Greetings and Welcome - thoughts, ideas welcome here in the chat.

yes

Welcome everyone to Science-based Solutions for Tobacco Cessation! A copy of today's slides, speaker bio, resources and audio recording will be uploaded shortly after the end of today's presentation.

Liza Eager Cheshire Medical Center Keene NH

Denise Woods, Carter County Drug Prevention Coalition, TN

Sara Prem American Lung Association in Kansas and Greater Kansas City

Kayla Noll

Nick Szubiak, NSI Strategies and excited to be here today - DC

WellAhead Louisiana

Good Day - Lori Younker, National Senior Director, American Lung Association - Lung HelpLine and Illinois Tobacco Quitline

Kimberly Janish - Comprehensive Mental Health Services/Burrell in Independence, MO

Kacee Redden, Tobacco Disparities Coordinator - South Dakota Tobacco Control Program - Sioux Falls, South Dakota

Carolyn James, CODAC Behavioral Healthcare, Providence, RI

Good afternoon. Leilani Brunet, RN. South Central Louisiana Human Services Authority.

Nanda Freeman - Hawai'i Community Foundation, HI

Becky Hayes Boober, Knox County (Maine) Community Health Coalition

Nancy Martin, American Lung Association/Illinois Tobacco Quitline

Good Morning everyone, Paola Alvarado, Union of Pan Asian Communities, San Diego, California

Karen Faulk, Altapointe Health Systems

Heather Wagner, RN CenClear, Clearfield, PA

Melissa Pathways Behavioral Services Waterloo Iowa

Brady Weaver. Custer Health in Mandan, ND.

Sadie Jensen, Tobacco Free Lancaster County/LLCHD, Lincoln NE

Adam Trahan

Sayra Soriano - Health Educator for Marin County (LLA)

Alicia Carranza, Health Educator/Interim Project Director, OCHCA TUPP, hello everyone

I m Jorge Uribe from Duane Dean BHC/ Kankakee IL.

Heather Leutwyler, RN, PhD from the UCSF school of nursing

Arriana Patraw, The Heart Network, Saranac Lake NY

Faith Jalabe, San Diego, CA

Brenda Wilson-Behavioral Health-Eastern Aleutian Tribes-King Cove, Alaska

Well-Ahead LA

Charles from Georgia

My name is Irene Enarusai. I am from the New Jersey Tobacco Control Program

Mikaila Bayers, Greater Nashua Mental Health, New Hampshire

Chinwe Ejikeme, Georgia Department of Public Health

Brittany Bevis-Sciuto (she/her), Snohomish Health District in Everett WA

Janna Vallo, Albuquerque Area Indian Health Board, NM

Griffin Hickey, Pathways Behavioral Services, Waterloo IA

Heidi Pace Tobacco Prevention & Control Program Coordinator for Alaska Family Services

Kyle Girone, Virginia Department of Health Tobacco Control Program Epidemiologist/Evaluator

Kayley Edelen- RiverValley Behavioral Health Regional Prevention Center, KY

Delaney Ginn, Tobacco Control Program, San Luis Obispo CA

Christie Cresswell, IQH. Tobacco Quitline Alabama & Tennessee

Karen, Marshall, Mo

Hello from the New York City Department of Health and Mental Hygiene.

Kaitlen Lee - City County Health District Tobacco Prevention Coordinator in North Dakota

James from Odessa, WA

Hi everyone! Sandra Hernandez, Kick It California

Ammar Khaleel, MSW BH Therapist / San Ysidro Health-San Diego County

Nohemy Durazo, LMSW. Behavioral Health Consultant. Salt River Pima Maricopa Indian Community. Scottsdale, AZ

Welcome everyone to Science-based Solutions for Tobacco Cessation! A copy of today's slides, speaker bio, resources and audio recording will be uploaded shortly after the end of today's presentation on our website at www.BHtheChange.org.

awesome - what a diverse group! Welcome

Hello joining you all from Springfield, MO Cox Health Northside Pediatrics CHW

Jenn Pohlmann RN, Nurse care manager and PCHH director at COMTREA in Jefferson County MO

Emily Koyagi, Program Manager for University of Kentucky’s Behavioral Health Wellness Environments for Living and Learning (BH WELL)

please use the chat for interaction today - thoughts and ideas are welcomed and encouraged!

