Published on January 22nd, 2014 | from CAMH

The Journey to Tobacco Free

By Lilian Riad-Allen, Project Manager, Tobacco Free Initiative

I’ve always had a sense of adventure so not surprisingly, my favourite movie as a child was “The Wizard of Oz”. As an adult, I embarked on a journey of my own and that path has led to me CAMH.

I entered the world of smoking cessation and tobacco control as a member of the Smoking Treatment for Ontario Patients program. I’m proud to say, the STOP Program is presently celebrating a tremendous milestone – over 100,000 Ontario residents enrolled in smoking cessation, and still growing. Now I am leading the charge to go tobacco free at CAMH – the biggest professional challenge I have faced to date – and certainly one of the most rewarding.

In the same way that I have been on an incredible journey, CAMH is also walking down the path of change. In my conversations with staff, I encounter those who still remember the bad old days of rolling cigarettes for clients, indoor smoking rooms and even dispensing tobacco to reward good behaviour. Clearly major changes have happened at CAMH, and as each of these changes were made, there were obstacles, concerns and even fears. It took quite a bit of courage to begin addressing those issues even though they are difficult for most of us to imagine.

Every day we are learning more about the harms associated with tobacco use. Fifty years after the U.S. Surgeon General reported that smoking causes lung cancer, we are learning how tobacco is implicated in diseases like diabetes, erectile dysfunction, colorectal and livers cancers, and how it is robbing our patients of valuable years of life.

We’ve certainly come a long way but our journey isn’t over. In November 2013, CAMH launched the first phase of our Tobacco Free policy. This policy addresses tobacco use on our campus, serves to de-normalize tobacco use on hospital property and creates a mindful, recovery zone for those making changes to their smoking behaviours.

We’ve heard from both clients and staff how this change will help them. While they have told us it won’t be easy, they are not alone. This Weedless Wednesday, people across the nation may be feeling that same way. On this journey, we will need to keep reminding ourselves that this is a process and not an event, that lapses happen and even the smallest victories are worth celebrating. We all know someone that has or is struggling with their tobacco use, and even if we haven’t personally experienced it, we all know how difficult it is to make big life changes.

So let’s work to support one another. This Weedless Wednesday, let’s celebrate how far we’ve come and look forward to how far we still have to go. It certainly won’t be easy, but with a bit of courage, we can get there.

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10 Responses to The Journey to Tobacco Free

  1. Patricia Jane says:

    More than 80 percent of people living with schizophrenia smoke, which is much higher than the national average. Research shows this is because nicotine helps them manage symptoms, especially difficulty concentrating. When they arrive at a hospital in a psychotic crises, it does not seem like the best time to introduce smoking cessation as they obviously have way too much to contend with already. Apparently some people can switch to a nicotine patch for their hospital stay, but for others, the patch causes terrifying nightmares. How does CAMH help this population through their psychotic crises while also enforcing the no smoking rule?

  2. Lilian Riad-Allen says:

    Dear Patricia,
    Thank you for your comment. I want to clarify that the Tobacco Free initiative is not about making people quit smoking, it is about promoting health by reducing exposure to second-hand smoke and raising awareness about the impact that tobacco use has on others. For those that wish to continue to smoke, they can do so by going off of CAMH property.

    We know that the smoking rate is significantly higher in this population compared to the general population, but what we are hearing is that our patients do have an interest in quitting and that sometimes those quit attempts are compromised when the person is consistently exposed to smoking related triggers. We appreciate that this is a large change and are working with various interdisciplinary teams to develop clinical strategies to support our patients through this challenging journey.

    Best Wishes,
    Lilian Riad-Allen

    • Patricia Jane says:

      Dear Lilian,
      Thank you for your clarification. As you know, people in a psychotic crises are often in the hospital involuntarily or on a form, so they cannot go off CAMH property to smoke. So i guess it is another program that helps them with this.

