CHARLOTTE, N.C. -- Smoking is prevalent among people with substance-use disorders, but tobacco-prevention efforts often overlook this population.

The McLeod Addictive Disease Center in Charlotte is trying to change that.

Mary Ward, president of the center, said a recent community mini-grant from the American Heart Association and Blue Cross/Blue Shield of North Carolina will allow the organization to expand its nicotine-replacement therapy program for residential patients.

"And what we learned in surveying patients is that patients really were interested in receiving some type of therapy or care for nicotine addiction," Ward reported.

About 1 in 4 adults in the U.S. has some form of a behavioral health condition, and smokes nearly 40% of all cigarettes consumed by adults, according to the Centers for Disease Control and Prevention.

Ward noted smoking and other health-harming behaviors are on the rise, as households cope with increasing anxiety, depression, financial hardship and uncertainty amid the pandemic.

She added even folks who work from home are feeling the effects.

"The blurring of the 9-to-5 business day. People beginning to drink much earlier in the day," Ward outlined. "The ability to hide it, if you will, even in a drinking vessel when you're on a video call."

Shannon Emmanuel, vice president for health strategy at the American Heart Association, said quitting smoking is guaranteed to improve the health of North Carolinians during the pandemic and beyond.

She pointed out one vaping pod is equal to smoking a pack of cigarettes.

"Tobacco cessation and vaping efforts is a very big part of the work that we do, as it has a direct correlation with your cardiovascular health," Emmanuel explained.

Smoking is a major cause of heart disease and is linked to one out of every four deaths from heart attack.

Doctors say the risk of heart disease increases with the number of cigarettes smoked per day and from long-term smoking. Research shows exposure to secondhand smoke can also trigger heart disease in nonsmokers.

Legislation in Congress, co-sponsored by U.S. Sen. Richard Durbin - D-IL - could expand treatment choices for people with opioid use disorder.

Current federal regulations mandate that people battling addictions use government-approved treatment programs to receive methadone - a drug that curbs opioid cravings.

Senate Bill 644 would expand access through board-certified addiction specialists, who could prescribe methadone in a clinic or doctor's office.

Lindsey Vuolo - vice president of health law and policy at the nonprofit Partnership to End Addiction - said the measure would remove hardships for people who need help.

"The fact that methadone can be prescribed for pain without these restrictions really demonstrates that there isn't medical justification for these types of restrictions," said Vuolo. "And so, it's really crucial to make effective treatment low barrier - or ideally, no barrier - so that people who are in need of these medications can access them without undue restrictions."

Opponents of expanding methadone access have concerns about possible misuse, or that the drug could be distributed or sold illegally.

The bill is in the Senate Committee on Health, Education, Labor, and Pensions, and has been there since February. Nearly 3,300 people died from opioid overdoses in Illinois in 2022.

Under the current restrictions, the government-approved programs are the only option for people getting methadone treatment.

Vuolo pointed out that there aren't enough of these programs, and people receiving the treatment must undergo counseling - which can create even more hurdles to getting care.

"People have difficulty using their insurance to access care and can't afford to pay for the cost out of pocket, and lack of access to providers," said Vuolo. "There's a workforce shortage, so there aren't enough trained providers who are able to provide treatment for opioid use disorder and substance use disorder. Behavioral health in general, there's also lack of mental health providers."

The Illinois Department of Public Health says in 2022, the state's mortality rate from opioid use was 26 deaths per 100-thousand residents.

March Madness is in full swing, and depending on where you live, you might be able to place a bet on a college basketball tournament game. Wisconsin hasn't fully embraced the movement, but experts still advise people to avoid unhealthy habits.

A 2018 U.S. Supreme Court ruling paved the way for states to decide if they want to legalize sports betting. That helped fuel the presence of online platforms where people can place wagers through their smartphones. Wisconsin limits live bets to tribal casinos. But bettors can flock to some neighboring states for online access.

Rose Blozinski, executive director of the Wisconsin Council on Problem Gambling, said they're neutral on these laws but still have concerns.

"We know that more people are going to do it, and we also know that more people are going to become addicted to gambling," she said.

Since the legalization wave, Connecticut officials havehave reported a 200% increase in calls to gambling addiction hotlines.

To protect yourself from falling into traps, prevention experts recommend only betting what you can afford. If troubling patterns emerge, they suggest things like deleting betting apps and switching to flip phones. Nearly 40 states allow some form of sports betting, but some do have restrictions for college games.

The financial impacts of problem gambling can be obvious, but Blozinski noted that compulsive gamblers also have a higher suicide rate. And with mobile betting marketed toward young adults, she said this demographic should be considered high-risk.

"They're at a time where they're high risk-takers to start, and gambling fits right in with that, especially the sports betting. It makes them feel important; if you're winning, you can brag to all your friends," she added.

She said a big problem in helping young adults falling into addiction is that Gamblers Anonymous resources are outdated in the age groups they cater to. Industry leaders note their ads come with disclosures about problem gambling and where to seek help. But prevention experts say they're not easy to understand, and called for broader funding to carry out assistance programs.


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Communities across the Commonwealth want to minimize traumatic experiences for the state's youngest residents - as a way to help stem the drug epidemic, and prevent future generations from struggling with substance-use disorders.

According to Kentucky Youth Advocates, at least one in five Kentucky kids has had at least two Adverse Childhood Experiences or 'ACEs.'

These include physical, sexual and emotional abuse, neglect, having family members with a substance-use disorder, witnessing domestic violence, and parental incarceration.

Dr. Connie White, deputy commissioner for clinical affairs with the Kentucky Department for Public Health, said research shows ACEs can increase risky behaviors and the development of chronic diseases - and even lead to a shorter lifespan.

"All of these things contribute as that child's neural pathways are developing," said White, "as they're learning how to make choices - healthy choices, unhealthy choices - as they're chronically stressed and their cortisol levels are chronically elevated."

White added that it's becoming clear that interventions promoting safe, stable environments for kids can strengthen the building blocks for healthy coping mechanisms - and reduce their likelihood of dependence on alcohol or drugs in adolescence or adulthood.

Barry Allen is president and CEO of the Gheens Foundation. It's a member of BLOOM Kentucky, a statewide coalition pushing for policy changes to prevent ACEs.

He said increasingly, communities are recognizing the correlation between addiction and childhood trauma.

"And so, a small group of us grantmakers proceeded to seek an audience with then-Attorney General Daniel Cameron," said Allen, "to plead the case to apply at least half of the opioid abatement settlement dollars - over $400 million - to apply those to prevention."

This legislative session, Bloom Kentucky says it's advocating for sustained funding for school-based mental health providers to improve access to services, for establishing a process to automatically expunge an eviction from a family's record after a reasonable amount of time, and to prohibit minors from being named in eviction filings.




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