Breaking the Myth: Tobacco-Free Policies Don’t Hurt Retention in SUD Treatment

jameliahand
Aug 19
3 min read

By Jamelia Hand MHS CADC CODP I

Aiden (34), struggled with opioid and alcohol use disorder for years. When he checked into a residential SUD program, he faced not only the challenges of sobriety but also a well-worn habit, smoking. The program had recently gone tobacco‑free, which initially felt like a double burden. Aiden worried, “If I can’t even smoke, how can I handle detox?” The silence outside room doors felt heavy and judgmental.

On admission, however, he was offered nicotine replacement therapy (NRT). He started with patches and, later, gum when cravings hit. He met a counselor who’d gone through similar struggles; her empathy helped Aiden feel seen, not shamed. On day three, he faltered: the patch that morning didn’t seem enough. But the nurse was ready with lozenges and encouragement. That made all the difference. Aiden stayed through withdrawal; not just of substances, but of habits he hadn’t dared face before.

By week two, Aiden was quieter and more present, no longer ghosted by cravings, but grounded. The program celebrated small wins, like when he took a smoke‑free pledge during group. At graduation, he didn’t just walk out sober, he walked out health-ready. “Quitting smoking isn’t easy,” he admitted, “but having the support made it possible.”

Philadelphia Citywide Ban (2019)

In January 2019, Philadelphia mandated tobacco‑free policies across its 80 city-funded inpatient SUD treatment programs (including detox centers, short‑ and long‑term rehab, and halfway houses) sources from WHYY and related evaluations. Six months later, the number of people entering treatment increased by nearly 19 % compared to 2018, while the AMA rate held steady around 20 %, unchanged since 2015; thus, showing that fears of patients fleeing due to a smoking ban were unfounded.

Veteran Residential SUD Programs (JSAT, 2019)

A study of veterans in residential SUD treatment found that implementing a tobacco‑free policy did not reduce client engagement or retention. Instead, the use of NRT rose alongside interest in quitting smoking.

California Residential Programs (Multi-Site Interventions)

Several California programs demonstrated substantial reductions in client smoking prevalence following tobacco‑free policy implementation. In one initiative, smoking dropped from 54.2% to 26.6% among clients over about 15 months. The programs also increased NRT and cessation support use.

Implementation Infrastructure (Texas TTTF Program)

Under the Taking Texas Tobacco Free (TTTF) initiative, programs implemented policy changes alongside staff education, clinician training, resource provision (like NRT), and technical support. Results included increased tobacco screening, NRT distribution, and clinician-delivered cessation interventions.

Broader Context: Why Tobacco-Free Policies Often Stumble, But Can and Should Succeed

In 2023, only 33.9% of SUD treatment facilities reported having tobacco-free policies, and among those, 40% offered NRT, and about 70% offered counseling. There's still a significant gap between policy support and on-the-ground implementation.
Historically, fear of patient drop‑out and beliefs that quitting smoking interferes with recovery discouraged policy adoption, despite evidence to the contrary.

Some Key Lessons & Principles

NRT from Day One- Aiden’s experience mirrors evidence: immediate NRT on admission (patches, gum, lozenges) counters nicotine withdrawal and lowers AMA risk.
Staff Training + Clear Communication- Train clinicians in the “Five As” (Ask, Advise, Assess, Assist, Arrange), tobacco-related care, and ensure messaging to clients is supportive, not punitive.
Pair Policies with Support Services- Offer NRT, counseling, quitlines, and even peer support to create a safety net (not a cliff edge) when removing smoking as an option.
Use Data to Reassure Stakeholders- Point to the Philadelphia city evaluation, veteran program studies, and California prevalence drops to counter fears about dropping admissions or higher AMA.
Invest in Organizational Capacity- Low-resource settings often show the greatest gains when given training and tools; don’t let perceived lack of readiness block progress

How Vantage Brings This to Life

At Vantage, our mission is to ground policy in pathways to success:

Immersive Storytelling: We weave personal narratives, like Aiden’s, into policy briefs, engagement sessions, or training decks to humanize the data.
Implementation Blueprints: Ready-to-deploy templates for NRT order sets, staff training modules, policy language, and communication plans.
Real-time Data Tools: We help you track admissions, AMA, nicotine treatment uptake, and smoking outcomes to measure impact and adapt.
Stakeholder Story Packs: Arm your leadership with balanced, visual stories: story narratives, evidence tiles, and data dashboards showing that going tobacco-free doesn’t compromise care, it elevates it.