UW-CTRI to Help Train Substance Use Providers on New DHS 75 Requirements

Journey is a tobacco-free campusThanks to funding from the Wisconsin Department of Health Services (DHS) Tobacco Prevention and Control Program (TPCP), UW-CTRI will provide training and technical assistance to public health professionals across the state to help patients with substance use disorders quit smoking, in support of new state requirements in the revised Wisconsin Administrative Code DHS Chapter 75.

Specifically, Section 75.23: Service Levels of Care includes added language that strengthens standards regarding tobacco treatment and smoke-free facilities. Wisconsin providers who treat substance use disorders are required by October 2022 to formulate plans to assess and treat tobacco use and have a policy about smoke-free environments.

UW-CTRI will conduct three activities to help Wisconsin substance use providers fulfill or surpass the new code requirements. They will:

  1. Expand knowledge and develop information and resources regarding DHS 75.
  2. Provide training and technical assistance to substance use providers across Wisconsin about how to incorporate evidence-based treatment for tobacco use into their standard of care and establish smoke-free campus policies.
  3. Measure the outcomes of these activities.

Information and resources will include a special web section on DHS 75, a web-based toolkit, webinars, emails, and both proactive and reactive training and technical assistance by UW-CTRI regional outreach specialists.

Early in 2022, UW-CTRI will conduct a brief survey of substance use providers to gauge initial compliance with the new DHS 75 requirements. UW-CTRI will also request current protocols to treat tobacco dependence and copies of smoke-free campus policies. The collected information will be summarized in a report to TPCP.

The potential benefits from this project are substantial. According to the US Substance Abuse and Mental Health Services Administration (SAMHSA), while people with serious mental illness smoke about twice the rate of the general adult population, services to help them quit lag. In 2017, only 39 percent of mental health treatment facilities in the United States provided cessation counseling. Only about 25 percent of these facilities offered medications to help people quit tobacco use. Furthermore, only half of mental health treatment facilities had smoke-free policies both inside and outside their facilities. According to the Public Health Law Center, as of March 15, 2020, 11 states require tobacco-free grounds for most mental health facilities. Five states require tobacco-free grounds for most substance use facilities.

Yet, some states have demonstrated successes while trying to change that trend. For example, in 1999, New Jersey became the first state to require residential treatment centers to assess and treat tobacco dependence as well as maintain smoke-free facilities and campuses as a matter of maintaining licensure. A year later, all 30 residential programs surveyed provided some tobacco dependence treatment and half had tobacco-free grounds. Eighty-five percent of the programs accepted the state’s offer to provide free medications to quit tobacco use, reaching more than 2,326 clients. Seventy-seven percent of all clients smoked, and 65 percent of those who smoked reported they wanted to stop or cut down tobacco use (Journal of Substance Abuse Treatment, Dr. Jill Williams et al). However, due to weak enforcement, some of those gains have receded in recent years.

“People with substance use disorders want to quit, and we’ve seen time and again that they can quit with evidence-based help,” said WiNTiP Project Manager Karen Conner. “What’s more, they tell us that nicotine is a trigger for their other addictions—and quitting nicotine helps them quit all substances of abuse.”

This new work on DHS 75 requirements expands on that of the Wisconsin Nicotine Treatment Integration Project (WiNTiP), co-founded more than 13 years ago by WiNTiP Managing Consultant David “Mac” Macmaster and WiNTiP Committee Member Dr. Eric Heiligenstein. WiNTiP has been supported by funding from DHS and managed for years by UW-CTRI Distinguished Scientist Dr. Bruce Christiansen, and now since his retirement by Conner. Several other UW-CTRI employees have served on the committee since inception.

WiNTiP educates and advocates for behavioral health patients to have access to evidence-based treatments to help them break free from tobacco addiction, the leading preventable cause of disease and death in Wisconsin and across the nation.