Pablo Ortiz, LMHC with Optum NM, Outreach Specialist with Quitline

Hello this is Annie Thomas Addiction Counselor from MLK Community Healthcare Clinic Los Angeles, CA 90059

Hello! Susan Friedlander, LCSW...NYS OMH NYCFO Field Office

Becky from ND

Cheryl Sutton, TTS with Northeast Delta Human Services Authority, Monroe, LA

Amanda Powell, CCBHC Project Director for Many Rivers Whole Health, Great Falls, MT

Teresa Kershaw RT, NCTTP Sanford Health Bismarck, ND

Greetings! Robin Geurs, Clinical Research Coordinator Pediatric Pulmonary Medicine, UAB

No camera or mike but hi from Monroe, Louisiana

Hello from Minnesota :)

Gage VanDine, Community Outreach Manager for Rethink Tobacco Indiana

Hello from Missouri!!

Kelcie Metz- West Virginia

Good morning. Irene Linayao-Putman, with the Tobacco Control Resource Program at the County of San Diego in CA.

Aloha, Nanda👍🏽🌈

Dotti Loaiza, FNA Residential Treatment, Fairbanks, Alaska

David Archer

Hello everyone! Northwest Health Services, St. Joseph, MO.

David Archer - Recreation/Wellness Coordinator, Chattahoochee Technical College, Marietta, GA

Teresa Mills Huntington WV

Heather Robertson, UK CON BH WELL, Lexington KY

Gary Hall, Health Educator, Green River District Health Department, Owensboro, KY gary.hall@grdhd.org

Sometimes. Especially from those that get set in their ways.

Can you define what you see as the difference between bias, stigma and discrimination

Addiction is a disease and should have reduced stigma.

Please feel free to raise your hand to be in "queue" to be unmuted!

There's still a lot of stigma and bias in the community, among clients and even in the field.

Yes, I work at a hospital and the least amount of my clients are employees. A lot of them hide their smoking/vaping because they are ashamed and don't want to be judged. So many people don't understand addiction and how the brain changes and it's not their fault.

I was working on calling different SU treatment facilities in MO. I had one person tell me that they do not screen nor treat for tobacco use for it is not a controlled substance.

I think it starts out as a "choice" but once the brain gets addicted it becomes a disease. Living in Appalachia, people grow tobacco to support their families, thus the stigma is there from people who grow it and chew or smoke it

what about the bias in the providers substance abuse vs tobacco use?

Language that we use within the field among co-workers and clients is really important and I continue to hear "addict" "clean/dirty" etc with staff and it's our job to make sure we're correcting each other and staying up to date with person centered language and making sure we're not increasing stigma

Grandpa used it so it is ok for me to use it

are we discussing unconscious vs conscious?

We have had the same experience as Mikaila. Some of our SUD patients stigmatize those who use tobacco in addition to substances.

I used to always get told "Tobacco is not a priority when compared to meth (or other hard drug)." or "Our staff only have a short amount of time to assess a client, so they don't have time to add extra by addressing tobacco use and adding ANOTHER form to complete." It has improved in the past few years, but not great yet. We're getting better. :)

There's definitely a culture in substance misuse treatment allowing smoking to slip by without addressing it and not making it as much a priority as other substances even though we know that becoming smoke-free supports their substance misuse treatment and long term recovery

@Kimberly-I hear the same feedback frequently from regarding tobacco use not being a priority to talk with clients about bc of other substance use issues. But, when I talk to clients, they are generally open and very interested in talking about tobacco use and how they can begin the cessation process. It is getting better and the culture is changing in mental health programs but so much work to do.

Yes so true Mikaila. But we know that individuals can increase their long term recovery when we co-treat for co-occurring substance use challenges!

