STATE TO END SMOKING IN ALL ADDICTION PROGRAMS

ALBANY -- For decades, addiction-treatment programs have focused on
drug and alcohol abuse and shrugged at patients' near-universal use
of tobacco.

But faced with growing awareness of the power of nicotine addiction
and that smoking kills more people than all other addictive drugs
combined, New York officials have decided the state can no longer
afford to ignore smoking.

"The entire field has struggled with the really incorrect notion
that treating nicotine addiction would be really a hardship on the
chemically addicted," said Karen Carpenter-Palumbo, commissioner of
the state Office of Alcoholism and Substance Abuse Services.

In July, New York will become the first state in the nation to ban
smoking at all its chemical dependence prevention and treatment
programs, including those that treat gambling addiction.

The 1,400 providers treat some 110,000 people on any given day.
About 10,000 of them are in 13 state-operated addiction-treatment
centers, which already are smoke-free. The policy also applies
to employees, visitors and volunteers.

"If we truly care about people's health and wellness, we have to
care about their addiction to tobacco," the commissioner said last week.

In New York, up to 92 percent of the chemically dependent population
smokes, compared with 18.2 percent of smokers in the general
population, Carpenter-Palumbo said. An estimated 25,000 deaths each
year in New York are tobacco-related, according to the agency.

The move is a progressive one and will save many lives, said Richard
Hurt, director of the Mayo Clinic Nicotine Dependence Center in
Rochester, Minn.

An 11-year study conducted by Hurt and colleagues found that 51
percent of deaths of addiction-treatment patients were due to
tobacco-related disease.

"To me, the ultimate outcome is whether or not the patient lived or
died," he said.

But there is fear that patients finding out that they have to tackle
their tobacco addiction in addition to their drug and/or alcohol
abuse "could be the straw that breaks the camel's back and they
leave treatment," said Keith Stack, director of development and
grass-roots advocacy for the state Association of Alcoholism and
Substance Abuse Providers.

Stack said he received addiction treatment and is in recovery, but
he wasn't a smoker.

"You don't think of tobacco causing a problem in your life," said
Stack, a member of Faces and Voices, a group whose 10,000 members
nationwide are in recovery from addiction.

The association is supportive of the initiative, which is designed
to reduce death from tobacco-related illness among people in
recovery, said John Coppola, executive director of the group.

"I think, in part, the assertion is that it makes not a lot of sense
to help people stop drinking and stop using other drugs only to see
them die from their addiction to nicotine," he said.

Smoking can be a hard habit to break because cigarettes are legal
and there is a lot more social acceptance of them than hard drugs
and alcohol abuse, said Russ Sciandra, tobacco-policy specialist for
the American Cancer Society.

"I think it's important that people sort of be forced to confront
what they're doing to their body by smoking cigarettes," he said.

Providers have voiced concerns about getting staff training and
having appropriate smoking-cessation medication on hand.

The state is providing $8 million to fund nicotine-replacement
therapy for patients who do not have coverage for that service and
to teach staff about medications and smoking-cessation techniques.
Most insurance companies pay for nicotine-replacement therapy.

By implementing the change statewide, the Office of Alcoholism and
Substance Abuse Services is making sure that one facility won't lose
patients to another, said Thomas Nightingale, an associate
commissioner with the agency.

The idea of going smoke-free is not a new one at OASAS. Three of its
upstate addiction treatment centers -- John L. Norris in Rochester;
Dick Van Dyke in Ovid, Seneca County; and Margaret A. Stutzman in
Buffalo -- were the first to do so 11 years ago. The rest of the 13
state facilities joined later, and all have been tobacco-free for at
least two years, Nightingale said. At the first three, there was a
small dip in patient numbers during the first few months of the
change, but ultimately the population went up, he said.

Joseph LaCoppola, program director of the Whitney M. Young Jr.
Health Center methadone program in Albany, said 13 treatment centers
in the region have already gone smoke-free and are having success.

Overall, the response to the statewide regulation has been
favorable, Nightingale said.

"It's a significant change for the field. It's an area that our
field has struggled with and been very hesitant to address for the
better part of the last 30 years," he said.

Tobacco is a trigger, and by eliminating it, treatment centers will
help improve patients' overall sobriety and prevent relapses,
Carpenter-Palumbo said.

The commissioner said other states are calling New York to learn
about the initiative. "They want to go that way. They're not ready
yet," she said.