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DRINK & DRUGS NEWS :: Q&AYou ask the questions - you answer the questions. Please keep your answers coming, and feel free to email a new question. Thanks to this issue's respondents for their contributions. Question:Tobacco smoking is one of the deadliest addictions, yet seems
to be largely ignored by the substance misuse field. Do any treatment
providers give advice on stopping smoking while treating other addictions?
[Jodie, smoking cessation co-ordinator] Your replies...Dear Jodie I am currently training at a Treatment centre in Dorset that is abstinence based. As I am doing a degree in Addictions Counselling, I was surprised that the agency has no guidance or support for the 75 per cent of service users that smoke excessively and drink copious amounts of coffee, both highly addictive and providing triggers to other addictive substances. I have currently given up smoking as I felt hypocritical smoking tobacco whilst helping support clients through their addiction. I think treatment centres should find a process of change that helps smokers cut down or give up while in treatment. This would in turn help recovery as client would have to find an alternative to smoking and change behaviour to reduce cravings. Angela Earley
Dear Jodie I was very interested to read your question on tobacco smoking and whether any treatment providers offer options on stopping smoking while treating other addictions. Life Works is a private treatment centre with both day care and residential facilities in Surrey and London W1. We have joined forces with The Third Space gym to develop a Holistic Smoking Cessation Programme. This will be the first UK programme that will offer real clinical support and treatment to its participants within a treatment setting. It will be a combination of proven methodology alongside cutting edge therapeutic support, incorporating a relapse prevention element. The programme will include a medical assessment, 1.5 days counselling group, 0.5 days group work, 6 week gym membership at The Third Space Soho, Acupuncture, and Hypnotherapy. We would be delighted to provide full details of this forthcoming programme: 0800 081 0700, www.lifeworkscommunity.com Beth Bacchus, sales & marketing director, Life Works
Dear Jodie I am a qualified and experienced smoking cessation advisor now working in the substance misuse field at APAS (Alcohol Problems Advisory Service) in Nottingham. I give advice and support on smoking cessation alongside alcohol treatment on a daily basis. I believe this should be routine throughout substance misuse services and am, myself, surprised that this is not already the case. It is estimated that around 90 per cent of people with alcohol problems smoke and 70 per cent are heavy smokers. Alcohol problems are 10 times more prevalent among smokers than among non-smokers. We know that dual dependence of alcohol and nicotine can bear up to a shocking 15-fold risk of certain cancers such as brain, mouth, throat, oesophageal, stomach, pancreatic, liver, bowel, bladder, breast and cervical cancers. Historically, it has been recommended that clients should not attempt to quit smoking at the same time as undergoing treatment for alcohol problems. However, latest research shows that treatment of tobacco dependence amongst dependent drinkers who smoke does not seem to cause excessive relapse to drinking, and, in fact, stopping smoking may enhance abstinence from drinking. Smokers with alcohol problems, as a rule, are more dependent on nicotine than those without, and may need more intensive pharmacological and behavioural therapy. Debi Wood, Alcoline co-ordinator/advice worker
Hi Jodie I have recently set up a smoking cessation service within a Mental Health Trust which includes a Substance Misuse Directorate. It is very hard for people to stop smoking whilst receiving treatment for other addictions, but it is not impossible! Smoking cessation can be provided without necessarily risking a relapse with other substances. Patient awareness of the benefits of treating both addictions can increase abstinence rates. In my experience many patients want to quit smoking and often feel that they are more motivated to quit whilst receiving treatment for other addictions. Others want advice on stopping smoking and will than plan to give up smoking as their next goal. Where I work, recording a patient's smoking status and encouraging smoking cessation is now routine with all patients on admission. Patients are referred to me if they choose to quit smoking and I provide one-to-one and group support, which is maintained until they have quit for a year. The service I provide is flexible and I try to meet the needs and choices of the individual. Smoking rates are much higher among people receiving treatment for addictions than among the general population, but as you suggested, tobacco smoking is largely ignored by the substance misuse field. This is concurrent with mental health, and has to change. Not providing advice on stopping smoking for people receiving treatment for other addictions is discriminatory and will continue the risk of smoking-related illnesses in this field. All health care professionals should discuss smoking and advise smokers to stop in all areas of health care. Helen, Help 2 Quit liaison nurse - mental health, Shropshire
Dear Jodie At Clouds we certainly do take smoking seriously. Nicotine is a powerful drug and the negative consequences of smoking are established. So how do we reconcile having Clouds House as a treatment centre that promotes 'abstinent recovery' with the issue of continued smoking? Our view of abstinence is focused on the addictive or dependent nature of the relationship that people form with both substances and behaviours. In this context it is clear that nicotine as a drug and smoking as a behaviour need to be addressed. We are particularly interested in any connection that might exist between continued smoking and vulnerability to relapse into other drug use and would welcome any feedback regarding existing evidence, or interest in researching this issue further. It is of course ultimately up to the client to decide if they need to abstain. We want their decision to be an informed one and we will do everything we can to support them in gathering the information they need. However, we are pragmatic and realise that the process of this decision-making may not be the top priority for those in an intensive and relatively short treatment episode. I guess that you could say that smoking doesn't present the immediate or short term risks that continued drug and alcohol use might present to our clients, although the long-term effects could be life threatening. Clouds House is a non-smoking environment but provision is made for clients to smoke outside of the house if they wish. If our clients want to abstain from smoking we will assist them with nicotine withdrawal (with nicotine patches) and they will be able to utilise the 12 Step programme to maintain abstinence. If not they will have at least begun a process of evaluating what they need to do and thinking about when they might be ready to do it. Kirby Gregory, head of client services, Clouds.
Dear Jodie Far from being ignored, smoking is an issue very much on our agenda at Broadway Lodge. Whilst the main focus of our work is with alcoholism, drug addiction and eating disorders, we also consider it important to raise awareness of addiction manifesting in all its guises. In the primary care setting at Broadway Lodge, smoking opportunities are restricted - both in time by treatment activities and in space by having only one room in the building where it is permitted. More proactively, all patients are provided with information and education about healthier lifestyles including smoking habits within a lecture programme routinely delivered by staff. We hope that as patients grow in awareness along with improving levels of self-worth and self-efficacy, a healthier and more productive future is considered both desirable and possible. In early treatment, with all the adjustments required by this, any patient wishing to stop smoking will be advised to settle in first before embarking on a non-smoking regime. However patients sufficiently motivated to do so will be supported in giving up smoking at whatever stage in their treatment. Support comes particularly from staff trained by the local PCT to become Support to Stop Advisors. These staff members provide specialist help for patients, including where appropriate, the use of nicotine replacement patches, stress management and relaxation sessions. In the secondary care setting, patients are much more actively encouraged to address their smoking habit. As part of their weekly workshop programme patients will be given specific information and help with addressing their smoking. It is at this stage that patients are also encouraged to be more conscious of financial matters and the need for budgeting and this often proves to be the additional incentive required for them to cut down or even to stop smoking. Finally, the needs of non-smokers have to be taken into account as well. As an organisation we are continually exploring the ways in which we respond to the varying needs of the whole community. In this case, we are currently considering how we might move smoking from the main body of our buildings and into designated, well-ventilated smoking areas and in so doing minimise the impact of passive smoking for everyone. Peter Smith, head of counselling, Broadway Lodge
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