      • says:

        Hi Jane,
        You are correct, for people that are at CAMH on an involuntary basis they would not be able to go off of the property to smoke. We are working with our inpatient units to support these clients through the use of nicotine replacement therapies. In your earlier comment you mentioned that some people may experience negative side effects associated with the patch, for those clients, we would be able to support them using other types of nicotine replacement therapies, like nicotine gum, lozenges and nicotine inhalers (as these products are not used while a patient is asleep there is no risk of vivid dreams while using these products). Through this delivery system patients would still have access to the cognitive benefits of nicotine without exposure to the thousands of other chemicals in cigarettes.
        Best Wishes,

  3. Hi Lilian,
    You’ve highlighted a very important aspect of the smoke-free issue, which is the range of alternative delivery mechanisms for nicotine that are available to smokers when they aren’t able to smoke. Ideally, of course, we hope that everyone exposed to the wide range of toxic chemicals in cigarettes will stop, but if they aren’t ready to or have issues w/r to nicotine’s effects on other conditions they have, then the many NRTs available, in doses ranging from mild to strong, can help many if not most people who try them.
    If people still don’t want to use NRT or the prescription meds available, then they can try a range of non-medical therapies, from hypnosis through one-on-one counselling to acupuncture.
    The key issue in smoking cessation is to keep trying. For many people, stopping smoking is a process,rather than an event, and the key is to start the process! Providing a smoke-free, trigger-free environment as CAMH has done, is a great assist.

    Michael Perley
    Ontario Campaign for Action on Tobacco

  4. Lilian Riad-Allen says:

    Hi Michael,
    Thank you for your thoughtful comment, addressing tobacco use is certainly a process and the first steps are often the most challenging. CAMH is invested in supporting the health of our patients, clients, visitors, staff and our community — and a non-triggering environment is certainly a first step. As part of our process, we hope to de-normalize tobacco use, while normalizing tobacco assessment and cessation supports for persons with mental health and addictions.
    We know that tobacco use has a long history with our population and by not addressing tobacco use, we risk worsening health inequities and promoting stigmatization of our patients. We know that many of our patients want to reduce or quit their tobacco altogether and we are doing our part to support them. Thank you for all of the great work coming out of the Ontario Campaign for Action on Tobacco.
    Best Wishes,

  5. Hospitals, psychiatric or not, albeit temporary, are these people’s home. How do you justify subtracting these patients from the fundamental rights to pursue happiness as they deem right for themselves like the rest of the population? How cruel to even forbid them to bring tobacco products to the hospital property causing them to have to buy a pack of cigarettes and discard it before regaining hospital grounds anytime they have an urge to smoke!

    Some inmates have more rights and priviledges than your patients. If you consider that tobacco addiction is an illness, making it impossible for them to smoke in your zeal to see them quit, is tantamount to forced medication. You may have read many studies even from prominent anti-tobacco advocates that nicotine replacement therapy is virtually useless with an average long term failure of 92% and varenicline is a dangerous drug especially for people with psychiatric problems. It is inhuman, unethical and borderline illegal to leave them no other choice than accept your anti-smoking drugs. Have you no regard whatsoever for the Hippocratic Oath?

    Iro Cyr
    CAGE Canada
    Montréal, Qc

  6. Patricia Forsdyke says:

    Timing is everything but I think an acute admission is hardly the best time.

  7. Lilian Riad-Allen says:

    Dear Iro,
    Thank you for your comments.

    I appreciate that you feel passionately about providing care to people with mental health and addictions and I want you to know that I share this sentiment.

    Evidence demonstrates that tobacco interferes with successful treatment outcomes for mental health patients and contributes to depressive symptoms and re-hospitalization. In other words, both patients’ mental health and physical health are adversely affected. (List of evidence: (pdf)

    Addressing tobacco use when we know that it is worsening patient outcomes is exactly what the Hippocratic Oath calls on us to do. As a hospital we must make decisions that promote health and safety of our patients, staff and community. While tobacco is a legal product, so are alcohol and supplements, all of which are not allowed on our inpatient units as they have the potential to interfere with medications and negatively impact patient outcomes.

    We couple our approach by offering free nicotine replacement therapy and behavioural support to patients. Many of our patients have shared with us that they appreciate that we are undertaking this challenging initiative. We have an obligation to reduce tobacco triggers for those that wish to quit and to support them in their recovery. We are here to support those that will be impacted by this in the best ways that we can.

    Please note that our policy does not require patients to quit smoking. While patients are here, we offer NRT in order to reduce withdrawal symptoms. Upon discharge, or while on community passes, patients may continue to smoke if they wish, however, we hope that if they are successfully abstinent in hospital, they will continue to remain smoke free.

    Thank you,

  8. Lilian, I am blunt enough to suggest that one trained nurse with empathy would make a much better expenditure of funds at CAMH than funding you to go on about the dangers of tobacco. You mention the hippocratic oath, but I suggest that you take some wisdom from Florence Nightingale instead,which may be better suited to the questions at hand. ” To cure sometimes, heal often , to comfort always”

    Or to quote from Portia in The Merchant of Venice ” The quality of mercy speech…. look it up. It is quite enlightening.

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