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Table 3 Current regulations in states not working toward a state policy (n = 31/50, 62 %)

From: Overview of state policies requiring smoking cessation therapy in psychiatric hospitals and drug abuse treatment centers

State

Policy

Alaska

Tobacco Cessation is not a mandatory requirement for treatment plans for Inpatient Psychiatric Care, Residential Psychiatric Care, or SUD Residential Treatment. However, some of Alaska’s SUD programs have trained Tobacco Cessation specialists who include this component in the treatment program. However, there are state policies that promote the inclusion of tobacco cessation services and smoke/tobacco free campuses:

1. Alaska Psychiatric Institute (Alaska’s state-run psychiatric hospital) is a smoke-free hospital. It has been smoke-free since 2007. Patients are provided smoking suppressants and smoking cessation services. Employees have access to tobacco cessation services through AlaskaCare (the state employee health insurance program).

2. All behavioral health providers are required by state regulation to be accredited by Joint Commission, CARF, Council on Accreditation, or similar bodies. This results in a de facto requirement for tobacco use policies and tobacco cessation services. For example, the Joint Commission has quality measures related to screening for and treating tobacco use. CARF requires that organizations have policies related to use of tobacco products on campus and requiring screening for tobacco use. The Council on Accreditation also requires policies on tobacco use by employees, and requires organizations to provide information on health living choices (specifically including smoking cessation).

Arizona

Arizona has not yet ‘enacted’ any formal regulation with the exception that facilities have to abide by the clean indoor air act; no smoking is allowed within 20 ft of a building. The state has focused on concentrated work within behavioral health organizations to increase access to the state Quitline by the target populations.

California

The California Tobacco Control Program (CTCP) supports the treatment of tobacco dependences per the Treating Tobacco Use and Dependence: Clinical Practice Guidelines. The CTCP has also funded several educational trainings as part of its funded tobacco control projects working with the behavioral health (substance abuse and/or mental health) community and their partners to call attention for the need of this practice.

Delaware

Currently, the only tobacco cessation law in Delaware is designed to allow pregnant women and Medicaid beneficiaries to receive tobacco cessation counseling.

Florida

Florida has not enacted requirements or regulations for mental health, chemical dependency or other rehabilitation facilities or providers. However, many of these organizations have adopted no tobacco use policies supported by Florida’s clean indoor air laws. These laws have resulted in no tobacco use policies for in-patient psychiatric and chemical dependency services. They also restrict tobacco use in all indoor out-patient treatment facilities.

Georgia

The Georgia Tobacco Use Prevention Program has provided technical assistance towards the adoption of a model tobacco-free policy (adopted in 2010) within buildings and on the grounds of all of the Georgia mental health communities at the state and county level. Upon adoption of the model policy, discussions pertaining to developing cessation protocols for inpatient and outpatient consumers did not occur due to a lack of interest by the leadership of the mental health communities at the state and local levels. The goal of the Georgia Tobacco Use Prevention Program was to plan, implement and evaluate the model protocols for these populations/consumers in accordance with the U.S. Public Health Service Guidelines 2008 (updated version).

Idaho

Idaho currently does not have any statewide regulation or standards around cessation within substance abuse or psychiatric treatment facilities. The state owned mental health facilities do have smoke-free campus policies, however.

Kentucky

The need to integrate tobacco cessation services into substance abuse and mental health treatment services is becoming more widely recognized within Kentucky’s treatment provider community, and the Tobacco Program has sought to strengthen the connections between members of the Tobacco Prevention & Cessation Program and mental health and substance abuse treatment providers.

Additionally, the Department for Behavioral Health, Developmental and Intellectual Disabilities has encouraged smoking cessation services be provided to clients with SUDs, and encouraged providers to go tobacco-free.

Michigan

Michigan’s state-owned psychiatric hospital campuses went smoke-free by law several years ago.

Missouri

There is no statewide policy but the policy for state owned facilities is that they be smoke free. Missouri is exploring tobacco cessation services with its Tobacco Treatment Handbook which the state has promoted at 3 different pilot sites.

Nevada

Although some Nevada-based providers do provide cessation, it is not mandated. What is mandated by the state’s Substance Abuse Prevention and Treatment Agency (SAPTA) with their providers is that there will be no smoking anywhere within the facility or on the external grounds of the facility. There can be no designated smoking areas either. That is by SAPTA policy. Nevada’s mental health agencies – Northern Nevada Adult Mental Health Services (NNAMHS), Southern Nevada Adult mental health Services (SNAMHS) and Lake’s Crossing Center have similar policies and requirements as well.

Pennsylvania

At this time no regulations or requirements for smoking cessation exist in Pennsylvania, but some of the residential facilities provide it voluntarily.

South Carolina

The South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS) has not enacted a tobacco cessation policy in its residential programs. However, the South Carolina Department of Health and Environmental Control has a Tobacco Quitline that clients can be referred to for services.

South Dakota

South Dakota does not have any formal policies requiring tobacco cessation treatment in substance abuse treatment facilities and psychiatric wards. However, the South Dakota Department of Health Tobacco Control Program just started a partnership with all the community mental health and substance abuse centers in South Dakota and plans to help them with setting buildings and grounds tobacco-free policies and educating their staff on promoting the use of the SD QuitLine.

West Virginia

The state provides educational information to its mental health facilities only.

Wisconsin

Wisconsin’s regulations of mental health and substance abuse provider agencies include a requirement to complete a comprehensive assessment of the clinical needs of their patients and to address identified needs with their clients based on an individualized treatment/recovery plan.

Additionally, UW Madison’s Center for Tobacco Research and Intervention has been working with the Wisconsin Department of Health Services to provide training and technical assistance for the state’s mental health and substance abuse treatment providers to promote the best practice of integration of smoking cessation into treatment programs.

Wyoming

Wyoming has no statewide law, but 6 counties have gone smoke free.

  1. Some states are omitted because current regulations do not address tobacco cessation in substance abuse centers/psychiatric wards in any capacity (Connecticut, Hawaii, Illinois, Indiana, Kansas, Minnesota, Mississippi, Nebraska, North Dakota, Ohio, Rhode Island, Tennessee, Utah, Virginia)