curricula

23
Next Steps

• Pilot policy change at 3 providers ? Minimum
  change required is to assess tobacco use in all
  clients and to advise quitting ? Revisions by
  October 1
• Provide incentives to staff to include tobacco on
  client treatment plans
• Send provider staff to National Conference on
  Tobacco or Health
• Offer face to face training on a regular basis

24
Final Step

• Create change plan to integrate tobacco treatment
  into all substance abuse providers in Colorado