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Building a Tobacco-free Future for Minnesotans with Mental Health and Substance Use Disorders
Despite years of success in lowering the rate of adult tobacco use and its diminishing health consequences among the general population, this benefit has not been realized among persons with mental illness or substance use disorders. The disproportionate impact of tobacco use on these individuals’ lives is striking. Recent studies show that people with mental illness or substance use disorders (SUD) are more than twice as likely to smoke cigarettes as adults without these conditions, are more dependent on tobacco, smoke more heavily and are actually more likely to die from tobacco-related illness than from the result of their mental health or substance use conditions. 75% of adults with serious mental illness and/or substance use disorders want to quit smoking, but only 40% of Minnesota’s mental health treatment facilities and 31% of substance use disorder treatment programs offer tobacco treatment.
Tobacco Treatment Improves Mental Health and SUD Outcomes Contrary to long-held beliefs, treating tobacco dependence not only helps improve overall health but mental health as well. People with SUDs who are treated for tobacco in addition to other addictive substances have a 25% greater chance of long-term abstinence than those who do not receive tobacco cessation services. Evidence suggests the beneficial effect of stopping smoking on symptoms of anxiety and depression can equal that of taking antidepressants.
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By Annie Krapek, MPH Program Manager, Twin Cities Medical Society
Working Together to Reduce Tobacco Use Among People with Behavioral Health Conditions Twin Cities Medical Society is proud to be an active part of The Lung Mind Alliance, a statewide coalition that is working to reduce disparities related to the impact of commercial tobacco on people with mental illness and/or substance use disorders.
At least 13 states require mental health and substance abuse disorders treatment facilities to provide tobacco treatment services to their clients.
The coalition is working to close this gap by increasing the number of mental health and substance use disorder programs that offer tobacco treatment and that have tobacco-free grounds using the following tactics: • changingsocial norms around tobacco use by those with mental illness or SUDs, • creatingfree educational resources for health facilities serving this population, • working to increase reimbursement for facilities that provide tobacco treatment, • and building a coalition to integrate tobacco treatment and tobacco-free environments in all Minnesota mental health and substance use treatment settings. The Lung Mind Alliance includes partners from mental health, substance use treatment, and public health organizations, as well as the Minnesota Department of Health and the Department of Human Services.
What Can You Do? Successfully reducing tobacco-related disparities for people with mental illness or SUD will take a team effort. • Challenge myths Many people believe that people with mental illness and SUD do not want to or cannot stop smoking. These beliefs are not true, and you can help by educating your peers about the importance of tobacco treatment for people with mental illness and SUD. • Provide tobacco treatment People with mental illness and SUD may need more intensive support and a longer period of treatment in order to successfully quit tobacco. Providing individual or group counseling along with smoking cessation medications greatly improves the chances that a person will be successful in their quit attempt. • Engage your colleagues Talk with your colleagues about how your workplace can better provide tobacco treatment services and create tobacco-free environments across all settings. By working together, we can help individuals reach their recovery and wellness goals and add years to their lives.
The US House Select Committee on the Climate Crisis is charged with delivering climate policy recommendations to achieve substantial and permanent reductions in carbon emissions and related pollution that are worsening the climate crisis. In September the Select Committee on the Climate Crisis called for public comment and input. Health Professionals for a Healthy Climate (www.hpforhc.org/) responded by submitting the following comments and recommendations: Adaptation and Resilience: Healthcare facilities are critical community and regional resources that are vulnerable to climate extremes. Policies are needed to ensure resilient healthcare systems. We recommend the following steps: A. Enhance CDC/Public Health/FEMA capacities to manage climate/pollution-related health crises and multiple simultaneous climate/pollution-related disasters. B. Increase support for research on infectious diseases entering or spreading within the US due to climate change. C. Increase support for public health departments to develop and implement planning and programs addressing climate change-related vulnerabilities in their jurisdictions. D. Provide support for the evaluation, regulation, and compliance monitoring of health facilities related to: 1. adequate emergency power with a focus on on-site, clean and renewable generation to reduce dependence on vulnerable power grids. 2. supplies, staffing and staff training for prolonged climate/pollution emergencies.