Not only are they much higher users but like you say, it is often used to self medicate, is a coping skill, & can have affects on how a medication works for a person. We really need to pay attention to it in mental health

Yes, Kimberly! And we will get to the coping mechanism part soon but you are so right.

Many if not most drug addicts (especially those in recovery) are typically high-functioning in society. They are forced to hide their disease to avoid discrimination and stigma. Many will also replace their addiction with more socially acceptable addictions such as caffeine, nicotine, binge watching, video gaming, etc. to appear "normal" due to the stigma of addiction. This approach is not sustainable due to the hidden dangers in tobacco use. Rehabilitation centers need to move towards a holistic treatment approach to treat ALL addictions, not just those that are illegal.

Agree, Adam-100%!

Need to address treatment of “addiction” as disease. Many types alcohol, drugs, I-phones, technology, food etc. So many times alcohol or drugs are addictions with tobacco addiction.Stigma of addiction may come when given type. Need to treat Addiction in general-not give it a specific type.

caffeine

Sugar

chemotherapy

insulin

TV

anti-inflammatory

cannabis

?

anything that gives a dopamine release

any regular medications for BP, diabetes, etc.

running

antidepressants

Phones and instant entertainment

(Insulin is a hormone not a drug; impossible to ne addicted, but I always find it interesting that some people don't want to get "addicted" to insulin.)

surgery!

yes

oh, yes - this is your brain on drugs

oh yea

yes

Yes!

Failed War on Drugs propaganda🙃

backfire effect

I agree with Brittany...failed

I agree with Brittany too

same with DARE

Aren't we still trying to scare people with media. I. e.-missing toes, oxygen tubes, holes in throat.

Yes, Jean!

Jean, I

Jean, not sure about that - those are real effects, not an analogy

Tips from former smokers - while hard hitting/graphic - have been shown to increase calls to quit lines.

Yes, Susan.

Whenever we can actually implement the graphic warning labels on cigarette packs, they will be very graphic, and have been shown in other countries such as Australia to scare kids away from smoking cigarettes

TIPS from former smokers is definitely effective at getting current users to quit, but I think the question is does that work as prevention messaging to keep kids from using drugs? And also does TIPS continue the shame cycle that people feel about their substance use?

TIPS From Former Smokers offers the individual help by providing the information on the free Tobacco Quitlines, many of which now offer NRT in addition to counseling. That is one thing that makes it different from previous "scare tactic" approaches. The research I have reviewed indicates that if you show negative consequences you also need to provide free and easily accessible options for helping them quit smoking.

I also think that besides the shame cycle it also can be helping the,"it's too late to quit now, I am already damaged." I find it is harder to convince folks that it is never too late to quit, you will always start to heal if you quit.

If anyone knows some data about the effectiveness of messages like TIPS on prevention with youth who aren't using, I'd be interested to hear it!

For people lead to substance use challenges caused by chronic toxic stress or racialized trauma or intergenerational trauma...is it about feeling euphoric? Or reducing the load of toxic stress? Does the framing change the conversation?

+-

Are we able to have access to the PowerPoints?

How do you effectively combat ALL addictive disorders simultaneously when the human body operates through a reward system (dopamine release) and negative-feedback loop (body senses it is missing a chemical so it starts producing it)?

Hi Malia! Yes the recording of this event, along with a PDF copy of the PPT, will be posted to our website at www.BHtheChange.org within 24 hours of the end of the event. A follow-up email with these resources will also be shared.

Really love the Wizard of Oz comparisons. I am using that for sure. I have played the Wicked Witch of the West on stage many times and knew about the poppy fields but never connected the snow to cocaine. (interesting)

hungry!

mouth watering

salivating

nom nom nom

YUM! hungry

Happy and comforted and hungry

Sweets trigger me to EAT!

chocolate is my nemesis

Blocked arteries

What am I eating for lunch

(I am hungry-it is lunchtime.)

tummy's grumbling

Yum to the pizza. no to burgers.

Just give me the chocolate!!!!!

calling my name

Suddenly want these!

I can smell those cookies.

