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The Journey to Tobacco Free

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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.

7 Comments Post a comment
  1. Patricia Jane #

    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?

    January 22, 2014
  2. Lilian Riad-Allen #

    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

    January 24, 2014
    • Patricia Jane #

      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.

      January 24, 2014
      • lilian.riadallen@camh.ca #

        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,
        Lilian

        January 28, 2014
  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
    Director
    Ontario Campaign for Action on Tobacco

    February 10, 2014
  4. Lilian Riad-Allen #

    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,
    Lilian

    February 10, 2014
  5. Patricia Forsdyke #

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

    April 22, 2014

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