3. facility hardening to withstand weather/climate-related damages. E. Develop and regulate programs to maintain the availability of electronic health records (including insurance coverage information) and on-line communications connecting care providers, laboratories, radiology facilities, pharmacies and other healthcare resources during climate crises. F. In recognition of the heightened vulnerabilities of communities of color and low income communities we recommend: 1. Directives and support for state/ regional health departments to develop transportation/evacuation capabilities and shelter planning and implementation for vulnerable communities. This should include special provision for welfare checks on the disabled, the isolated elderly, and families with small children. 2. Enhanced support for hospitals/ clinics that serve communities of color, indigenous communities, impoverished communities, and communities with higher rates of chronic medical and mental health disorders. 3. Planning and support for the special needs of rural communities to manage climate/pollution-related crises. 4. Planning and support to protect indigenous peoples from climate/ pollution related crises. This should include increased support for Indian Health Services, particularly in the areas of mental health and preventive services. G. Consult with behavioral health professionals to develop interventions that are grounded in psychological and behavioral science to increase engagement, behavior change, and stress resilience. Mitigation: Urgent reduction of carbon emissions, pollution and waste generation from health facilities. We recommend the following: A. Support carbon reduction programs and policies: 1. Implement policies for rapid reduction of carbon emissions throughout the healthcare sector including facilities, transportation services, and medical supply infrastructure. 2. Implement policies that move toward adapted infrastructure. B. Reduce waste and pollution: 1. Institute organics recycling and food donation programs to reduce waste that contributes to methane emissions. 2. Institute waste and pollution prevention/reduction programs including the elimination of single-use materials. C. Institute Sustainability Benefits Programs: 1. Incentivize healthcare sustainability practices, e.g.: hospitals must implement plan to go carbon free. Estimates are that hospitals will save $15 billion by 2050 with basic energy efficiency investments. 2. Incentivize insurers to reduce premiums for healthy behaviors that have a climate co-benefit (e.g., bike commuting, local produce, low meat diets). 3. Institute “green benefits” for patients/staff who use telehealth services, green commuting, etc. 4. Institute incentives for staff/employee pension plans to divest from fossil fuel investments. You can follow their recommendations at https://climatecrisis.house.gov.
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Steven Miles, MD Receives 2019 Shotwell Award
On January 7, 2020, in partnership with Abbott Northwestern Hospital and its Medical Staff, the 2019 Shotwell Award was presented to Steven Miles, MD by Chris Johnson, MD, Chair, Twin Cities Medical Society Foundation. Dr. Miles, Professor Emeritus of Medicine and Bioethics at the Center for Bioethics, University of Minnesota, is known for tackling controversial issues. He participated in the development of the Do Not Resuscitate order and the treatment of tuberculosis in refugee camps. He worked with the failed Clinton healthcare reform and the successful MNsure legislation. He conducted research that largely ended the dangerous use of restraints in nursing homes. He candidly spoke about his mental illness and its prevalence among healthcare providers; his successful lawsuit advanced physicians’ rights to get confidential care of this disability without Board intervention. He exposed medical complicity with torture and has testified in the United States and Africa. For the past 28 years, Twin Cities Medical Society Foundation has held the privilege of serving as the executor and fiscal agent of the Shotwell Award with the award funded through the generosity of Abbott Northwestern Hospital and its Medical Staff. The Shotwell Award has recognized outstanding leaders throughout the State of Minnesota since 1971. This was the final granting of the award. A permanent plaque is located in the Courage Kenny Lobby on the Abbott Northwestern Hospital campus. Dr. Steven Miles (center) receives the Shotwell Award from TCMS Foundation Chair Chris Johnson, MD (Left) and Daniel O’Laughlin, MD, Medical Staff President, Abbott Northwestern Hospital.
BERTON BARRINGTON, MD, passed away on January 7, 2020. An Ophthalmologist, Dr. Barrington practiced for 50 years primarily throughout southern Minnesota and ended his career at the VA Hospital in Minneapolis. Dr. Barrington joined the medical society in 2006.
EDWARD DONATELLE, MD, passed away on January 1, 2020. Dr. Donatelle practiced Family Medicine in Minneapolis. He joined the medical society in 1952.
MATTHEW GALL, MD, passed away on November 28, 2019. Dr. Gall was an oncologist practicing at Minnesota Oncology. He joined the medical society in 2005.