I can taste the melted chocolate

Oh we can smell these pictures :-)

that's how advertising works

making me want an iced coffee

🥲

so even a Quitline billboard with a giant cigarette is a trigger for a smoker

Good point Pablo

Love the Dragon image - I've been using a 5-Headed Dragon to illustrate the 5 reasons we want.BehavioralSocialChemicalEmotionalPsychologicalhttps://QuittersWin.blog/besochemps

Adam Trahan asked a great question earlier:How do you effectively combat ALL addictive disorders simultaneously when the human body operates through a reward system (dopamine release) and negative-feedback loop (body senses it is missing a chemical so it starts producing it)?

"Compulsive consumption" is a great explanation based on neuroscience of addiction, but when you say that nicotine addiction is like a compulsive disorder especially to behavioral healthcare providers, that immediately think of compulsive disorders in the OCD spectrum. Treatment modalities including pharmacotherapies for O-C disorders have only shown limited efficacy for treating tobacco dependence. How do you square that circle?

so are you suggesting we go 'more' into the substance abuse education/ like you are presenting, to help or be sure they understand it, rather, than much of what we do with triggers/ behavior and cognitive actions, etc.

Let's meet back here at 18 min past the top of the hour!

If we have time when we return can we discuss how Nicotine binds to nicotinic receptors and how does that affect the body.

Do the brain changes you spoke of occur at different rates in nicotine users of different ages? What about in males vs. females?

Will the power point be available for download and printing?

Jean Hartzog, yes, I've talked to several current tobacco users and they hate those ads. They know those things are true, but it just seems to anger them. I have heard though that the Quitline gets more interaction when those ads play, so apparently it encourages some to respond.

I missed what samara said I left the room

Hey Victoria! No worries, the PPT and recording of the event will be posted on our website at www.BHtheChange.org and will also be emailed to you all.

Thank you!

Thank you

I work at a CMHC and through a research program offer smoking cessation treatment where I'm the TTS. It's far more supportive than traditional smoking cessation. I meet with the clients regularly, we explore how they feel about their smoking, I help coordinate appointments with their PCP to discuss NRT and smoking cessation medications, we discuss their triggers and high risk situations before and after they quit and develop coping skills and plans for those situations. They can have as many quits as they need within the year of the program. Outside of that 1 year I can continue to support them but it's outside of the research. They can also be paid to track their smoking within the first 16 weeks. It's hugely supportive and although the incentives will no longer be available once the project has been completed we have chosen to continue to provide smoking cessation counseling and support for our mental health and substance misuse clients in additional to the other services we provide.

12 years ago, our agency worked with James Prochaska (Stages of Change) to offer tobacco cessation to our co-occurring patients (Opioid Use Disorder and Mental Health). The results were astounding: near twice the initial quit rate and 6-month sustained quit rate of the general population. Unfortunately, because we are not adequately reimbursed by insurers, we cannot continue to support a cessation program.

Please do a brief introduction:NameLocationOrganization Groups will stay the same One or two volunteers to take some notes for large group report outs and summariesWhat are (1-3) of the barriers, obstacles, obstructions in your organization/community?Are these unique?  Shared with colleagues?  Culturally unique?

I can see your comments, Leilani.

I mean this comment, nothing before*

We have been bought by MaineHealth so some of the independence we had no longer exists,

Time and Communication with admin

no one could hear me.

access to NRT

Accessing resources (lack of willingness from state officials)

lack of funding resources

Connecting with the DOE to provide services

Lack of reimbursement for tobacco cessation treatment.

Rural location restricting access to care

Varying opinions and assumptions about promoting tobacco treatment within the BH population include several barriers that included time, willingness to adopt new procedures and billing challenges.

The fear that if treatment centers, casinos, et. went smoke free no one would come.

Staff turnover

Lack of local data in regards to percentage of individuals with substance use disorders who smoke.

EHR limitations for clinical tracking of tobacco use

In Virginia they are a big tobacco state and they provide a lot of funding for the state, so it was hard for them to encourage tobacco cessation.

