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The 13th World Conference on Tobacco OR Health

Building capacity for a tobacco-free world

July 12-15, 2006, Washington, DC, USA

Thursday, July 13, 2006 - 12:00 PM

Building Capacity for Tobacco Treatment within a Statewide Substance Abuse Treatment System: the Massachusetts Experience

Janet S. Smeltz, M.Ed., LADC-I, Institute for Health and Recovery, 349 Broadway, Cambridge, MA 02139 and Sarah Ruiz, MSW, Bureau of Substance Abuse Services, Massachusetts Department of Public Health, 250 Washington St., 3rd Floor, Boston, MA 02108.

Objective: Substance abuse treatment clients smoke at 3-5x greater rates than the general population and suffer high mortality from tobacco–caused illnesses and increased relapse rates to alcoholism/drug addiction. Treatment occurs in systems that have historically seen tobacco dependence as low-priority, and in which staff may also be tobacco dependent.

Beginning in 1994, the Massachusetts Department of Public Health, Bureau of Substance Abuse Services (BSAS) prioritized addressing tobacco dependence, starting with development of smoke-free policies. Tobacco dependence is now addressed with every client entering the BSAS system. This workshop will describe strategies employed to create and maintain change. Information will be helpful to states and individual tobacco control or addictions/mental health treatment programs.

Methods: Systems change has been accomplished through: state funding for a targeted capacity building contract focused on integration of nicotine addiction treatment into the BSAS system; implementation of smoke-free policies; NRT funding; linkage and collaborative planning with the Massachusetts Tobacco Control Program; provision of staff and client education/training; conferences; maintenance of a treatment provider advisory group; development, review and implementation of mandated guidelines; ongoing technical assistance. Evaluation components have included focus groups; surveys taken at intervals to measure change; analysis of pre/post tests for NRT recipients.

Results: Mandatory policy and treatment component guidelines have been implemented requiring substance abuse programs to conduct 5A interventions on all clients at admission and integrate tobacco education into group treatment. Barriers have been reduced; buy-in has increased. Integration of tobacco into the BSAS MIS system, licensing regulations, and a manual for providers are underway.