The rate of tobacco use among those who struggle with an alcohol or substance use disorder is much higher than the rate among the general population (between 40%-90% depending on the substance, compared with 14% for the general population). Individuals who smoke and use other substances are more likely to die from smoking-related illnesses than from any other substance use disorder. Despite the clear health implications of smoking among individuals seeking treatment for substance use disorders, there is an enduring cultural norm of allowing tobacco in substance use inpatient facilities. One important barrier to implementing tobacco-free policies within residential treatment facilities is the concern that census levels and treatment completion rates will drop and that tobacco users will seek services elsewhere. Limited evidence exists to inform policy makers about whether these concerns are warranted when a facility chooses to implement a tobacco-free policy.
To address these questions, BHWP partnered with the University of Colorado Hospital’s Center for Dependency, Addiction and Rehabilitation (CeDAR), a for-profit residential addictions treatment center specializing in treating patients dealing with dual substance abuse and mental health disorders. With support from BHWP, CeDAR transitioned to a tobacco-free facility in early 2013, presenting us with an opportunity to examine effects of the policy shift in facility census rates, treatment completion, and patient intentions to quit smoking. Contrary to common concerns, CeDAR experienced an increase in census rates following the tobacco free transition. Moreover, we detected no evidence that treatment completion rates declined after the policy was implemented. Over half of individuals who used tobacco at admission reported their intention to continue their tobacco-free status following discharge.