Systemic Issues – systemic solutions
In the United States, over the past decade or two there has increasing pressure to creates smoke free public facilities. Increasingly, in some states, this has included public housing faculties. As of July 30, 2018, it will include all public HUD/public housing units. It is my understanding that the United States Department of Housing and Urban Development (HUD) will not ban electronic cigarettes although some states may do so.
Samhsa (United Substance Abuse and Mental Health Service Administration) and CDC (Centers for Disease Control) have long advocated for such restrictions. If indeed individuals quit smoking as a result of these new rules there would be consequent savings in health care and in building maintenance.
On the surface, the ban would seem to be advantageous for all those who smoke, all those who are exposed to second hand smoke and all those who are responsible for the maintenance of the HUD facilities. Long gone are the days when even health care professionals believed or pretended as if the use of nicotine in any form was safe to the user and the person exposed to second hand smoke.
Yet, I have some grave concerns about the new policy. First, a reminder of who lives in public housing:
According to the CDC “25 % of adults in the United States have some form of mental illness or substance use disorder, and these adults consume 40% of all cigarettes smoked by adults. Samhsa reports the same figures.
The new rules allow some latitude in terms of the consequences of being caught smoking in HUD facilities. Some will first issue warning letters. Some will even refer individuals for smoking cessation programs. or substance abuse cessation programs. All will eventually evict a person if the behavior continues. It is my understanding that once evicted from public housing it can be very difficult to ever get approved again.
Sadly, we know that nicotine addiction is one of the toughest addictions to treat. Many of those addicted cannot use Chantix or other medication assisted approaches because of co-occurring disorders. One cannot risk increasing symptoms such as depression or anxiety.
I have a number of questions:
As a health care professional and as an individual who has not used any tobacco products for many years, I do not want to be exposed to second hand smoke. I am very grateful that most hotels and other public facilities which I visit are smoke free.
As a human and a community member I emphasized with those who struggle with any sort of addictive disorder. I know that I could be the one struggling with an additive disorder.
As a community members who believes we are meant to take care of each other I feel responsible for my neighbors. Most of us, given the right set of circumstances could easily become homeless.
Once homeless, how does one take care of oneself? How is the rest of the community affected? What are the direct and indirect costs of homelessness?
The goals of reducing the use of nicotine, exposure to second hand smoke, the maintenance cost of HUD buildings are very laudable. It may be that some individuals who are already motivated to become non-tobacco users will use the new rules as additional motivation to quit the use of tobacco. I am fearful that many will not be able to do so.
Once again, instituting a policy without planning for the potential long-term consequences is not, I believe, a realistic approach to what most of us agree is a serious issue. Attempting to problem solve without viewing a problem as a systemic one, never works well long term.
Let’s do, as a community, put on our creative hats and together problem solve looking at all potential solutions and all potential consequences of said solutions.
Written July 5, 2018
In the United States, over the past decade or two there has increasing pressure to creates smoke free public facilities. Increasingly, in some states, this has included public housing faculties. As of July 30, 2018, it will include all public HUD/public housing units. It is my understanding that the United States Department of Housing and Urban Development (HUD) will not ban electronic cigarettes although some states may do so.
Samhsa (United Substance Abuse and Mental Health Service Administration) and CDC (Centers for Disease Control) have long advocated for such restrictions. If indeed individuals quit smoking as a result of these new rules there would be consequent savings in health care and in building maintenance.
On the surface, the ban would seem to be advantageous for all those who smoke, all those who are exposed to second hand smoke and all those who are responsible for the maintenance of the HUD facilities. Long gone are the days when even health care professionals believed or pretended as if the use of nicotine in any form was safe to the user and the person exposed to second hand smoke.
Yet, I have some grave concerns about the new policy. First, a reminder of who lives in public housing:
- Those on disability because of a mental illness or a physical disability whose disability check is low enough for them to qualify for assistance.
- Those with a substance abuse disorder who are unable to afford other housing.
- Those with young children who are unable, for a variety of reasons, to afford other housing.
- Senior citizens who may or may not have a mental illness or an addictive disorder.
According to the CDC “25 % of adults in the United States have some form of mental illness or substance use disorder, and these adults consume 40% of all cigarettes smoked by adults. Samhsa reports the same figures.
The new rules allow some latitude in terms of the consequences of being caught smoking in HUD facilities. Some will first issue warning letters. Some will even refer individuals for smoking cessation programs. or substance abuse cessation programs. All will eventually evict a person if the behavior continues. It is my understanding that once evicted from public housing it can be very difficult to ever get approved again.
Sadly, we know that nicotine addiction is one of the toughest addictions to treat. Many of those addicted cannot use Chantix or other medication assisted approaches because of co-occurring disorders. One cannot risk increasing symptoms such as depression or anxiety.
I have a number of questions:
- What happens to those who are unable to stop smoking in the HUD facilities and get evicted? Where do they live?
- How many of them would become homeless?
- How much assistance would be provided for those with co-occurring disorders such as other addictions or acute mental illness?
- How many available beds in treatment facilities which accept Medicaid?
- How many mental health or substance abuse treatment centers are prepared to treat nicotine addiction.
As a health care professional and as an individual who has not used any tobacco products for many years, I do not want to be exposed to second hand smoke. I am very grateful that most hotels and other public facilities which I visit are smoke free.
As a human and a community member I emphasized with those who struggle with any sort of addictive disorder. I know that I could be the one struggling with an additive disorder.
As a community members who believes we are meant to take care of each other I feel responsible for my neighbors. Most of us, given the right set of circumstances could easily become homeless.
Once homeless, how does one take care of oneself? How is the rest of the community affected? What are the direct and indirect costs of homelessness?
The goals of reducing the use of nicotine, exposure to second hand smoke, the maintenance cost of HUD buildings are very laudable. It may be that some individuals who are already motivated to become non-tobacco users will use the new rules as additional motivation to quit the use of tobacco. I am fearful that many will not be able to do so.
Once again, instituting a policy without planning for the potential long-term consequences is not, I believe, a realistic approach to what most of us agree is a serious issue. Attempting to problem solve without viewing a problem as a systemic one, never works well long term.
Let’s do, as a community, put on our creative hats and together problem solve looking at all potential solutions and all potential consequences of said solutions.
Written July 5, 2018
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