Welcome to the Spring 2008 issue of The TAPE Project News! This e-newsletter will be published four times a year, offering information and resources focused on tobacco issues in substance use treatment programs.
You can subscribe to the TAPE Project Newsletter by sending an e-mail to subscribetape@healthrecovery.org
In the NEWS!
Massachusetts DPH/BSAS NRT Initiative Is Making a Difference by Helping Clients to Quit Tobacco Use
The Massachusetts Bureau of Substance Abuse has awarded Nicotine Replacement Therapy (NRT) to substance abuse treatment programs since 1997. Through an application process, programs have to meet certain criteria, including demonstrating their preparation and readiness to use NRT effectively with their clients. From December 2005 through December 2006, 414 clients participated at the following programs:
Anchor House, Plymouth
Bay State Community Services, Quincy
Baystate Health - Carlson Recovery Center and Opportunity House, Springfield
BPHC - Transitions, Mattapan
Cooley Dickinson Hospital - Arbor House, Holyoke
Hairston House, Northampton
Gavin Foundation - Cushing House, South Boston
Granada House, Inc., Allston
Hurley House, Inc., Hurley House, Waltham
Jeremiah's Inn, Worcester
Lowell House - Sheehan Women's Program, Tewksbury
NEBCOA - Harmony House, New Bedford
Providence Behavioral Health Hospital - MMTP, Holyoke and Springfield
SMOC - Serenity House, Hopkinton
Spectrum Health Systems Outpatient, Worcester
The Brien Center Outpatient, Pittsfield
The staff at these programs trained and worked hard, putting in extra time and energy to help make the addition of NRT another way to integrate tobacco addiction into their programs and to give the clients a chance to make a quit attempt with support of the program.
Out of the 414, almost twice as many men than women tried the patch, ranging in age from 16 to 64 years old. With 62% reporting that the patch helped reduce cravings and 35% reported not smoking at the time they stopped the patch, the data suggests a positive experience for many participants. Encouraged by these findings and the feedback from the participating programs, in April 2007, BSAS funded 10 additional programs to receive NRT. The NRT awards went to:
Arch Foundation - Gavin House, Boston
Baystate Medical Center - My Sister's House, Springfield
CAB Health and Recovery Services, Inc. - HART House, Tewksbury
Community Healthlink - Faith House and Highland Grace House, Worcester
George B. Wells Human Services Center/Harrington Hospital - George B. Wells Recovery Services Center, Southbridge
High Point - Brockton Addiction Treatment Center, Brockton
Interim House, Inc. - Interim House, Dorchester
Phoenix Houses of New England - Phoenix House, Springfield
Steppingstone, Inc. - New Bedford Women's Treatment Program, New Bedford
Congratulations and kudos to all the programs committed to doing this important work!
Massachusetts Smoke Alarm!
Tobacco Trend: Is "Hookah" Smoking Dangerous?
If you go into a "hookah" bar, you will immediately notice the exotic surroundings and probably see college-aged students involved in the resurgence of an ancient method of socializing and relaxing. It is the growing fad of smoking flavored tobacco through a water pipe, known as a "hookah." Users find the experience both peaceful and communal, since there are several hoses off the pipe, so one smokes with other people. The smokers believe it is a safe way to smoke, because it is thought that the water in the pipe acts as a filter that keeps the user from inhaling the dangerous chemicals in cigarette smoke. But is it?
» Full text at Boston.com
Source: Boston (MA) Globe, 2007-04-29
Author: Kathleen Burge, Globe Staff
» Related link to hookahs at the American Lung Association
In This Issue
Treatment News
Health News
Special Topics
Teens and Smoking
Special Feature
Resources for Information and Materials
Treatment News
Spotlight on Pharmacotherapy: Understanding the New FDA Warning on Chantix
On 11/20/2007, The Food and Drug Administration (FDA) informed healthcare professionals of reports of suicidal thoughts and aggressive and erratic behavior in patients who have taken Chantix (varenicline), a smoking cessation medication. The MedWatch FDA Safety Information and Adverse Event Reporting Program states that "there are also reports of patients experiencing drowsiness that affected their ability to drive or operate machinery. FDA is currently reviewing these cases, along with other recent reports. A preliminary assessment reveals that many of the cases reflect new-onset of depressed mood, suicidal ideation, and changes in emotion and behavior within days to weeks of initiating Chantix treatment. The role of Chantix in these cases is not clear because smoking cessation, with or without treatment, is associated with nicotine withdrawal symptoms and has also been associated with the exacerbation of underlying psychiatric illness. However, not all patients described in the cases had preexisting psychiatric illness and not all had discontinued smoking. Healthcare professionals should monitor patients taking Chantix for behavior and mood changes. Patients taking this product should report behavior or mood changes to their doctor and use caution when driving or operating machinery until they know how quitting smoking with Chantix may affect them."
