Introduction

In June, 1994 the Bureau of Substance Abuse Services (BSAS) received funding from the Massachusetts Tobacco Control Program to address tobacco use throughout the substance abuse prevention and treatment system. As part of this effort, BSAS established the Council to End Nicotine Addiction in Recovery (CENAR), a statewide tobacco advisory committee consisting of substance abuse prevention and treatment providers from across the Commonwealth. Broadly stated, the role of CENAR is to assist in the development and implementation of policies that promote tobacco free environments and to support the treatment of nicotine addiction in substance abuse treatment settings. To achieve this goal, CENAR identified the following Year One objectives: 1) to call attention' to addiction, illnesses, and death caused by tobacco products; 2) to promote the implementation of work-site tobacco free policies; and 3) to initiate onsite training and technical assistance designed to assist programs in establishing tobacco free policies.

Justification for Tobacco Free Policies

In 1988, the U.S. Department of Health and Human Services published a report, The Health Consequences of Smoking: Nicotine Addiction, which stated that "smoking is the chief avoidable cause of death in our society". Nicotine is a mood altering, psychoactive substance that is highly addictive. The same 1988 Surgeon General's Report stated that the pharmacology and behavioral processes that characterize tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine. Since 1980, the Diagnostic and Statistical Manual of Mental Disorders has listed both Nicotine Withdrawal and Nicotine Dependence as diagnosable conditions.

The 1993 report of the Environmental Protection Agency (EPA), Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders classified environmental tobacco smoke, the "secondhand" smoke from the end of cigarettes and that exhaled by smokers, as a known human carcinogen. The same level of classification is assigned to asbestos, radon and benzene. Recent research has demonstrated that exposure to environmental tobacco smoke (ETS) dramatically increases rates of Sudden Infant Death Syndrome. The health effects of ETS on infants and young children must be considered in addressing tobacco use in treatment facilities. Children of smokers have more respiratory problems than children of nonsmokers, ETS exposure doubles the risk of bronchitis and pneumonia in children. Children of smokers tend to be hospitalized more frequently for these conditions. In nonsmoking adults, ETS is responsible for approximately 3,000 lung cancer deaths yearly,

While it is currently estimated that 27% of the general population in the United States smoke cigarettes, studies show that more than 80% of people with histories of substance abuse and close to 60% of professional and support staff working in substance abuse treatment services smoke tobacco.

Tobacco smoke is a dangerous pollutant which harms nonsmokers and smokers alike. Substance abuse clients who smoke and have coexisting complex conditions are at increased risk for developing smoking related health complications. Pregnant and parenting women and their children, HIV positive persons and people with AIDS, and men and women with chronic health problems such as hewn and respiratory illnesses are at increased risk for exacerbated health complications due to nicotine, alcohol, and other drug use. Also at increased health risk are nonsmoking clients who have medical conditions, such as pregnancy, asthma, heart disease, and HIV related respiratory problems. These conditions are exacerbated by exposure to environmental tobacco smoke (ETS).

Smokeless or "spit" tobacco, such as oral snuff and chewing tobacco, contains dangerous chemicals, Smokeless tobacco is frequently perceived by youth and many young adults to be a "safe" alternative to smoking tobacco. However, nicotine addiction from smokeless tobacco appears similar to smoking and its use results in short and long term unfavorable health consequences A dose response relationship exists with increased oral diseases and cancer risk associated with the length and intensity of smokeless tobacco use.

The Bureau of Substance Abuse Services recognizes tobacco as an addictive substance that can result in compromising health problems and ultimately death, As such, BSAS is responsible for promoting healthy, protected environments that are free of tobacco use.

The Massachusetts Department of Public Health, Bureau of Substance Abuse Services, in conjunction with the Council to End Nicotine Addiction in Recovery (CENAR); has developed the following policy for the development and implementation of system wide tobacco free policies. Many substance abuse prevention and treatment programs are currently addressing tobacco use among staff and clients. This policy supports current efforts and provides a framework for promoting work-site environments that are free from tobacco use, In the interest of promoting healthy, protected and safe environments, the Massachusetts Department of Public Health, Bureau of Substance Abuse Services has developed a tobacco-free policy.

Tobacco Free Policy

As of July 1, 1996 all BSAS funded substance abuse programs must have written policies that ensure a tobacco free indoor environment, All agencies contracting with BSAS must establish tobacco free work-sites for all facilities that deliver BSAS funded services. A tobacco free facility is defined as an environment free of tobacco use, including the use of smokeless tobacco, such as snuff and chewing tobacco, Tobacco use must be prohibited throughout the entire workplace with no exceptions, including, all indoor facilities., ,offices, hallways, waiting rooms, rest rooms, elevators, meeting rooms, community areas, and agency owned and/or leased vehicles. This policy applies to all employees, clients, contractors, and visitors.

In acute care treatment settings, where clients may not leave the building or unit for reasons of health and safety, a ventilated indoor smoking room will be provided fort clients only. A ventilated area is defined as a designated, non work room that is not a common area shared with nonsmokers. It must be ventilated to the outdoors in such a way that smoke does not move into the rest of the workplace. These work-sites/facilities will require all staff, visitors and volunteers to use tobacco in outside designated spaces.

In support of this effort, technical assistance, training, and information on nicotine addiction and treatment will be made available to all BSAS providers BSAS strongly encourages all programs to develop linkages with local Massachusetts Tobacco Control Programs and other relevant resources that support the treatment of nicotine addiction.

This information is provided by the Bureau of Substance Abuse Services within the Department of Public Health.