treatment beyond detoxification typically is a
medical necessity.^57 In 2008,* only 12.6 percent
of discharges from detoxification programs
transferred to a treatment facility. About one in
10 (10.8 percent) of alcohol detoxification
discharges were transferred to a treatment
facility, as were 20.7 percent of marijuana
detoxification discharges, 13.6 percent of other
illicit drug detoxification discharges,† 18.2
percent of prescription drug detoxification
discharges and 13.9 percent of multiple
substance detoxification discharges.^58 Another
study found that only 32.8 percent of Medicaid-
enrolled adult patients discharged from
detoxification received follow-up care within 30
days of discharge.‡ 59
Addiction Treatment Rarely Addresses
Smoking. Although recent scientific evidence
underscores the unitary nature of the disease of
addiction and the consequent need to address
addiction involving all substances,^60 many
addiction treatment providers continue to
address addiction involving alcohol, illicit drugs
and controlled prescription drugs while largely
ignoring addiction involving nicotine.^61
Smoking cessation services are not commonly
implemented in addiction treatment settings^62 or
in psychiatric treatment settings.^63
The reluctance to provide smoking cessation
services to patients in treatment for addiction
involving alcohol or other drugs stems in part
from an unfounded concern that it might
jeopardize patients’ ability to abstain from
alcohol or other drug use.^64 There is no
evidence that quitting smoking interferes with
- Most recent available data.
† 19.4 percent of opioid (other than heroin)
detoxification discharges, 16.4 percent of
cocaine/crack detoxification discharges and 12.4
percent of heroin detoxification discharges
transferred to a treatment facility.
‡ This disparity stems in part from financial
constraints. Some insurance plans pay only for
medical detoxification but not for addiction treatment
including psychosocial and pharmaceutical therapies.
Some plans that do cover both detoxification and
treatment manage them separately, making continuity
of care difficult.
the effectiveness of treatment for addiction
involving alcohol or other drugs.^65 In fact,
research shows improved addiction treatment
outcomes among patients who receive smoking
cessation services, including reduced risk of
relapse following treatment and improved
outcomes for co-occurring addiction involving
alcohol.^66 In light of this evidence, some states§
are banning smoking in addiction treatment
facilities and requiring that smoking cessation
services be provided to patients.^67 Making
smoking cessation a key component of addiction
treatment programs would go a long way toward
improving treatment outcomes as well as the
long-term health of patients with addiction.^68One study found that fewer than half (43
percent) of addiction treatment programs in the
United States offer formal smoking cessation
services; no data are available on the extent to
which nicotine addiction is fully integrated into
these treatment programs.** Among those that
do offer cessation services, more offer
pharmaceutical interventions than psychosocial
interventions (37 percent vs. 18 percent).^69Although rates of smoking among adolescent
addiction treatment patients are high and
effective interventions are available,^70 less than
half (42.8 percent) of treatment programs
designed specifically for adolescents offer
smoking cessation services; 13 percent offer a
comprehensive formal program with
pharmaceutical therapy, 15.3 percent offer
counseling only and 14.5 percent offer
pharmaceutical therapy only.^71Less than 20 percent of addiction treatment
providers received any training in smoking-
related issues in the past year.^72 This is despite
the fact that the majority (between 65 and 87
percent)†† of patients in addiction treatment§ NY, NJ, WA.
** CASA Columbia’s survey of directors of addiction
treatment programs in New York State found that the
majority (89.2 percent) indicated that treatment for
addiction involving nicotine is offered in their
addiction treatment programs.
†† Data based on a review of several studies.