Margaret Meriwether, PhD Smoking Cessation Leadership

Center, University of California San Francisco

LA County HIV, Drug & Alcohol Task Force

September 15, 2010

A Word About SCLCBegun in 2003 as a national program office of

RWJF, housed at UCSF in Dept. of MedicineDirector is an internistWe have worked with a broad array of

clinicians and specialistsIn last 4 years have moved into addictions

and mental healthPartners with CADCA, FAVOR, NASADAD,

NAADAC and other addiction groups

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Tobacco’s Deadly Toll443,000 deaths in the U.S. each year4.8 million deaths world wide each year10 million deaths estimated by year 203050,000 deaths in the U.S. due to second-hand

smoke exposure8.6 million disabled from tobacco in the U.S. aloneTobacco kills nearly half the people who use itTobacco related diseases are the #1 cause of

death in people previously treated for alcoholism

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81

4119 14

30

0

50

100

150

200

250

300

350

400

450

Behavioral Causes of Annual Deaths in the United States, 2000

Nu

mb

er

of

death

s (t

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ds)

Source: Mokdad et al, JAMA 2004; 291:1238-1245 Mokdad et al; JAMA. 2005; 293:293

AIDS Alcohol Motor Guns Drug Suicide Smoking Vehicle Induced Also suffer from

mental illness and/or substance use disorder

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435

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Why the Focus on Addictions?44% of cigarettes smoked in the US are

consumed by individuals with an addictive or mental disorder.

Addictions counselors have traditionally chosen to allow smoking to continue, believing that people in recovery could not handle the stress of cessation.

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Most states make an exception for addictions treatment settings when

regulating smoking in the workplace.

AddictionWe Are in the Same BusinessNicotine is a pervasive, legal addiction (43 million

users, a third to a half will die from using)

Nationally 77-93% of people in addictions treatment settings use tobacco, more than triple the national average

Source: Richter et al., 2001

Tobacco use may increase the pleasure experienced when drinking alcohol

Source: US DHHS NIDA Alcohol Alert, 2007

Heavy smoking may contribute to increased use of cocaine and heroin

Source: US DHHS NIDA Notes, 2000

Heavy smokers have other, more severe addictions than non-smokers and moderate smokers

Source: Marks et al., 1997; Krejci, Steinberg, and Ziedonis; 2003

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Project SCUM

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Project SCUM in the news

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Project SCUMProject SCUMtargets their targets their

marketing to marketing to vulnerable vulnerable

urbanurbanpopulationspopulations

Need for Smoking InterventionSmoking cessation needs to become a higher

priority in the addictions treatment field.While focusing on addictions and mental

health, clinicians sometimes miss this more deadly condition.

Addressing tobacco use can improve health, ease pain, and save lives.

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Tobacco Dependence and Addiction CareTobacco use is a leading cause of death in people

with addictive disordersTobacco use is associated with worsened

treatment outcomes, whereas treatment of tobacco dependence supports long-term sobriety

Tobacco use is associated with increased depressive symptoms and suicidal risk behaviors

Tobacco use is a lethal and ineffective long term coping strategy for stress

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New Insights about QuittingTreating tobacco use improved alcohol and

other drug outcomes by an average of 25%. We now know it is better to quit all addictions up front, not wait with nicotine until later.

Source: Prochaska et al., 2006

Tobacco use impedes recovery of brain function among individuals whose brains have been damaged by chronic alcohol use

Source: Durazzo et al., 2007; Durazzo et al., 2006Source: Marks et al., 1997; Krejci, Steinberg, and Ziedonis, 2003.

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Reduction vs. Abrupt Cessation In Smokers Who Want To QuitThere are two schedules to stop smoking for the

behavioral health population: immediate cessation versus gradual reduction. As of now, there is no clear evidence supporting one over the other.

Also, the risks from lower intensity smoking are not much less than higher intensity.

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What Happened to ATOD?

We used to address alcohol, tobacco and other drugs

Tobacco got sidelined somewhere along the way

It needs to be put back– we can do it together

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Our Own “T” PartyPutting the T back in ATOD

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3 Key Ingredients to Maximize Success in Smoking Cessation

1. Coaching2. Pharmaceuticals3. Social Support

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Make Cessation Simple, Concrete, DoableWe provide lots of free resources and

technical assistanceWe have helped build an army of tobacco

interventionists in an array of health care and other settings

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Ask

Advise

Assess

Assist

Arrange

Ask. Every patient/client about tobacco use.

Advise. Every tobacco user to quit.

Refer. Determine willingness to quit. Provide information on quitlines.

Refer to QuitlinesRefer to QuitlinesADHA Smoking Cessation Initiative (SCI)ADHA Smoking Cessation Initiative (SCI)

Why the Focus on Quitlines?They work--calling a quitline can more than

double the chance of successfully quittingMany clinicians say the 5 A’s are too

complicated and time-consuming Most clinicians seem unaware of quitlines,

but when they learn about them they are willing to refer smokers to them

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Addictions and Mental DisordersAmong Helpline Callers (CA Smokers’ Helpline)

Drug/alcohol problem 8.1%Anxiety 31.8%Depression 45.0%Bipolar Disorder 16.6%Schizophrenia 8.7%At least 1 of above 52.0%

19Source: California Smokers’ Helpline, unpublished data

Thank you

http://smokingcessationleadership.ucsf.edu1-877-509-3786 for free technical assistance