Al Bliss, Health EducatorAl Bliss, Health Educator

La Crosse County Health DepartmentLa Crosse County Health Department

April 22, 2009April 22, 2009

This project was funded by the American Legacy Foundation. The grantees information materials do not necessarily represent the views of the foundation staff or its board of directors.

The Challenges of Tobacco Cessation Among Binge and Heavy

Drinkers

Is it too much to ask those addicted Is it too much to ask those addicted to alcohol and other drugs to quit to alcohol and other drugs to quit tobacco at the same time? tobacco at the same time?

Myths Among Those in Myths Among Those in Substance Abuse ProgramsSubstance Abuse Programs

Quitting smoking is too difficult at Quitting smoking is too difficult at the same timethe same time

Quitting tobacco will interfere with Quitting tobacco will interfere with recovery outcomesrecovery outcomes

It costs too much to quit It costs too much to quit Those in recovery have no interestThose in recovery have no interest

Drinking Culture in Drinking Culture in WisconsinWisconsin

Wisconsin has the highest binge Wisconsin has the highest binge drinking rate in the United States.drinking rate in the United States.

Behavioral Risk Factor Surveillance System, 2007Behavioral Risk Factor Surveillance System, 2007

World's largest six-packWorld's largest six-pack La Crosse, WI La Crosse, WI

Social Costs of AlcoholSocial Costs of Alcohol

Alcohol is the 3Alcohol is the 3rdrd leading actual cause leading actual cause of death in the U.S. (CDC, 2005)of death in the U.S. (CDC, 2005)

21,083 deaths annually (NVSR, 2008)21,083 deaths annually (NVSR, 2008) 13,470 annual deaths in alcohol-13,470 annual deaths in alcohol-

impaired driving crashes (NIAAA 2002)impaired driving crashes (NIAAA 2002) $185 Billion in annual economic costs $185 Billion in annual economic costs

(NIAAA, 2002)(NIAAA, 2002)

Drinking Culture of Drinking Culture of La Crosse, WILa Crosse, WI

La Crosse County has one of the highest La Crosse County has one of the highest binge drinking rates in Wisconsin at 24.9% binge drinking rates in Wisconsin at 24.9% (combined 2000-2007 data), higher than the (combined 2000-2007 data), higher than the nationwide average of 15.7% (2007). nationwide average of 15.7% (2007).

Behavioral Risk Factor Surveillance System, 2007; www.cdc.gov/brfss;Wisconsin Dept. of Health Services, Division of Public Health, Bureau of Health Information and Policy. Wisconsin Interactive Statistics on Health (WISH) data query system, http://dhs.wisconsin.gov/wish/, BRFS Module, accessed 04/20/09;

Binge Alcohol Use in Past Binge Alcohol Use in Past Month among Persons Aged 12 Month among Persons Aged 12

or Olderor Older

Source: SAMSHA, Office of Applied Studies, National Survey on Drug Use and Health, 2005 and 2006.

http://www.no-smoke.org/goingsmokefree.php?id=519#maps

What Local Counties and Cities What Local Counties and Cities

Can DoCan DoLa Crosse County La Crosse County Health and Human ServicesHealth and Human Services The Mission of the Clinical Services section is The Mission of the Clinical Services section is

to assure that residents of La Crosse County to assure that residents of La Crosse County with problems of mental illness and with problems of mental illness and substance abuse have substance abuse have equal access to an equal access to an array of services which promote array of services which promote wellness and recoverywellness and recovery, in a system which , in a system which emphasizes optimism, eradicates stigma, emphasizes optimism, eradicates stigma, involves consumers in meaningful ways, and involves consumers in meaningful ways, and is committed to a responsible stewardship in is committed to a responsible stewardship in our human and financial resources.our human and financial resources.   

Complications of Smoking and Complications of Smoking and AlcoholAlcohol

Approximately Approximately 30 years30 years of life lost on average of life lost on average were attributable to excessive alcohol use in were attributable to excessive alcohol use in 2001. 2001.

