Sober N Clean

New regulation bans tobacco use in programs for other dependencies

By now, most people understand the dangers of smoking and the benefits of a tobacco-free environment — but it never hurts to make the point again, and what better entity to do so than the state and what better time to start than the present?

On the anniversary of the Clean Indoor Air Act, the commissioner of the New York State Office of Alcoholism & Substance Abuse Services announced a proposed Tobacco-Free regulation for all programs funded or certified by her office — no tobacco use in any facilities, any grounds under provider control or any vehicles owned, leased or operated by the programs.

That places New York in a group of states that require all of their chemical dependence prevention and treatment programs to become tobacco-free. The new regulation took affect July 24.

Commissioner Karen M. Carpenter-Palumbo presents a compelling argument for the need: Up to 92 percent of the chemically-dependent population smokes, even though the overall state average is 18.2 percent. Research shows that those in chemical dependence treatment programs are more likely to die from a tobacco-related illness than from alcoholism or drugs.

The new regulation should be a direct benefit to the 110,000 New Yorkers within the Alcoholism & Substance Abuse Services system on any given day — but the state-funded agencies must also work to ensure that the new tobacco- free environment in those programs does not deter new or current clients.

Part of treating addiction is treating nicotine, said K. Michael Cummings, senior cancer research scientist and director of the Tobacco Control Program at Roswell Park Cancer Institute. More and more, Cummings said, experts find that people who are still smoking also tend to have other “comorbidities,” substance abuse problems and, possibly, mental health issues such as depression.

The percentage of those in New York state and nationally who smoke is declining, but those who do smoke tend to have fewer resources to quit — so if the state is investing funds to help people end their cocaine, alcohol or heroine addiction, nicotine addiction also should be treated.

This is a shift from the mind-set of years ago in the treatment field, when forcing clients to give up cigarettes was taboo. The belief was that quitting tobacco would have an adverse affect on getting addicts to quit alcohol or drugs. There have been enough studies completed now to suggest that is not the case, as Cummings said, adding that he hasn’t seen evidence that people will forgo substance abuse treatment because they can’t light up a cigarette indoors.
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source: The Buffalo News, http://www.buffalonews.com

New York became the first state in the country to require all state-run addiction treatment centers to help their patients quit smoking. The plan, which went into effect last week, requires treatment centers to help patients quit smoking by offering nicotine replacement therapy, including nicotine gum and patches, to all smokers. For those lacking health insurance, the nicotine replacement therapy will be free of charge.

The treatment centers also will be required to be smoke-free. Officials estimate the new law will impact up to 250,000 patients. Approximately 92 percent of those in alcohol and other drug treatment programs are cigarette smokers, according to estimates.

As someone who dedicates my life to advocating for treatment for those struggling with addiction and as someone who is personally addicted to cigarettes, I have mixed feelings about the new rule. I applaud the effort to help people quit smoking, but am worried that the smoking ban may deter some smokers who are hoping to quit other addictions from seeking help.

Helping smokers kick the habit will save lives and should be applauded. More than 400,000 people die prematurely from cigarettes — more than all other legal and illegal drugs combined.

It is important that public health officials and treatment providers acknowledge that cigarettes — a legal drug — can cause as many health problems as the more demonized illicit drugs. Having a proactive strategy to help people quit is a positive initiative that should be supported.

The second piece of the new law is more problematic. Prohibiting smoking at the treatment centers may sound like a worthwhile public health objective, but it is clear that this policy will discourage some people from seeking treatment. Some people may be seeking treatment for drugs like alcohol, heroin or cocaine, but they may not be ready to quit smoking.

Do we really want to set up barriers and conditions for people that keep them from seeking treatment? Not everyone can or wants to abstain from all drugs all at once. If someone wants to quit heroin, but is not ready to quit cigarettes, we should not discourage them from getting help.

Much of the campaign to help people quit cigarettes is positive and lifesaving. It is smart, cost-effective and humane to offer people free assistance and tools for quitting the harmful habit.

But let’s remove the smoking ban at the treatment centers. We need open doors that encourage people to get help for their problems, and not establish inflexible rules that drive people away from life-saving programs.

While some may desire a more perfect world where people quit all drugs at the same time and never relapse, the reality is that some may need to quit different drugs at different stages and relapse is a common experience. Let’s help people where they are at and not let perfect be the enemy of good.
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source: The Buffalo News, http://www.buffalonews.com

WASHINGTON -- Tobacco companies have manipulated menthol levels to attract young cigarette smokers and keep older ones, researchers at the Harvard School of Public Health reported Wednesday.

Their finding, with which industry spokesmen disagree, is based on a review of more than 500 internal tobacco-industry documents dated from 1985 through 2007.

The documents showed, according to the researchers, that tobacco companies studied how controlling levels of menthol could increase brand sales.

They concluded that new and young smokers liked mild menthol that masked the harshness of tobacco smoke. Veteran smokers, the companies are said to have concluded, favored stronger doses of menthol for its cooling effects on their throats.