Resistance

Transportation

lack of motivational interviewing

Providers only get 15 minutes with patient.

The drugs that are legal are very dangerous. Perception of harm is lower as a result

A lack of transportation to MAT/Group Appointments

no money for gas to get to the visit- telehealth

Facilities that still allow tobacco use on site

insurance coverage for cessation education

mental health/SUD professionals getting reimbursed enough to provide tobacco treatment

reimbursement for tobacco treatment vs substance use

no smoke-free policy for treatment center

Getting clients who smoke in to see TTS initally.

The patients are not asked or they don't want to quit when in the hospital.

BH Center still allowing smoking on campus

The perception that Hookah (water pipe) is less of a problem with getting nicotine addicted.

Reaching rural, native-americas communities

Low SES impacts access

unique challenge: no organizational no smoking ban

Access to care- we live/work in rural areas

legality

lack of time

Having access to healthcare in a rural area.

requirement of evidence based

Organizational changes push timelines to accomplish goals.

We need to elevate the need for tobacco cessation services as a priority health service!

Getting into junior & high schools to educate & provide smoking cessation/ vaping

Youth having the desire to quit tobacco.

Affording transportation or access to phone/internet for Telehealth.

The perceptions of desire to quit between providers and clients

Connectivity

difficulty getting referrals

competing priorities

How to identify smokers and send for support-many clients are not referred to support that is free!

Impact of COVID -19

Costs for NRT, treatment and services. Either real or perceived.

Cooperation with admin in a timely manner to serve

Provider reimbursement (from insurers) for tobacco cessation services

retaining social worker staff. Many new hires are treading water with meeting client's most crucial social needs. Many social workers also smoke

inconsistent delivery of treatment

Policies that discourage tobacco free environments

buy in from actual service providers (mental health) to include nicotine cessation into tx

we screen but don't do any real follow-up with any real treatment for smoking cessation

Living in Virginia, lots of community funding and jobs with Altria/Philip Morris. Staff lack of intrest in smoking as it's so normal in Richmond VA

mindset that does not see the dangers or harm in legal drugs

attitude of providers

staff by in

Handling Stress

Tobacco cessation not being a priority

Mattie wrote this but it went DM to me: "medicaid reimbursement for tobacco treatment services"

per Leilani went DM to me: Per Teagan Shull "often I know for us it falls to the wayside because of the clients use of other substances" Same issue here Teagan

Unequal payment for substance use

What is one thing you can take from today and bring back to your organization/community to do.   

Stigma exists at all levels, from patients to medical providers to cessation providers. We need to continue to educate.

Engage youth with the addiction neuroscience and behind nicotine to improve their mental well-being.

I am going to take back using the addiction PPT to explain to my clients, teachers and physicians. Emphasizing it's not their fault and to stop the shame and guilt!!! Incredible webinar! WOW!

Working with the community to advocate for policy change (addressing contributing factors to youth vape use and second hand smoke)

Acknowledge readiness to change, and use language that is more comprehensible

Each one teach one to do what we have learned today!!! Use the recording/slides to help you do this

convert the graphics in to laymen's terms and use with the patient so they better understand their addiction

The statistics on prevention

Single most important activity we can do is to work to keep kids off nicotine until they are at least 21

neurological basis for the need for cessation treatment

The three stages that Nick presented

reinforced the need to combine treatment for "ALL" addictions to be addressed at the same time, and not ignore tobacco use

Initiate ACEs screening in adolescents when counseling them about nicotine avoidance / experimentation

The cycle of addiction in the brain.

It is nice to get a grant to give NRT to patients.

the definations to help create a common language for the conversations to help cessation efforts

I am going to use The Wizard of Oz example used because it is so meaningful. Hope all of us can help people find their way home.

Need to refocus - not just about consequences

Want to provide more resources re: impact on receptors. We've done some of that but could do more.

Comparing addiction to bank accounts.