(Source: Alcohol Attributable Deaths (AAD) and Years of Potential Life (Source: Alcohol Attributable Deaths (AAD) and Years of Potential Life Lost in the U.S. - 2001, CDC 2004) Lost in the U.S. - 2001, CDC 2004) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5337a2.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/mm5337a2.htm

Average years of life lost of smokers – 11.5 years Average years of life lost of smokers – 11.5 years for males and 12.0 years for femalesfor males and 12.0 years for females

(Source: CDC 2008)(Source: CDC 2008)

American Legacy FoundationAmerican Legacy FoundationPriority Populations Initiative Priority Populations Initiative

GrantGrant La Crosse County Health Department La Crosse County Health Department

received a grant from Legacy to received a grant from Legacy to address the dual challenges of address the dual challenges of smoker/drinkersmoker/drinker

Year One - $99,458Year One - $99,458

Year Two - $99,060Year Two - $99,060

Target PopulationTarget Population

320 individuals who self identify as 320 individuals who self identify as binge drinkers, heavy drinkers or are binge drinkers, heavy drinkers or are enrolled in substance abuse enrolled in substance abuse programs (Individuals with < 4 year programs (Individuals with < 4 year college degree and college degree and >> 25 years of 25 years of age)age)

50 AODA counselors / staff at 50 AODA counselors / staff at recovery centersrecovery centers

Project OutcomesProject Outcomes

Reduce tobacco use among heavy Reduce tobacco use among heavy drinkers, binge drinkers and those in drinkers, binge drinkers and those in recovery programs (total to enroll = recovery programs (total to enroll = 320)320)

Train AODA counselors in treating Train AODA counselors in treating tobacco dependencetobacco dependence

Recovery centers will sustain tobacco Recovery centers will sustain tobacco cessation programs when funding endscessation programs when funding ends

Program Protocol / DetailsProgram Protocol / Details

Clients received 1 month supply of Clients received 1 month supply of nicotine replacement therapy (patches, nicotine replacement therapy (patches, gum or lozenges)gum or lozenges)

Recovery clients received a $40 cash Recovery clients received a $40 cash incentive for enrollingincentive for enrolling

All clients received initial 1:1 counseling All clients received initial 1:1 counseling and follow up at 1,3, and 6 months.and follow up at 1,3, and 6 months.

All clients will receive quarterly follow up All clients will receive quarterly follow up after 6 monthsafter 6 months

13

20

43

0

5

10

15

20

25

30

35

40

45

1 month 3 month 6 month

Percent ofSmokers whoQuit N=187

La Crosse County Health Department Tobacco Cessation Program Quit Rates Among Adults with Less than a 4-Year

College Degree

American Legacy Grant

October 1, 2007 – April 17, 2009

Improved Recovery RatesImproved Recovery Rates

Alcoholics who quit smoking were Alcoholics who quit smoking were more likely to maintain long term more likely to maintain long term abstinence abstinence (Bobo et al., “Cigarette Smoking Cessation Attempts (Bobo et al., “Cigarette Smoking Cessation Attempts by Alcoholics, Addict Behav. 1987;12(3):209-15;) by Alcoholics, Addict Behav. 1987;12(3):209-15;)

“…“…research shows that smoking research shows that smoking cessation does not disrupt alcohol cessation does not disrupt alcohol abstinence and may actually enhance abstinence and may actually enhance the likelihood of longer term sobriety”the likelihood of longer term sobriety” Gulliver et al, “Smoking Cessation and Alcohol Abstinence: What Do the Data Tell Us?”, Gulliver et al, “Smoking Cessation and Alcohol Abstinence: What Do the Data Tell Us?”, NIAAA PublicationsNIAAA Publications

It’s Safe to TreatIt’s Safe to Treat

Both can be treated simultaneously Both can be treated simultaneously without endangering alcoholism without endangering alcoholism treatment treatment

