Drug & Alcohol Recovery Center Goes Tobacco-Free

In April 2022, when the annual spending on cigarettes and nicotine patches at the Stout Street Foundation approached $100,000, Sharol Wells, CEO and President of the Stout Street Foundation, knew something had to give. 

The $100,000 expense represented about 12% of the addiction recovery center’s budget.

But the issue involved health as well. People who receive support to quit smoking at the same time as treatment to quit drugs or alcohol, according to research, are 25% more likely to stay clean long-term.

But Wells was worried. This wouldn’t be the first time Stout Street tried to snuff out smoking. And the first time didn’t go well. 

The first push, in 2006, prompted what Wells called “the mutiny.” Residents smuggled in cigarettes. They smoked in the basement and dorm rooms, and some residents climbed up on the roof. Fires were a worry. In the face of the revolt, the staff caved. The weekly allotment of free cigarettes, however, was dropped from four packs per resident to two. Calm was restored.

Removing cigarettes from the addiction recovery center was tricky business. Since Stout Street Foundation opened its doors nearly 50 years ago, residents had been supplied with free cigarettes. Residents aren’t allowed to leave the facility other than for work development programs, so cigarettes were provided — no different than food and water. Weaning residents from other drugs and alcohol was the priority. The center currently serves 95 residents in a two-year program and another eight in a 28-day “intensive” treatment program.

“The idea was that the residents would stay in therapy when you keep them happy,” said Wells. 

Wells knows that tradeoff. She is a former Stout Street Foundation resident. She was treated at the facility in the late 1990s for an addiction to crack cocaine. When she walked in for the first time (when Wells was given the choice of either going to treatment or prison), Wells said she was floored to discover that cigarettes were free. 

“I thought this was the coolest thing ever,” recalled Wells, who smoked for 25 years. “Why do we get all these cigarettes? What’s happening here?”

Wells, who went from resident to staff member when she graduated from the program in 1999, and later promoted to president in 2022, said she has occasionally raised the idea of going smoke-free over the past 10 years. But she was warned against it. The staff was afraid of a repeat of “the mutiny”.

The cost of tobacco kept rising but there was another problem, too. Residents are not allowed to keep their own cell phones, so there was a logistical problem with helping residents make regular calls to the Colorado QuitLine for free nicotine patches and lozenges. With the residents working offsite at job locations, it was a challenge to figure out how and when each of them would place those calls. 

One idea was to have family members donate cigarettes, but Wells took the idea to a staff meeting, and it was rejected. “That wasn’t happening,” said Wells. “We didn’t want family members helping with any kind of an addiction.”

So Wells called the University of Colorado’s Behavioral Health and Wellness Program (BHWP) and the Denver Department of Public Health & Environment in search of bulk nicotine patches. The staff at BHWP offered something better. “They said, ‘What if we were to come out and train your staff on what it looks like to teach your residents to be non-smokers?’” said Wells. 

It was April 2022. Wells thought that broaching the idea of going smoke-free was “scary” but knew, this time, that the rollout would require planning.

First, Wells  invited BHWP to lead a training for her five staff members in the fundamentals of tobacco, including nicotine replacement therapy. She drew on resources from the departments of health in Denver and Adams counties, whose populations Stout Street Foundation serves. And the staff started prepping residents with messages — posters and signs were posted around the facility that warned about the health problems associated with smoking. 

And, this time, the staff collaborated with the residents.

“We talked to the residents, and they gave us suggestions on how things would work for them,” said Wells. “My goal was to treat the whole client — to not only help them in their health with substance abuse, but also in helping them to be healthier individuals without the issues of lung cancer or the things that come along with using cigarettes and tobacco, because it’s horrible.”

In February of this year, Stout Street staff began weaning residents off tobacco — down to one free pack each week, though residents are given all the nicotine lozenges and patches they need to subdue cravings. The center obtained a supply of 21,000 patches from National Jewish Hospital.

The center also engaged local artist Darrell Anderson to work closely with residents to design, sketch and ultimately paint a six-canvas mural that serves as a unifying symbol of the journey to maintaining a smoke-free environment. 

And on May 1, Stout Street Foundation went smoke-free. 

So far, so good. Of the 95 residents, 20 completely quit. Another 50 are weaning themselves off nicotine with patches, reducing the dosage as they progress. The rest are in the process of choosing their best option. And when residents violate the policy, Stout Street Foundation is choosing an approach that doesn’t involve punishment.

It’s been almost two months since Stout Street Foundation went smoke-free and, so far, no resident has left due to the new policy.

“I could not see myself going back to smoking cigarettes,” said Carly S., who arrived at the Stout Street center in April 2022 to fight a pill addiction. Carly started stealing her mother’s cigarettes at age 12. She thought smoking was cool at the time and became a heavy smoker for 16 years. She’s 41 years old now. She switched to patches and lozenges last September but is grateful that Stout Street Foundation went smoke-free this spring to further remove the temptation. “This is a hard program and a lot of work,” says Carly, “but it’s definitely worth it.”

Resident Nicholas G. agrees that living in a smoke-free environment is critical. Nicholas, who endured an abusive childhood and is being treated for addiction to drugs and alcohol, chewed through two cans of tobacco and smoked a pack of cigarettes every day. The training at Stout Street Foundation, he said, has helped him realize that all his addictions, including tobacco, were holding him hostage. “I’m in control of making my day better as long as I project the right wavelengths in my life,” he said.  

Wells knows that quitting tobacco is not easy. Anxiety and depression are real. Emotions come up. Long-time smokers are enduring detox. Coping skills are required. 

“It has been difficult,” says Thomas P., who checked himself into Stout Street Foundation because of an addiction to meth. With no court case holding him at the center, he could walk away to smoke. “There are moments where I’m like, ‘O.K., you know, I’m out of here.’ But then it’s like, O.K., it’s just a cigarette. Like, am I really going to derail the progress that I’ve made here over something as trivial as a cigarette?”

If you’re involved with a behavioral health care or substance abuse treatment facility that may be interested in taking steps towards a tobacco-free policy, please contact Derek Noland with the University of Colorado’s Behavioral Health and Wellness Program at derek.noland@cuanschutz.edu or Peggy Sarcomo with the Denver Department of Public Health and Environment at peggy.sarcomo2@denvergov.org for more information.