The findings come as Congress weighs whether to grant the U.S. Food and Drug Administration authority to regulate tobacco products, including additives, at the national level. The bill would let the FDA ban all cigarette flavorings except menthol. If FDA tests of menthol showed that it added to the health risks of smoking, the agency could ban menthol, too.

No conclusive evidence shows menthol cigarettes to be more harmful than conventional ones, said Terry Pechacek, associate director of the Office of Smoking and Health at the Centers for Disease Control and Prevention.

In the 2006 National Survey on Drug Use and Health, 44% of smokers aged 12 to 17 reported smoking menthol cigarettes. Among smokers older than 35, 31% smoked them.

According to the Harvard study's lab tests of menthol concentrations in cigarettes since 2000, menthol went down in brands that young people preferred, such as Newport, Salem Black Label and Kool Milds. It went up in brands such as Marlboro Menthol, which were aimed at older smokers.

The report says that in 2000, Philip Morris launched Marlboro Milds with a lower concentration of menthol to attract young smokers. That same year, according to the report, Philip Morris increased the menthol in Marlboro Menthol to attract older smokers.

Behind the moves, the researchers assert, was an effort to woo new smokers. Their report cites, among others, a 1987 R.J. Reynolds document that suggests menthol can make it easier to get started. "Initial negatives can be alleviated with a low level of menthol," it says.

According to the researchers' report, a rapid introduction of milder menthol brands in the past decade violates a provision in the Master Settlement Agreement of 1998 between tobacco companies and state governments that prohibits them from directly or indirectly targeting youths.

"They are going after the most vulnerable population," said Gregory Connolly, a coauthor of the report and director of Harvard's Tobacco Control Research Program.

Michael Robinson, a spokesman for Lorillard Tobacco Co., called the report "a politically motivated lobbying tool."

"Lorillard does not control levels of menthol to promote smoking among adolescents and young adults," he said in a statement. "Lorillard does not engineer any of its cigarettes to promote smoking initiation or nicotine addiction."
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source: Detroit Free Press

People who are dependent on alcohol are also likely to smoke cigarettes. Many experts believe that it's important to counsel alcohol-dependent individuals to give up smoking as well as drinking not just to improve their health, but also to increase their chances of staying sober, reports the June 2008 issue of the Harvard Mental Health Letter.

It is a common worry that trying to quit smoking and drinking at the same time will undermine treatment for alcohol dependence. However, most studies have reported that efforts to quit smoking either have no impact on maintaining sobriety or actually increase success of alcohol treatment.

There are no smoking cessation guidelines specifically for alcohol-dependent adults. For now, the best option is to follow the federal guidelines for treating tobacco dependence, which recommend a combination of counseling and medication.

A major and still unresolved question is whether it's better to give up smoking and drinking together, or whether it's better to tackle one addiction at a time. Researchers have found that when smoking cessation support was delayed by six months, study participants were more likely to remain sober compared with those who received concurrent treatment for both addictions. But a follow-up analysis found that this may have been true only for white people in the study.

Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter, notes that no single approach is best for every person struggling with both alcohol and nicotine addiction. Whether an individual quits smoking during alcohol treatment or later, it's a net health gain.

Harvard Health Publications
Harvard Medical School 10 Shattuck St., Ste. 612
Cambridge, MA 02115
United States
http://www.health.harvard.edu
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source: http://www.medicalnewstoday.com

Plans to ban the open display of cigarettes in Scottish shops have been welcomed by the UK health secretary.

Alan Johnson said it was important to stop children from taking up smoking.

But he told BBC One's Andrew Marr show that Scottish Government plans to ban 10-packs of cigarettes would "have to be looked at".

Ministers last week announced a raft of plans to restrict and enforce tobacco sale in the drive to cut smoking - one of Scotland's biggest killers.

Other proposed measures, some of which would need the co-operation of Westminster, included tobacco licensing and a move to plain packaging for cigarettes.

Mr Johnson said the UK Government was considering similar moves.

He said: "Banning vending machines, where you can't have any control over the age of the person who's buying it, happened in many other European countries a long time ago, with startling results there."

The health secretary went on: "The ability to buy 10 cigarettes - I'm going to have to confess I started smoking very young when I was a kid, and you could get 10 woodbines, and you could get thrupenny singles.

Well they've taken thrupenny singles away. Whether you should still be able to buy 10 cigarettes or whether you should insist that you can only buy 20, that's an issue we need to look at."

It is two years since Scotland led the UK in banning smoking in enclosed public places, and six months since the legal age for buying cigarettes was raised to 18.

Mr Johnson's comments were welcomed by anti-smoking group Ash - but pro-smoking organisation Forest has dismissed the Scottish plans.

Smoking in Scotland is responsible for about 13,000 deaths and 33,500 hospital admissions each year at a cost of £200m to the health service.
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source: BBC News