Quitting tobacco is added to drug-treatment plans

A Vancouver educator is taking the lead as drug-treatment programs in Washington prepare to go tobacco-free over the next year.

Deb Drandoff, with Educational Service District 112 in Vancouver, will offer training sessions across the state to help agencies help their clients kick the smoking habit.

“It’s all about giving someone their life back,” said Drandoff, manager of the ESD 112 tobacco prevention resource center.

“In the end, it’s the tobacco that is going to kill them. They’re 10 years clean and sober. The thing that will take their life is the one thing we haven’t been addressing.”

That will change on July 1, 2010. The state’s Department of Social and Health Services announced last month that all agencies within its Division of Alcohol and Substance Abuse will be tobacco-free. That includes public agencies as well as private providers with state contracts.

Drandoff has done tobacco-prevention work with Southwest Washington school districts, and also has a state contract to manage tobacco-free training with a full range of agencies.

But those had been voluntary training programs; they will become mandatory.

“I’ve been hoping the policy would change,” she said. “Traditionally, people advised quitting the harder stuff first and tobacco later. That had been the traditional thought in the field.”

And one of those people is her husband, Richard Drandoff. He runs the ChangePoint treatment agency that has one center in Vancouver and five in Oregon.

“I’ve been doing this kind of work for over 40 years and the conventional wisdom has been to leave them something,” Richard Drandoff said.

“Before Deb’s input, I was one of those who said we can’t deal with everything; let’s leave them something. Now, research shows that addressing all addictions produces a better outcome.”

The Alcohol and Substance Abuse Division issued a Q&A document addressing that topic.

“Research shows that it may be easier to quit tobacco as part of an overall addiction cessation program. In addition, patients who continue to use tobacco products are more likely to relapse into their past addictions than patients who quit using tobacco products. Patients who quit tobacco or are smoke-free during a cessation program are twice as likely to be drug-free in follow-ups,” the state document said.

There is a significant overlap in the two addictions.

“I ask at the time of the orientation. I have 800 clients at a time, and my guess is between 600 and 700 are nicotine addicts,” Richard Drandoff said.

And on the flip side, “People who don’t use tobacco don’t abuse other drugs in significant numbers,” he said.

There are two types of programs, so not everybody in drug and alcohol treatment will be equally affected.

“For outpatients, it’s not as big an impact,” Deb Drandoff said. “It’s a two-hour group session and people go home. They’re not mandated to quit smoking to participate.

However, “Agencies will offer help, and people probably will get nagged a lot,” she said.

In the other type of program, the client lives in a treatment center like Lifeline Connections, based at the county’s Center for Community Health.

“For somebody in Lifeline Connections, boom! They are not able to use tobacco for 30 days. Agencies really need to gear up nicotine therapy and offer support,” Deb Drandoff said. Not just to suppress the urge while they’re in treatment. “It’s so when they walk out after 30 days, they don’t light back up.”

Those stop-smoking resources are important, agrees Lynn Samuels, the chief executive officer at Lifeline Connections. But, she wonders, who will provide the nicotine patches and medications?

Lifeline Connections operates three residential units: a 16-bed detoxification unit; the 16-bed Northwest Deaf Addiction Center; and Lifeline’s 60-bed inpatient program.

Lifeline Connections won’t be significantly affected next year when the policy changes, Samuels said, since “We already do tobacco cessation treatment in our setting.”

But the policy will equalize requirements around the state, and all treatment centers will follow the same rules.

“Making the change statewide benefits us by creating a level playing field,” Samuels said. “So I don’t have to look at it from a business perspective. We can focus on our programs.”

The treatment agencies might find some willing clientele for the stop-smoking programs, Deb Drandoff added.

“Most of these folks really want to quit,” the ESD 112 program manager said. “A lot of agencies are asking their clients if they want to quit, and most say, ‘Yeah. Thanks for asking.’”