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Ravell Call, Deseret News
Stephen Willard said he has had a lot of support from friends, co-workers and family in his battle to stop smoking.
For a long time we built smoking breaks into the residential treatment regimen. We need to change the paradigm a little bit and move to some healthier behaviors.

OGDEN — All manner of numbers are running through Stephen Willard's mind these days.

It's been 55 years since he took up cigarette smoking, which, at times, was a two-pack-a-day habit that started when he was 7 years old. It's been 10 weeks since Willard, an aide at Weber Human Services' mental health residential treatment facility, quit smoking.

He can tell you off the top of his head the number of days remaining before Weber Human Services becomes smoke-free under the statewide Recovery Plus initiative. The program requires mental health treatment and substance abuse treatment programs in Utah that receive public funding to be tobacco free by the end of the year.

Willard, 62, has flirted with the idea of quitting. He's managed to reduce his smoking to 10 cigarettes a day. But this is different. He's quit, he hopes, for good.

"I have 16 or 17 clients at any time. In order to get the clients to get smoke-free, I need to be smoke-free, too," he said.

The wellness initiative is a joint project between the Utah Department of Human Services and the Utah Department of Health. It seeks to improve clients' overall health and lengthen the life spans of people in substance abuse and/or mental health treatment. Research shows these clients have shorter life spans than the general population, largely due to poor physical health. Smoking contributes to many of these issues.

As part of ramping up to the deadline, the Utah Division of Substance Abuse & Mental Health asked local substance abuse/mental health authorities to survey its staff and clients regarding the opportunities and barriers to moving to a tobacco-free status.

Most respondents said tobacco cessation was a step in the right direction. Although some clients indicated they did not like the no-tobacco policy, they said it would not preclude them from seeking treatment.

Both clients and providers said the policy was a significant "culture change."

Smoking breaks and using smoking as a reward have long been staples of mental health treatment.

"For a long time we built smoking breaks into the residential treatment regimen," said Noreen Heid, Recovery Plus program administrator in the state Division of Substance Abuse and Mental Health.

"We need to change the paradigm a little bit and move to some healthier behaviors."

In the substance abuse treatment arena, traditional practice has been to "deal with one addiction at a time."

Heid said a growing body of research says when smoking cessation occurs in tandem with substance abuse treatment that clients are more likely to maintain long-term sobriety.

Research published in the journal Nicotine & Tobacco Research in August 2010 said clients of substance abuse treatment facilities who received smoking cessation counseling from their primary care doctors were five times more likely to quit.

"It's … been thought that with this patient population, doctors should only deal with one thing at a time, for example treating an opiate addiction and opting to deal with the smoking cessation later. But at the end of the day, we showed that smoking cessation counseling is effective in this patient population and should definitely be pursued," said Dr. Michael Ong, a researcher at Jonsson Comprehensive Cancer Center at the University of California-Los Angeles, in a UCLA Health Sciences news release.

Although Utah has a very low rate of smoking among the general population, an average of 66 percent of people in substance abuse treatment programs are smokers.

"There's a even a higher percentage among mental health clients," Heid said.

There appears to also be a higher incidence of smoking among people who work at mental health and substance abuse treatment facilities. Some clinics estimate the rates of smoking among employees nears 20 percent.

Willard, for one, is attempting to be a good role model.

It's a challenge, though.

"I enjoy smoking. I really do. That's my big dilemma. It's not so much quitting, it's staying quit," he said.

At the same time, Willard recognizes that American society has become increasingly intolerant to smoking.

"The incentive to quit is, that any more, there's a stigma with it. It's like 'Go over there with the other stinky people if you want to do that.' It used to be a cool thing. Any more, you can't smoke anywhere."

The cost has also become prohibitive. "Last year they went up a buck just for taxes. I thought 'Whoa, man, this isn't right. You're just wasting money.'"

Willard said he has had a lot of support from friends, co-workers and family. While he used to enjoy a cigarette after eating a large meal, Willard said "I don't crave them or anything like that."

Willard said he has particularly enjoyed one aspect of his tobacco-free status.

"I don't miss going out in the cold to smoke," he said.

The goal of the program is to enhance the overall wellness of mental health and substance abuse clients statewide, but no one will be denied treatment if they continue to smoke. But all will be provided education, nicotine replacement therapy and support and guidance in quitting.

"Most people want to quit but they don't know how to go about it and they fear they won't be successful," Heid said.

Recovery Plus wants to provide positive incentives to quit smoking. Some estimates suggest that 15 percent of all smokers statewide are part of the publicly funded mental health and substance abuse system.

"We have potential to have huge impact. We're very hopeful that this will be successful," Heid said.

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