Nick mentioned "tobacco dependence" is an old term. That was something new we learned. We also wondered what is the correct term we should be using? Tobacco use disorder?

infographic of brain on addictive substances & 8 steps along the way to addiction as educational tools and gain buy in

reducing stigma/helping patient not feel at fault and accept help to quit

Stages of addiction and how addiction functionally changes the brain. It is not about choice to quit.

Neuroscience for smoking is the same as other substances

Youth don’t respond unless it’s an immediate response/harm

more discussion with my patients about why it "isn't their fault".

Incorporate more of the neuroscience into my community presentations already being conducted.

good understanding on the 3 stages of Addiction

Remember to approach our clients with Compassion.

I appreciated the attention paid to the PROPER usage of dependent/addicted, etc.I intend to be more precise and teach my medical folks to do likewise.

Sharing this information with our staff, especially around language.

continue to consider client perspective

The 3 stages of addiction

The slide that gave the don’t’ with addiction

Meeting clients where they are at and recognizing all efforts to quit as a success.

Educate, educate, educate to reduce stigma, including internalized stigma - all levels, co-workers, clients, community ourselves.

Increased effort in staff education on AAR.

We will be able to offer key statistics and concerns regarding addiction to our student body.

  bring neurological background regarding addiction to providers in connection to nicotine - help reinforce that nicotine dependence is a substance use disorder

increasing knowledge re: addiction

In helping with opioid Settlements, let's not forget that tobacco tx can help

I work in prevention. I want to use that food/dopamine example. Right now we use rollercoasters but I don't love that it doesn't relate to low-income groups who have never been to an amusement park. The food/dopamine example relates better. I will definitely use that.

To save the slides and reference the brain diagram and 3 steps of addiction info

Examples of how addiction to tobacco/smoking is the same thing of dieting and not having sugar/carbohydrates same feeling

Encourage clients to consider cutting back with smoking while going through recovery program if they don't think they can quit both

The stages of addiction and the stigma cause, controllability and addiction sections will be good pieces of info to give to my community

Making the linkage of how health is the main factor for our clients and we need to provide all of the resources available for clients to live a healthy life.

Shifting drivers that start to change the brain

Smoking does no relate to an addictive personality. It can be linked to genetics, quality of life, etc. Behavioral health consultants can help people to change their risk behaviors

That psychiatrists are less likely to screen or refer regarding tobacco

Wanting to pay closer attention in using person first language.

Medical providers not just ask, spend time education patient.

helping clients reduce their own stigma about their disease

Education of staff-New staff and prevention with youth is something on the radar.

training retraining of staff with updated information

Ongoing learning/training to be more personally invested

Please take 3 minutes to fill out a brief survey on our workshop today: https://www.surveymonkey.com/r/9TYHZ6F

Excellent job by this team to put all this together. I look forward to MORE!

What was the website for the slides again? Will they be sent to us via email if we registered?

This was a great training! I’ve been to many webinars on this subject and this one was engaging, informative and covered a lot of ground. Thank you!!!!

They will be emailed! Also our website is www.BHtheChange.org/join. Join for FREE and get access to more events and resources!

AWESOME! Thank you!

Nick and all great job. One of the best seminars I have participated in. Awesome info. Blessings

Thank you for this informative and truly engaging webinar!

Please take 3 minutes to fill out a brief survey on our workshop today: https://www.surveymonkey.com/r/9TYHZ6F

Thank you for your time

This webinar was so informative and I can’t wait to teach my patients what I learned today. Mahalo🌺🤙🏽🌈

Thank you all!

thank you for uthe recharge

This was great!!

Thank you !

Thank you again! AMAZING Nick! Great presentation! Going to share, share, share with all our groups! =)

Please take 3 minutes to fill out a brief survey on our workshop today: https://www.surveymonkey.com/r/9TYHZ6F. Thank you all! :)

Aloha!

Thank you, Nick! Great presentation! Very informative.

West Hawaii community health center was my hom e!

Great presentation!

Thank you for this information, great presentation

Thank you!!!

Thank you!

Please take 3 minutes to fill out a brief survey on our workshop today: https://www.surveymonkey.com/r/9TYHZ6F

:)!

Thank you so much!