John de Miranda and his entrepreneurship that restores lives
By REDACCION VT - February 25, 2022
The lack of concern for smokers and the high rates of tobacco addiction among vulnerable populations led the American John de Miranda to develop a toolkit to help people reduce the harm of tobacco smoking.
Vulnerable populations, particularly, people diagnosed with emotional health disorders, mental health disorders, or those who have substance use struggles have the highest rates of tobacco smoking. This phenomenon occurs throughout the world, regardless of cultural particularities, education, income levels, access to quality public services, or the presence of social welfare. Also, as might be expected, these populations have the highest rates of failure when attempting to quit smoking. In the United States, this population consumes a shocking 40% of all cigarettes smoked in the country. The situation is such that it really does not seem to be efficient to think about the prevalence of tobacco smoking, drug abuse, and psychiatric diagnoses as isolated issues.
In this scenario, smoking is not merely an added problem, but it can mean many fewer years of life. Among illicit drug users alone, the prevalence of smoking in the United States is between 74% and 88%. As journalist Helen Redmond has pointed out, “of the 480,000 people who die in the US from tobacco smoking related illnesses each year, an estimated 200,000 had a mental health diagnosis.” Likewise, a study under the leadership of Maria A. Parker, of the Department of Psychiatry, Center for Behavior and Health at the University of Vermont, verified that “the probability of current cigarette smoking were significantly higher in individuals with substance use disorders and affective disorders.”
The ethics of care: against marginalization and stigma
In general, despite the high rates of mortality and morbidity related to tobacco smoking among this group of people, there are few entities that put tobacco use at the center of addiction treatment. Addiction recovery programs commonly avoid the issue of tobacco use, often by allowing their clients to continue smoking or by banning smoking altogether.
In the United States there are at least 15,000 public and private services units with more than 1.3 million people served. The addiction treatment and recovery system has supported some 24 million people. Knowing this reality, John de Miranda has used his long experience to find solutions. “A colleague and I had been talking for some time about the very high incidence of tobacco smoking among people who abuse alcohol or drugs, in addiction treatment or in recovery. Here in the US, the tobacco smoking rate in the general population is about 14%, but rates of 60% or more are regularly reported among these other populations.”
The Smoking & Recovery Toolkit developed by de Miranda seeks precisely to help individuals, organizations, and addiction treatment and recovery programs to focus on the reduction or cessation of cigarette consumption.
To generate good practices with a robust foundation, the kit contains tools to analyze and evaluate existing policies and practices and provides the necessary foundations for the preparation of treatment and recovery programs seeking to optimize their response to tobacco smoking. It also features two training curricula that focus on harm reduction practices, both for technical staff and for clients themselves.
"Don't let the perfect be the enemy of the good"
With a career spanning more than 40 years, John de Miranda has extensive and cross-sectional experience in the field:
He was associate director of Door to Hope, an addiction treatment and recovery program in Salinas, California, specializing in family treatment, including services for drug-exposed infants and children;
Served as President and Executive Director of Stepping Stone of San Diego, an addiction treatment and recovery program serving primarily, but not exclusively, LGBTIQ+ communities;
He is Executive Director of the National Association on Alcohol, Drugs and Disabilities Inc., a network of individuals and organizations dedicated to improving access to substance abuse prevention and treatment services for people with disabilities.
The 2019 and 2020 smoking harm reduction scholarships he received from Knowledge Action Change (KAC) have enabled the development of the Smoking & Recovery Toolkit. “I was initially awarded a KAC scholarship which allowed me to learn more about the subject. The scholarship also allowed me to conduct interviews with experts and focus groups with these populations. I learned a lot from talking to smokers in treatment or recovery. For many, smoking and quitting were major problems throughout their lives. After that year I received a second enhanced grant that allowed me to develop a solution to the problem, which was the toolkit.”
“A softer approach is better than requiring a zero-tolerance commitment. Instead of asking someone if they are ready to quit, the initial question should be “are you ready to do something about your smoking habit?”
Well received help
We asked how the toolkit has been received by organizations and by the users or customers themselves.
“To my knowledge, there is nothing that includes the toolkit's harm reduction ideas, and treatment providers who have used it report that this type of approach is superior to the abstinence philosophy of traditional smoking cessation programs. We have learned in the addiction field that using a stages of change model with motivational enhancements improves outcomes, so the toolkit brings this knowledge to the issue of tobacco smoking."
Regarding the question about what are the main advantages of treating several addictions at the same time de Miranda has no doubts: “Years ago, conventional wisdom held that quitting smoking and giving up alcohol or drugs would jeopardize the recovery of [both addictions]. Recent research has found just the opposite. Clients in treatment programs are receptive to doing something about their tobacco smoking. The toolkit provides programs, as well as individuals, tools to reduce or eliminate the risk of combustible tobacco.”
Likewise, “a softer approach is better than requiring a zero-tolerance commitment. Instead of asking someone if they are ready to quit, the initial question should be “are you ready to do something about your smoking habit?”
View or download the Kit:
General notes about the translation:
The text was translated as directly as possible. Changes have been made in some cases to increase fluency for English speaking audiences.
For clarity, tabaquismo has been translated as tobacco smoking.
Use of the Oxford Comma has been included in the translation although not present in the original text.
With the exception of the date of publication, capitalization has been maintained.
Font sizes are not exact, but formatting (i.e. Bolding, Italics, etc.) haas been maintained.
Hyperlinks have not been included.
Translation provided by Colin de Miranda, LCSW
Link to original Spanish language article