GERALD MULLIN, MD, passed away on December 13, 2019. Dr. Mullin was affiliated with Downtown Internal Medicine (Minneapolis) where he practiced Internal Medicine and Rheumatology. He joined the medical society in 1961.
RICHARD OLSON, MD, passed away on January 19, 2020. Dr. Olson was a family physician in Chaska, MN, practicing for nearly 50 years. He joined the medical society in 1986.
POPATLAL SHAH, MD, passed away on December 31, 2019. Dr. Shah practiced Internal Medicine at North Memorial Hospital and the Osseo Clinic, and later at HealthPartners. Dr. Shah joined the medical society in 1972.
IRVING SHAPIRO, MD, passed away on December 31, 2019. Dr. Shapiro practiced Ophthalmology in Minneapolis and was the founding medical director of the Phillips Eye Institute. He joined the medical society in 1957.
DONALD WOODLEY, MD, passed away on December 12, 2019. Dr. Woodley was an internist and worked as the medical director for several insurance companies. He joined the medical society in 1961.
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of Twin Cities Medicine
By Marvin S. Segal, MD
LEIF IVAR SOLBERG, MD
Modesty is a quality that attempts to diminish one’s significant abilities and accomplishments. Our unassuming Luminary demonstrates this attractive attribute in both word and manner.
Dr. Leif Solberg was born 81 years ago in a downtown Minneapolis hospital, geographically in proximity to both the site of his current home and the setting of his long-standing career. He earned his BA and MD degrees at our U of M distinguishing himself academically with Summa Cum Laude, Phi Beta Kappa and AOA honors. After completing a medicine residency at the University of Maryland and a G.I. fellowship at the University of Pennsylvania, he entered the Army, serving at the Walter Reed Institute of Research and later directing the Automated Military Operating System (AMOS) experiences, he states, “influenced the future direction of my career.” After Washington D.C. stints in private practice and academia, he, his wife and young children succumbed to the “gravitational pull” of family and the Twin Cities—they returned “home” for good. With that move, his future life in medicine unfolded. Though sub-specialty trained, he realized that for him the early principles created while he was leading AMOS seemed most applicable to their development in primary care settings. Thus began his long tenure and faculty assent to Clinical Professorship in his alma mater’s Department of Family Practice and Community Health. Those military operating system formulas adapted particularly well in an ambulatory care framework, and he was able to refine and enhance them through the years while serving as Quality and Care Improvement Director at Blue Cross and more currently, as Senior Advisor of HealthPartners Care Group. Concepts of quality/care improvement are diverse and far-reaching. They encompass the need to balance advances in medical care treatment capabilities with ever-changing economic factors. Resource utilization, electronic medical record institution and accepted evidence-based guidelines are among the most important of variables that Dr. Solberg has studied and implemented via comprehensive population research analyses. He played prominent roles in numerous studies conducted to help determine which approaches work, and which don’t in caring for patients. His tireless efforts, very well documented in over 270 published articles, have encompassed topics including suicide prevention,
breast and uterine cancer, diabetes, approaches to mental illness, geriatric care, emergency management, medication errors and lung cancer screening. His efforts in smoking cessation are among his most gratifying of pursuits —undoubtedly resulting in remarkably successful morbidity and mortality outcomes. His ability to share the integration of research with pragmatic practice care delivery has been gratefully appreciated by legions of colleagues. Leif has served on US Preventive Service panels, lectured widely and held multiple peer review journal editorial positions. He has been rightly recognized with honors including the Army Commendation Medal, numerous Researcher of the Year awards, the Maurice Wood Lifetime Contribution to Primary Care Research Award, the U of M Distinguished Medical Alumni Award, and membership in the National Academy of Medicine. When the good doctor is asked about the highlight of his career, he responds, “It’s right now, when I am able to still contribute a bit in both the realms of research and administration and meet, work with and learn from a wonderful group of colleagues. I have no intention of retirement!” Dr. Solberg opines, “The future of medicine is bright as it encourages the applications of the principles of consistency while still allowing individuality to play a prominent role.”
We are proud to add the honor of Luminary to this reserved, unpretentious and brilliant physician who has long shared his extraordinary abilities and accomplishments with us.
This last page series is intended to honor esteemed colleagues who have contributed significantly to Twin Cities medicine. Please forward names of physicians you would like considered for this recognition to Nancy Bauer, Managing Editor, nbauer@metrodoctors.com.
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