State Council Endorses Addressing Tobacco Use Disorders at Addiction Treatment Programs

Beer and cigaretteThe Governor’s State Council on Alcohol and Other Drug Abuse (SCAODA) last month voted to adopt a policy that recommends integrating Tobacco Use Disorders into Wisconsin Substance Use Disorder treatment services, and to make it a standard of practice at recovery centers.

SCAODA was established by state statute to advise all state departments on all matters related to treating Substance Use Disorders (addictions). It is comprised of stakeholders, including representation from both parties and legislative houses, from across the state.

For 30 years, when the Wisconsin administrative code defined “Substance Use Disorder,” it explicitly excluded nicotine dependence.

By unanimously approving the new measure to remove that exclusion, the governor’s council took a significant step forward in opening the door to allowing people addicted to nicotine to get outpatient, inpatient, or residential care at addiction treatment centers.

The proposal was shepherded by David “Mac” Macmaster, an addiction-recovery expert and managing consultant to the Wisconsin Nicotine Treatment Integration Project (WINTIP), a collaboration between the Wisconsin Department of Health Services and UW-CTRI. Under the direction of UW-CTRI Researcher Dr. Bruce Christiansen, WINTIP has been working for 13 years towards the goal of integrating treatment of tobacco use into standard behavioral healthcare.

David Macmaster on smoking and behavioral health
WINTIP Managing Consultant David “Mac” Macmaster discusses why the state council’s endorsement is a milestone for behavioral health patients who want to quit smoking. To watch the video, click here.

While the council’s move is highly significant, it’s still only a SCAODA policy recommendation. As such, it recognizes that counselors in residential settings can and have treated tobacco use with success, have billed for it under general addiction services, and have found anecdotally what research has said for years:

Patients who quit smoking are 25 percent more likely to recover from other addictions, are more likely to be happier and to have reduced symptoms from mental illness.


“I know, first-hand, what smoking and my addictions, how they go hand in hand,” said Ronnie (right), a former patient at Libertas, a residential recovery center in northern Wisconsin. “This was my sixth time through a 30-day treatment, and I relapsed. I kept smoking.” He finally quit everything when Libertas helped him quit smoking. “It feels great to be tobacco-free, I’m not a prisoner anymore.”

“Whenever I’d go out drinking, I’d need a pack of cigarettes,” said Brandon, a past Libertas patient. “For me, they go hand-in-hand.”

Libertas had success due in part to a grant from WINTIP to integrate tobacco treatment into its treatment protocols.

Still, unfortunately, many patients in recovery across the state don’t get the help they need to quit smoking.

Macmaster pointed out that all the mechanisms are in place—counselors already know how to treat addictions and insurers could pivot to cover it as they do other substance-use disorders. It just needs the administrative infrastructure and systems changes.

With this recommendation in hand, Christiansen said he hopes to meet with state bureau officials to get treatment of tobacco use into state contracts with addiction treatment programs. “It takes more than just making things available,” he said. “There has to be training, support, requirements and funding.”

It took more than a decade to get this far, but Macmaster is hoping we are reaching a tipping point. “We now have clear leadership at the top agreeing with our view of what needs to be done.”

Macmaster said he hopes one day treating Tobacco Use Disorders will also be a requirement for addiction-counselor certification and program quality-assurance compliance.

He said recent police shootings of intoxicated citizens and the COVID-19 pandemic are both signs society needs to help people who are addicted to substances now more than ever. Further integrating Tobacco Use Disorder treatment into behavioral healthcare would be a positive step, he said, and it’s long overdue. So much so that he asserted it’s malpractice to not provide evidence-based treatment for the leading preventable cause of disease and death in the nation.

Macmaster has tirelessly advocated for decades to help those who are underserved.

“SCAODA, after years of study, is saying we want this,” Macmaster said. “As far as implementing this, it’s challenging but it can be done.”