For many, Feb. 14 means giving and receiving gifts, going to dinner, and spending time with a significant other to express love in a relationship. For those at the Aurora, Colo. Addiction treatment center CeDAR (Center for Dependency, Addiction and Rehabilitation), this Feb. 14 will mean giving back to themselves in a healthy way, according to Executive Director Steve Millette, MS, LAC.
Valentine’s Day will be the “quit date” at CeDAR– the day that all patients and staff are no longer allowed to use tobacco products on campus. Laura Martin, MD, ABAM, Medical Director at the Center for Behavioral Health and Wellness within the Department of Psychiatry at the University of Colorado School of Medicine (CeDAR is part of the University of Colorado Hospital affiliated with the School of Medicine), had the idea to implement the policy on Feb. 14. She says the timing has to do with the imagery of the heart, “taking care of our heart and taking care of ourselves.” The relationship with ourselves, she says, is a very important relationship that “frequently we give up when we’re not in recovery and leading well lives.”
Millette says the idea was born last summer during a staff meeting. While discussing patient care and various other policies, the group reviewed data from the nicotine cessation efforts that were currently in place at CeDAR. “The data was disappointing to say the least,” recalls Millette.
Visible was a trend of people coming into treatment as non-smokers and leaving as smokers. Additionally, Millette says not enough people were being successful in their nicotine cessation efforts. The next question asked by the group: “Are these nicotine cessation efforts ever going to be successful if we continue to allow patients to smoke on the premises?”
Millette comments, “It’s akin to patients having access to alcohol while they’re here—would we allow that?”
As a key resource in the planning and implementation of a smoke-free policy, Martin and her team were instrumental in putting together a toolkit, says Millette. For the last six months, Millette says they have been actively working on this process and trying to anticipate all of the potential concerns people might have about it.
Since the tobacco-free policy applies to CeDAR staff as well, Martin, one of CeDAR’s attending psychiatrists, says multiple approaches were taken. One approach was to make staff members who are currently smokers aware of resources for treatment. This includes providing educational sessions related to treatment of tobacco dependence, constantly working to identify their readiness for the transition, addressing any concerns they may have, and providing additional support that they need, she says.
With the patients, the organization held multiple focus groups “to elicit their hopes, dreams, fears and what practices would be most helpful for them in this transition,” Martin explains. CeDAR has also added a Nicotine Anonymous (NA) group to its campus, and has been specifically working with smokers and smokeless tobacco users throughout the past several weeks to assist in their “game plan” of how they will approach Feb. 14. Martin says that some individuals decided they would try to quit sooner rather than later, while others decided to wait until the policy goes into effect.
Focus groups were conducted for the patients to discuss their thoughts on the new policy. Martin says some patients shared concerns about how hard the transition would be, while others said that the policy was unfair. A majority of the individuals, however, were excited by the prospect that quitting tobacco while in treatment would increase their chances for recovery, says Martin.
“During the focus groups, I was struck by the fact that 10 to 20% of the smokers in each group either started smoking while in rehabilitation and/or increased the amount they were smoking or relapsed while they were in rehabilitation treatment,” Martin recalls.
Martin says CeDAR held these focus groups early enough so the majority of the participating individuals would be discharging prior to the transition.
Additionally, there were focus groups conducted without patients. The first several were with staff and one included staff and alumni because in early announcements about the policy, CeDAR received feedback from alumni that was both positive and negative, according to Millette.
He says many of the patient alumni had similar comments to those of the current patients: “It’s not fair,” “It’s making treatment harder,” “You’re putting people’s recovery at risk because quitting tobacco at the same time as other drugs just makes recovery chances harder,” etc.
Therefore, he explains that one of the main purposes of these focus groups was to dispel the myths that people had about this process. It was important to the administration, he says, to share with the concerned patients and alumni some of the telling research findings that led the way to this policy decision.
“The research doesn’t support the common perceptions that it makes recovery harder, treatment less effective, or that it’s going to have an adverse effect on people wanting to come into treatment. So dispelling those myths was really important and once we did that, we saw a pretty good turnaround in people’s attitudes about it,” Millette says.
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