Meet Colette

Why did Cyrenian House decide to become smoke free?

In the alcohol and other drugs (AOD) treatment sector it has been a long-term view that when people are coming in for treatment, they’re coming in to treat their illicit drug use or their alcohol use. There has been a view that smoking is completely separate to that, and if anything, asking people about their smoking would have been too difficult. As a result, smoking was a very normalised behavior that was strongly associated with socialising within AOD treatment. Unfortunately, this meant that sometimes, you had non-smokers taking up smoking whilst they were in treatment and leaving with that as an addiction.

We now have access to research that shows that quitting smoking can actually help people abstain from other drugs and remain AOD free. We also became aware that smoking is the most harmful behavior that people can engage in, in terms of substance use, given that it kills more people than any other drug. It didn’t sit right with us that we were condoning tobacco use while talking about harm minimisation and prevention of harm as it related to illicit drug use and alcohol use.

How did you manage the change towards becoming smoke free?

The biggest change was in the residential programs. We used our therapeutic community model to inform our process of becoming smoke free. We’ve tried to go about the change in a very positive way. We didn’t say to people ‘you can’t smoke’, what we did say is that we can offer you a smoke free treatment environment. Once we communicated this, we worked with the community to develop strategies that would work.

A lot of work was done to bring people along rather than impose a smoke free regime on people. A strong emphasis was placed on sharing the information and the rational for becoming smoke free, and supported both staff and residents throughout the change. Tim, the senior therapeutic counsellor was responsible for this and championed the change on site. . He provided a space for staff and residents to have input and articulate their fears throughout the process.

Working in AOD, the issues of relapse, relapse prevention, addictive behaviours, and stages of change are all very familiar to us. Increasing staff awareness that these same concepts apply to smoking as they would with any of the other illicit drugs or alcohol was important.

Were staff hesitant to talk about quitting?

Some staff were ambivalent about talking to people about their smoking, particularly those who smoke. Ultimately, we expect staff to integrate smoking cessation support into their job role. People do need to have a conversation with residents and with potential clients around the harms associated with tobacco use, the benefits of quitting and the strategies that we can use to support them to do that. However, providing a space they could express their concerns was important, as well as providing support to staff who wanted to quit smoking themselves - we continue to do that.

What support is provided to clients when they enter the program at Cyrenian?

Now, prior to engagement with our residential programs we offer pre-entry support to people. This involves a three session group program for people who are smokers to help them to quit before they come into treatment. Then, when people come into the Therapeutic Community they are given a smoking cessation program that takes about 10-15 minutes of their day for a 2 week period and that’s to help them look at their smoking behavior and manage their withdrawals. If someone breaches the smoke free rules of the program, they are put back onto that smoking cessation program to revisit some of the issues and principles they’ve learnt previously and to re-integrate them into their recovery program. People are also supported by their peers and counsellor.

What happens if a client is found smoking?

For us, smoking is seen as any other breach of the program rules and we will encourage and support people to address their behavior immediately. Staff and residents are encouraged to ‘flag’ residents for breaching the smoke free rule. If someone is flagged, they are asked to refrain from engaging in that behavior and to address the particular issue. If they continue, that are given a card which makes it much more serious and people know that if they have two cards they are at risk of being suspended from the program for a period of time and ultimately, they can be discharged.

Did you change any organisational processes when you became smoke free?

Yes. We now advertise that we are a smoke free treatment facility. We also ask clients about their smoking at intake or even before, it’s on the list just like any other drug. We’ve also increased our emphasis on healthy eating and lifestyle and our therapeutic communities have onsite gyms that people can use.

What would you recommend for other organisations considering to become smoke free?

For other organisations considering to become smoke free, I would recommend holding your nerve and hang onto the core reason why you’re doing this. In our industry and any service that provides support, care or treatment to people you have to remember that smoking is the leading cause of death. So, hold your nerve, continue to talk, discuss it, share concerns and try to get as much buy-in as possible. It’s a bit of a rollercoaster and journey into the unknown, but you have to very clearly give the message that this is something you are going to follow through to the end. For us, the key was planning, taking about it and sticking to it.

Did becoming smoke free affect the number of clients accessing your service?

The number of people assessing for our residential programs did decrease in the first 6 months. We had expected that and we knew our occupancy rates would go down. We pretty much rode that one out and waited for people to come to terms with the fact that we were smoke free. Gradually, our numbers came up again. It probably took at least 6 months for it to become clear that this was an ongoing smoke free program. Now, we get feedback from people that they really like the fact that it’s smoke free. It was a short-term cost for a long-term gain.

Has it affected people’s recovery from other substances?

It hasn’t taken away from other substance abuse recovery, without a doubt it has enhanced what we offer. It doesn’t meant that it’s not difficult for people, I think it really is, but by and large I think it works very well for the majority of people that come in.

 Have you noticed any positive changes since becoming smoke free?

I’ve worked in treatment services for many, many years. I think the sense of wellbeing you create from a clean environment, a smoke free environment is huge. The feeling of wellness that people have is significant and there is a great sense of optimism when people realise they can actually get rid of a habit that they’ve had for years for once and for all. It creates a sense of hope for ongoing health and recovery for people.

Click here to read more stories from the sector.