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SALT LAKE CITY — It's Dusti Benavidez's fifth day at Volunteers of America, Utah's Adult Detoxification Center, and she's craving a smoke — big time.
The facility is smoke-free under the state's Recovery Plus initiative, which requires all substance abuse and mental health treatment facilities that receive public funding to be tobacco-free by March 2013.
Salt Lake County instituted the change ahead of schedule. At VOA's short-term detox center, the change has meant some clients aren't completing the program. Others are shying away completely and that's causing concern among both the clients and those who are there to help them.
"The cigarette thing almost made me walk out," Benavidez said Monday.
"I mean I've been here five days and it's all I'm thinking about. Is there any chance someone can leave a cigarette on the window sill? I'm looking at butts on the ground, even though I don't have any way to light up. I mean, what's wrong with me?"
The impact of the change is significant because the vast majority of clients in the mental health and substance abuse treatment programs are smokers. Three- fourths of those in publicly funded mental health programs smoke, while 66 percent of those in substance abuse programs are smokers, according to the Utah Division of Substance Abuse and Mental Health.
Andrew Johnston, residential service director for VOA Utah, said he's aware of a number of detox clients who have left the program prematurely, which means they do not receive the assessments they need for admission to treatment programs.
"We're waiting to see if our numbers rebound to previous levels. It hasn't fully responded," he said.
I understand we have to climb a mountain to get clean. Can we climb one mountain at a time?
–Dusti Benavidez
Benavidez, who is in her first attempt of overcoming a longtime addiction to "booze, pills and meth," said she hopes that the additional challenge of giving up smoking does not become too onerous.
"I understand we have to climb a mountain to get clean. Can we climb one mountain at a time?" she said.
Rick Hendy, program administrator of adult mental health for the state Division of Substance Abuse and Mental Health, said research shows that people who also give up smoking during substance abuse treatment have a 25 percent greater likelihood of long-term abstinence from alcohol and other drugs.
While Hendy, a veteran mental health administrator, acknowledges the initiative is a "culture change," he's convinced the long-term benefits are worth the initial discomfort of coping with the new practice.
The initiative has two basic principles: No one will be denied treatment because of their tobacco use. Education and nicotine replacement therapy will be provided to all clients.
The overarching goal of the initiative is to promote health and wellness among Utah clients with mental illness and/or substance abuse, whose average life spans are 29 years shorter than the general population, according to a recent study.
"When this research came out showing so many people were dying so young, I knew that was true. I'd been to so many funerals. I've spoken at so many funerals of people with mental illness," Hendy said.
Knowing the statistics, treatment providers said they had an obligation to help.
"We're health care providers. We have a responsibility to view ourselves as health care providers," Hendy said.
The initiative has had other benefits. A number of people who work at the affected mental health or substance abuse facilities have also given up smoking.
Johnston said he agrees with objectives of Recovery Plus because the long-term data show smoking cessation helps people maintain their sobriety.
"We're still on board with Recovery Plus but we're still trying to figure out how to best implement it in a detox environment," he said.
The center, which is funded by Salt Lake County, may ask the state for a waiver from the requirement if the number of clients continues to drop. It is in the process of collecting data to determine whether that will be necessary, Johnston said.
VOA client Jason Gove, who has been in the detox program nine days, said he had to surrender the two packs of cigarettes when he walked in the door. He was not aware of the no-smoking policy until he arrived at the facility.
Now, he's using a nicotine replacement therapy patch to help with the cravings. "I'm glad I'm (working) in the kitchen because I stay busy. I'm fighting this all the time."
But he also recognizes that successful completion of the detox program is the first step in dealing with his longtime addiction to pills and alcohol. That means no smoking while in treatment.
"I was going down the wrong path. I knew I'd end up in jail or dead. My kids are like, 'Dad, please.'"
Another client, Jim Shadduck, has been sober for nearly 11 months. He said he's been an alcoholic for nearly 40 years and until the past year was drinking a half gallon of vodka a day, he said.
After several failed marriages, the loss of his children and an inability to hang onto a job, "I was getting low enough I knew I had nothing left. I was really at the bottom of my life."
His stay in rehabilitation is funded by the U.S. Department of Housing and Urban Development, which means he can leave the center to work. When he's not at the VOA detox center, he can smoke.
He has observed, however, that the policy is taking its toll on people going through detox.
"A lot of people aren't staying more than one or two days," he said. "If you can't smoke, your anxiety level goes up. They're already coming off addiction. They want to stay for 14 days and get that assessment but they can't take the pressure."
Shadduck, who is abiding the tenets of Alcoholics Anonymous, has not yet tackled quitting smoking.
"I'm in the middle of the fourth step, which is one of the hardest steps to do. It's causing anxiety already."
While people who are not smokers or addicts may not understand the additional challenge of giving up tobacco, Shadduck said the addicts themselves must commit to change.
"You have to want sobriety more than anything. You can't do it for your wife. You can't do it for your mother. You can't do it for your kids. You have to do it for yourself."
As for Benavidez, her promise to her children to get sober is her motivation to endure detox, which means respecting the no-smoking policy.
"If I didn't have my kids I wouldn't make it now," she said. "If I walk out, I'll disappoint my daughter so much. I've been this close to it, all over a cigarette."