» Click to read the complete 2007 MedWatch safety summary including a link to the FDA Early Communication Sheet about an Ongoing Safety Review regarding this issue.
Naltrexone-Nicotine Patch Combination Shows Promise
Although further research is needed, studies are showing that by adding naltrexone, an opiate blocker, to nicotine replacement therapy, cravings and withdrawal symptoms are reduced in smokers. The combination therapy may also help with weight gain associated with quitting smoking.
The article is highlighted in the Research in Brief section of NIDA NOTES, Volume 21, number 3, and the full study is available at Archives of Internal Medicine, 166(6): 667-674, 2006.
» Full text at Drug Abuse.gov
"Spiritual Beliefs/Practices May Help Smokers Quit: First-of-its-kind Pilot Study Shows Smokers Are Receptive, May Benefit from Personal Spiritual Beliefs, Practices when Attempting to Quit"
Researchers at the Oregon Health and Science University Smoking Cessation Center found that many smokers in clinical practice reported that in addition to the treatment clinicians provided, they relied on their own spiritual resources for help in attempting to quit smoking. Women were more likely than men to report a spiritual practice or belief, but research found that people of both sexes who smoked more than 15 cigarettes a day were open to having the subject approached by their health care providers. This decades-long study resulted in the team of researchers asking why spiritual practices and beliefs have not been considered a mainstay in tobacco dependence treatment programs.
» Full text at Eureka Alert
Standard Treatments Help Depressed Smokers Quit
"As smoking rates fall in the United States, mentally ill individuals comprise a larger percentage of people who continue to light up." (NIDA Notes 2007, 21:3) Researchers studying outpatient clients at four mental health clinics found that smoking cessation interventions effectively used in the general population also help depressed smokers. Dr. Sharon Hall and colleagues at the University of California, San Francisco, the University of Rhode Island, and Kaiser Permanente Northern California found "that depressed smokers who were treated with a combination of motivational counseling, nicotine patches, and behavioral therapy were more likely than their counterparts who did not receive the interventions to be smoke-free at 12 and 18 month assessments."
This information is particularly important because people with mental illnesses have been overlooked for tobacco treatment because of a cultural climate that does not recognize this high-risk population as willing and able to do the work. "Patients in our study mirrored the general population of smokers in their readiness to quit, acceptance of treatment, and cessation outcomes - findings that surprised me and my colleagues," says Dr. Hall, lead investigator of the study. People with severe symptoms of depression both accepted the interventions and benefited from them. "Our findings suggest that clinicians should offer depressed outpatients nicotine addiction treatment and should start with available smoking cessation interventions. They need not be overly concerned about patients' level of depression," says Dr. Hall.
Source: Hall, S.M., et al. Treatment of depressed mental health outpatients for cigarette smoking: a randomized clinical trial, American Journal of Public Health 96 (10): 1808-1814, 2006.
» Full text at Drug Abuse.gov
Health News
Scientists Reveal Smoking Gives Women Acne
Up until now, researchers have not been able to link smoking and acne. However, recent research shows that a specific type of acne called NIA (non-inflammatory acne) is common among smokers, particularly women. Dr. Colin Holden, President of the British Association of Dermatologists, said: "Dermatologists have long associated smoking with premature ageing of the skin, wrinkles and a leathery complexion." Now there is evidence that links smoking to NIA.
» Full text at the Daily Mail
Smoking May Raise Psoriasis Risk
A new study shows that smoking not only affects the body inside, but also affects how skin looks and feels on the outside. Researcher Hyon K. Choi, MD, of Harvard Medical School and colleagues in the American Journal of Medicine found that smoking increases the risk of psoriasis, which causes symptoms such as inflammation, redness, itching, and scaling of the skin. The study's findings show that compared with people who have never smoked, current smokers have a 78% higher risk of psoriasis, and that there is a 37% higher risk among smokers who had quit previously. Secondhand smoke exposure during pregnancy or childhood also increased the risk of psoriasis.
