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Improving Recovery Outcomes: Addressing Co-Occurring Nicotine and Opioid Use
Chad Morris, PhDSeptember 5, 2019
© 2019 BHWP
Trends in U.S. Adult Smoking
~14% of adults are current cigarette
smokers
49-90% Other Drug Abuse
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Smoking in Addiction Treatment Programs
A review of smoking prevalence in U.S. addiction treatment programs, from 1987 to 2009, found a median annual smoking
prevalence of 76%.
(Guydish et al., 2011, 2017)
© 2019 BHWP
Rates of UseAny Tobacco Product
75%
25%
General Population
People whoare tobacco-freePeople whouse tobacco
80%
20%
Criminal Justice Population
People who usetobacco
People who aretobacco-free
In the United States, the smoking rate among the justice-involved population is approximately 3 times
higher than the general population
© 2019 BHWP© 2019 BHWP
>70,000
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© 2019 BHWP
Behavioral Causes of Death in U.S.
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Dopamine Reward Pathway
Nicotine enters brain
Stimulation of nicotine receptors
Dopamine release
Prefrontal cortex
Nucleus accumbens
Ventral tegmental area
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SmokingIllicit Opioid Use
MethadoneBuprenorphine
Priming & Tolerance
Chronic Pain
Treatment Outcomes for SmokersIncreased Opioid Withdrawal
Increased CravingsLower Detox Completion/
Methadone Taper
Opioids and Smoking
© 2019 BHWP
§ Stigma§ Low SES§ Discrimination§ Chronic Stress§ Psychological Distress§ Coping Skills§ Environmental Exposure § Industry Targeting§ Biology§ Access to Treatment
Addiction
Social Determinants
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Coping Through Addictions
§The majority recognize they are unhealthy and life threatening
§ But mistakenly believe it has positive psychological functions
§ In particular relief from isolation, stress, anxiety, and depression
– Used as an indirect coping strategy– Reinforces coping through addiction – Perceived stress reduction is often relief of withdrawal symptoms
© 2019 BHWP
An addiction… is an addiction…
is an addiction.
© 2019 BHWP
Co-Treatment
§ Co-Treatment is the only adequate solution§ Bio-psycho-social underpinning are similar § And unrelated to the age, sex, race and
ethnicity, gender identity, or culture
Surgeon General’s Report, 2016
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Tobacco Use Affects Treatment & Recovery from Addiction
Addressing tobacco dependence during treatment for other substances is associated with a 25% increase in long-term abstinence
rates from alcohol and other substances
(Prochaska et al., 2004)
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Is This a Social Justice
Issue?Recent
Community of Practice
Findings
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2019 Opioid Planning Summit Potential Key Areas of Overlap
• Training specific to health disparity populations• Reducing stigma • Trauma informed care• Referral and access to quality care• Diversion and other health neighborhood programming• One-stop services• Workforce development - Peer-to-peer services
https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/opioid-planning-summit-summary.pdf
Implicit Bias and Stigma
Societal isolation Keeping secrets from medical providers, interfering with quality healthcareDelayed care
Un-aided attempts at abstinence
Corner, Hopkinson, & Roffe, 2006; Tod, Craven & Allmark, 2008; Gysels & Higginson, 2008
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A Whole Health Approach
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Motivational Interviewing
Planning
Evoking
Focusing
Engaging
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ASK
ADVISE
ASSESSASSIST
ARRANGE
The 5As
• Evidence-based best practice• Applicable across chronic
disease prevention efforts• Nutrition improvement• Physical activity• Diabetes management• High blood pressure mgmt.• Addiction
© 2019 BHWP
§ Screen for nicotine and other drug use at the same time
§ Address all addictions as part of the treatment plan
Integration into Standard Care
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Referral
1-800-55-66-222
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Behavioral Strategies
Behavioral Treatments§ Cognitive Behavioral Therapy§ Contingency management§Motivational enhancement
School-based
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Medication Assisted Treatment
Combination of behavioral interventions and medications
Highly effective treatment option for alcohol, opioid, or tobacco dependence
Reduces illicit drug use and overdose deaths
© 2019 BHWP
© 2019 BHWP© 2019 BHWP
Determinants of Health
Medical Care: 11%
Physical Environment: 7%
Individual Behaviors: 38%
Genetics & Biology: 21%Social Circumstances: 23%
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Sequential Intercept Model
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• Evidence-based information about the effectiveness of peer support programs
• Step-by-step instructions to create a successful and sustainable peer support program
http://www.bhwellness.org/resources/toolkits/
Peer Support
© 2019 BHWP
Creating Healthy Habits Through Policy
Cue Routine Reward
① Identify Cues②Change the Reward Pathway③Shape the Environment
Behavioral Health & Wellness Program
www.bhwellness.org
BHWP_UCDBehavioral Health and Wellness Program