NIAA, 1998; NIAA, 1998; http://pubs.niaaa.nih.gov/publications/arh293/208-212.pdfhttp://pubs.niaaa.nih.gov/publications/arh293/208-212.pdf

What’s Going on Statewide?What’s Going on Statewide?(WINTIP)(WINTIP)

Wisconsin Nicotine Treatment Wisconsin Nicotine Treatment Integration ProjectIntegration Project

““Saving Wisconsin lives by integrating Saving Wisconsin lives by integrating evidence-based nicotine dependence evidence-based nicotine dependence treatment into alcohol and other drug treatment into alcohol and other drug dependence and mental health dependence and mental health services”services”

www.wisconsinwintip.comwww.wisconsinwintip.com

WINTIP OverviewWINTIP Overview

One year (2008) planning project for One year (2008) planning project for integrationintegration

Funded by WI Division of Public Funded by WI Division of Public Health Tobacco Prevention and Health Tobacco Prevention and Control ProgramsControl Programs

Brings together tobacco control, Brings together tobacco control, mental health/substance use mental health/substance use systems, and governmentsystems, and government

The ChallengeThe Challenge

To To treattreat and and de-normalize de-normalize smoking and smoking and tobacco use in tobacco use in the recovery the recovery communitycommunity

Contact:Contact:

Al Bliss, Health EducatorAl Bliss, Health Educator

La Crosse County Health DepartmentLa Crosse County Health Department

608 789-4820 608 789-4820

Bliss.al@co.la-crosse.wi.usBliss.al@co.la-crosse.wi.usThis project is funded by the American Legacy Foundation. The grantees information This project is funded by the American Legacy Foundation. The grantees information

materials do not necessarily represent the views of the Foundation, Foundation materials do not necessarily represent the views of the Foundation, Foundation staff, or its board of directors.staff, or its board of directors.

AcknowledgementsAcknowledgements

WINTIP Steering Committee 2009WINTIP Steering Committee 2009

Rob Adsit, M.Ed., UW-Center for Tobacco Research and Intervention (UW-CTRI)Rob Adsit, M.Ed., UW-Center for Tobacco Research and Intervention (UW-CTRI)Bruce Christenson, PhD, UW-CTRIBruce Christenson, PhD, UW-CTRICarlos Edge, UW-CTRICarlos Edge, UW-CTRIRandal Glysch, MS., Tobacco Prevention Program, Bureau of Community Health PromotionRandal Glysch, MS., Tobacco Prevention Program, Bureau of Community Health PromotionEric Heilgenstein, MD., Clinical Director, Psychiatry, University Health Services, University of Wisconsin-MadisonEric Heilgenstein, MD., Clinical Director, Psychiatry, University Health Services, University of Wisconsin-MadisonDavid “Mac” Macmaster, CSAC, CTTS, WINTIP Managing ConsultantDavid “Mac” Macmaster, CSAC, CTTS, WINTIP Managing ConsultantGary Nelson, Section Chief, Bureau of Prevention Treatment and Recovery, Division of Mental Health and Substance Abuse Gary Nelson, Section Chief, Bureau of Prevention Treatment and Recovery, Division of Mental Health and Substance Abuse

Services, Madison, WIServices, Madison, WIJennifer Recoy Gombar BS, RRT, WINTIP Project CoordinatorJennifer Recoy Gombar BS, RRT, WINTIP Project Coordinator

Agencies:Agencies:

American Legacy Foundation (Funded)American Legacy Foundation (Funded)Coulee Council on AddictionsCoulee Council on AddictionsLa Crosse County Health DepartmentLa Crosse County Health DepartmentWestern Technical CollegeWestern Technical CollegeUniversity of Wisconsin Center for Tobacco Research and InterventionUniversity of Wisconsin Center for Tobacco Research and InterventionWisconsin Tobacco Quit LineWisconsin Tobacco Quit LineLa Crosse County Health DepartmentLa Crosse County Health Department