» Full text at CBS News
Special Topics
Disability Matters
The U.S. Centers for Disease Control and Prevention (CDC) reported in October 2007 that "Americans with disabilities smoke more than everyone else, according to the first national study to compare smoking rates between the two groups." The study included two groups considered high-risk populations for smoking addiction: people with alcohol and drug addictions and people with mental illness. About one in four disabled people are smokers, compared to about one in five among the non-disabled. According to the study, many disabled people are smokers in part because a large percentage is low-income, and poor people have higher smoking rates. Of the low-income disabled and non-disabled, the disabled smoke at a much higher rate. This information did not come as a surprise, except for one important factor: disabled smokers more often than non-disabled smokers reported getting medical advice to quit, although a substantial number said that advice did not include specifics.
» Article at the Washington Post
» Original article in Preventing Chronic Disease from the Centers for Disease Control and Prevention
Teens and Smoking
Massachusetts Study: Why Some Teens are "More Likely to Get Hooked" on Cigarettes
Researchers from the University of Massachusetts Medical School (UMMS) have shown that how the brain of an adolescent reacts to nicotine determines who gets addicted and who does not. "We know that nicotine can have an immediate impact on the brain, and yet we also know that not every adolescent who tries a cigarette gets hooked," said the study's lead author, Joseph R. DiFranza, MD, professor of family medicine and community health at UMMS. "We wanted to know what accounts for the difference in vulnerability among adolescents who pick up that first cigarette."
» Full text at Science Daily
Report Spotlights How Nicotine Affects Adolescent Brains
"The nicotine in tobacco products poses a significant danger of structural and chemical changes in developing brains that can make teens more vulnerable to alcohol and other drug addiction and to mental illness," according to Tobacco: The Smoking Gun, a paper released in October 2007 by the National Center on Addiction and Substance Abuse (CASA) at Columbia University. The scientific evidence is so significant for adolescents who smoke that the links to alcohol and other substance abuse and/or mental illness like depression and anxiety are devastating. Compared to youth who are non-smokers, teens who smoke are five times more likely to drink, 13 times more likely to smoke marijuana, and at higher risk for anxiety disorders and depression.
» Full text at MSNBC
From the National Center on Addiction and Substance Abuse at Columbia University:
» Press release
Depressed Young Adults More Likely to Start Cigarette Smoking and Other Substance Use
A new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) released to correspond with the 2007 Great American Smokeout finds that young adults aged 18 to 25 who have suffered from depression within the past year are at a higher risk of initiating substance use including cigarette smoking, alcohol and/or other drugs. Of those aged 18 to 24, "approximately 3 million young adults in the USA experienced one or more major depressive episodes in the past year."
» Full text at SAMHSA
Tobacco Treatment for Youth with Alcohol and Other Drug Use Problems (AOD)
Not much research has addressed effective treatment for tobacco use in teens with AOD use disorders, even though nicotine dependence is common in this population. Interventions shown to be effective with adults do not work with most adolescents, due to special considerations, such as peer influences, motivation, and the effects of nicotine on the adolescent brain. The studies that do exist "suggest that adolescents with AOD use behaviors may benefit more from relatively intensive multi-component programs rather than brief treatment for smoking cessation." Motivational approaches, not requiring stopping tobacco use but focusing on changing smoking behavior, could be especially important for engaging adolescents in treatment. Also, studies that demonstrated significant effects "included interventions delivered in group rather than individual treatment." The advantages of offering a tobacco-focused intervention as an integral part of AOD treatment is that "it appears to reduce barriers to participation and alter normative attitudes regarding tobacco use."
» Full text at the National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Special Feature
American Legacy Foundation Responds to New Study Indicating Teens with High Exposure to R-Rated Movies Have Increased Risk of Smoking Initiation
The American Legacy Foundation (ALF) and the American Medical Association (AMA) Alliance have launched Screen Out! A Parent's Guide to Smoking, Movies and Children's Health in response to yet another study that confirms what previous research has demonstrated: "Smoking on TV and in films is linked to youth smoking initiation." Working with researchers at Dartmouth Medical School, the ALF found that "youth with the highest exposure to smoking in movies were nearly three times as likely to start smoking, regardless of race or ethnicity." The study, from the University of North Carolina, "found a similar robust relationship with one exception: African American youth seem less responsive to media influences when it comes to smoking initiation."
To learn about the parent's guide and to read the American Legacy Foundation's 4-point strategy to address the major Hollywood studios and the Motion Picture Association of America, see » Voice: Indiana Youth Speaking out against Big Tobacco and the » American Legacy Foundation
Resources for Information and Materials
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