A smoke-free chemical dependency unit. The Cleveland Clinic experience.

An attempt to eliminate smoking from the CCF chemical dependency unit resulted from an institutional mandate that the campus be smoke-free. Initially, patients were given the option of either not smoking or smoking outside with staff supervision. Those who opted for smoking cessation received no specific treatment for nicotine addiction, but were only given snacks, therapeutic activities, and stress management techniques to aid in their effort. The initiative failed. Patient and staff resistance, hazardous conditions due to surreptitious smoking, and interference with other treatment components led to suspension of the policy. A second attempt, thought to be a superior design, included therapeutic interventions similar to traditional addiction treatment; however, it also failed to produce nicotine recovery in most patients. It was noted that patients with such adverse consequences from nicotine as emphysema or cancer could be motivated to recover from nicotine addiction and were helpful in motivating those without consequences to stop smoking. Significantly, despite several patients' refusal to enter or continue in treatment due to the no smoking policy, unit census actually increased.