We Need to Take a Closer Look at Tobacco

Let’s talk tobacco. If you’re reading this article, it means recovery is important to you or someone you know.

Maybe you’ve put in the work and made recovery a priority in your life. If so, honor yourself for that hard work. Maybe someone in your family is struggling and you just want to find some answers to help them. Once again, honor yourself for being willing to help. Or maybe you’re a treatment professional, wondering about how you can help the people you work with to get healthy.

But what does tobacco have to do with recovery? And we’re not talking about the sacred use of tobacco by American Indians or other groups. We are talking about commercial tobacco. We’re talking about cigarettes, chewing tobacco, cigars, pipes, even vape devices. So again, what does tobacco have to do with recovery?

Substance Use Disorder (SUD) is classified as a mental health issue. Tobacco is listed as the number one killer of people with mental health issues. In fact, estimates are that Minnesotans with a serious mental health issue will on average die 24 years earlier than people without.[i] How does this impact recovery? People with mental illness smoke at two to four times the rate of the general population.[ii] And there’s this: 25% of people living in the United States have been diagnosed with a mental health or substance use disorder. These people smoke 40% of all cigarettes.[iii] Tobacco affects people with substance use disorders, and people in recovery, at a disproportionate rate.

Consider this: In 2017, over 70,000 people died from an overdose.[iv] Shortly after these figures were released, the U.S. Department of Health and Human Services declared a nationwide public health emergency regarding the opioid crisis and nationwide attention was brought to bringing down the number of overdose deaths. In the same year, over 480,000 people died from tobacco-related causes[v] in the U.S. That’s the equivalent of three fully loaded Boeing 747s crashing every single day. Those deaths are disproportionately distributed among people with substance use or mental health issues.

At the Minnesota Department of Human Services, we are working with our partners and providers across the state to make a dent in these statistics. Our goal is to increase the number of SUD treatment facilities that offer nicotine treatment and work towards tobacco-free facilities.

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The Minnesota Department of Human Services (DHS) conducted a survey of licensed residential SUD treatment facilities, asking about tobacco policies and tobacco assessment and treatment. We found that:

  • 77% allowed smoking on their grounds;
  • While 90% of residential SUD treatment facilities assessed for tobacco dependence, only 59% addressed tobacco dependence as part of treatment;
  • Almost 75% offered access to nicotine replacement therapy;
  • While 69% offered nicotine treatment individually and only 42% offered it in group.

These results show that we definitely have our work cut out for us.

DHS next worked with three residential treatment programs over the last 18 months to provide nicotine treatment to clients that wanted it using evidence-based best practices. As a result, 11% of cigarette smoking clients stopped smoking and 7% quit using all tobacco products. Interestingly, compared to a similar group, people were more likely to finish substance use treatment with better results. Plus, smoke-free policies and nicotine treatment had positive impacts on staff attitudes and opinions, creating a more supportive environment.

Our community partners have been working hard at tobacco and treatment as well. The American Lung Association has been working for several years on what is now called the Lung Mind Alliance, bringing together a number of organizations, including DHS, to make tobacco treatment the norm in SUD and MH treatment and to encourage tobacco-free grounds. In addition, this fall, HealthPartners hosted a summit of Minnesota organizations working to improve health broadly for people with severe mental illness. Nationally, the Substance Abuse and Mental Health Services Administration (SAMHSA) is also in on the act, having published a tobacco cessation toolkit for substance use disorder treatment programs. You can find a range of information and resources at https://www.samhsa.gov/find-help/atod.

What can YOU do?

SAMHSA has some great advice on this. First, if you are thinking about quitting tobacco:

  • The best time to quit is now. If you are in treatment, quitting smoking while in addiction treatment may help improve your chances of achieving and maintaining recovery from other substances.
  • There are several different smoking cessation medications that can help you quit. Taking these medications AND finishing the program make quitting easier.
  • You could save thousands of dollars each year by quitting smoking.
  • Quitting heals your body and your mind. Studies show that your mood will improve, and your anxiety can lessen.
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There’s free help available and right now there are many options if you want to quit.  If you have insurance, you can ask your medical provider what they have available. Most insurance companies offer two quit attempts per year using nicotine replacement therapies (NRTs) such as nicotine patches, gum, or lozenges.  Minnesota also offers Quitplan, which provides free services in English and Spanish for anyone that qualifies and wants to quit. You can sign up at www.quitplan.com or by calling 1-888-354-PLAN (7526). If you use their services and tell them you’ve gone to treatment or have a mental health diagnosis, you are eligible for enhanced services. Most folks will receive four weeks of NRTs and four coaching sessions.  Enhanced services, for those that self-report either a mental health diagnosis or a substance use issue, are eligible for 12 weeks of NRTs and seven coaching sessions. For American Indians, culturally responsive services are available at www.aiquit.com or by calling 1-888-7AI-QUIT (1-888-724-7848)

If you’re not sure if your insurance covers quit attempts you can use the Quitplan website to call most insurance carriers tobacco treatment services at www.quitplan.com/minnesota-quitline-network.html

Remember: Tobacco is a drug. Nicotine replacement therapy can help to manage cravings.

There is help available, both for those using tobacco and for treatment providers building tobacco treatment into their programs.

If you are in treatment, or you know someone who is, speak up. Ask for help with tobacco. Make sure it is part of your treatment plan. See this as a fresh start to a healthier you.

Treatment is the time to get healthy in mind, body and spirit. Seize the opportunity; a lot is at stake.


Randy McCallum is the Human Services Program Consultant, Behavioral Health Division at the Minnesota Department of Human Services

Last Updated on January 7, 2023

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