People with mental illnesses and addictions can die decades earlier than the general population — and smoking is a major contributor to early morbidity and mortality.
Smoking and Behavioral Health: The Shocking Statistics
- About 50% of people with behavioral health disorders smoke, compared to 23% of the general population.
- People with mental illnesses and addictions smoke half of all cigarettes produced, and are only half as likely as other smokers to quit.
- Smoking-related illnesses cause half of all deaths among people with behavioral health disorders.
- 30-35% of the behavioral healthcare workforce smokes (versus only 1.7% of primary care physicians)
- General Resources
- Research and Articles
- Behavioral Interventions
- Nicotine Replacement Therapy/Use of Medications
Check out our November 2012 issue of eSolutions: Smoking Cessation, which discusses shocking facts about smoking, provides resources for consumers as well as practitioners, and much more!
DIMENSIONS: Tobacco Free Toolkit for Healthcare Providers is an update of previous resources developed by the Behavioral Health and Wellness Program. It is designed for a broad continuum of healthcare providers, including direct providers as well as administrators and healthcare organizations. The toolkit contains a variety of information and step-by-step instructions about: education about tobacco use; skills for engaging individuals in tobacco cessation discussions; efficient methods for assessing people’s readiness to quit; and information and research on treatments. The toolkit also includes a supplement that addresses individuals with behavioral health conditions.
This Journal of American Medical Association Patient Page provides information on quitting smoking including tips and cessation options.
The EX Plan is a free quit smoking program based on personal experiences from ex-smokers as well as the latest scientific research from the experts at Mayo Clinic. Re-Learn Life without Cigarettes is a 56-page booklet by Ex that is available for download.
The National Cancer Institute’s Clearing the Air is a booklet for those ready to quit smoking. It includes tips and strategies for starting a smokefree life.
BeTobaccoFree provides the best information HHS has on the health effects of tobacco, quitting smoking, and more.
Smokefree is the federal government’s interactive website dedicated to smoking cessation. Individuals can also access counseling via phone at 1-877-44U-QUIT (1-877-448-7848) and via trained Quit Coaches on www.smokefree.gov.
Sponsored by CDC and managed by the Tobacco Technical Assistance Consortium, the Tobacco Free Press provides readers valuable tobacco-related news and resources.
A national program office of the Robert Wood Johnson Foundation, the Smoking Cessation Leadership Center provides clinicians with research and information, and smokers with resources to quit.
The CDC is partnering with five leading physician groups to encourage smokers to talk to their doctor about quitting the habit, and launched a national television and online ad campaign.
The campaign, "Talk With Your Doctor," encourages clinicians to offer assistance in quitting to patients.
The Connecticut Department of Mental Health and Addiction Services has a gallery of “video briefs” on a variety of topics. Of particular interest is the video, “Never Quit Trying,” in which clients discuss how they quit smoking.
Cigarettes Are My Greatest Enemy deals with tobacco cessation among those who have had additional hurdles to overcome in their lives. The print campaign features real people and their stories of resiliency.
The Smoking Cessation Leadership Center has many materials available for download including this clinician handout/flyer to post in exam rooms, offices or break rooms and quitline poster or cards for clients.
The American Cancer Society has various resources available including this Don’t Quit Alone flyer that is available in various languages and fact sheet on the harms of smoking and benefits of quitting.
The Centers for Disease Control and Prevention shares free brochures and posters that can be ordered free of charge or downloaded.
The FDA Center for Tobacco Products has made two widgets available: News You Can Use and Tobacco Retailer Quiz to help stakeholders access and share news and information quickly and easily. The widgets are easy to add to any website.
General Tobacco Cessation
Multiple quit attempts are often a necessary part of the process of becoming tobacco-free; several failed quit attempts often precede successful smoking cessation. A 1998 Hazelden Foundation poll found that the average former smoker tried to quit 10.8 times before he or she was able to abstain from smoking tobacco products. This statistic was cited in the 2001 Surgeon General's Report—Women and Smoking.
Clinical Management of Tobacco Dependence in Inpatient Psychiatry: Provider Practices and Patient Utilization examines the clinical management of nicotine withdrawal in smoke-free inpatient psychiatry facilities, particularly the predictors of use of nicotine replacement therapy (NRT).
A New England Journal of Medicine editorial discusses new evidence that cigarette smoking remains the most important health hazard.New England Journal of Medicine article on 50-year trends in smoking-related mortality in the United States. The study found that the risk of death from cigarette smoking continues to increase among women and the increased risks are now nearly identical for men and women, as compared with persons who have never smoked.
New England Journal of Medicine article on 21st-century hazards of smoking and benefits of cessation in the United States. The study found that smokers lose at least one decade of life expectancy, as compared with those who have never smoked. Cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90%.
The Journal of Vascular Nursing article, “Utilizing clinical support staff and electronic health records to increase tobacco use documentation and referrals to a state quitline,” discusses whether documentation and referrals for smoking cessation can be increased in organizations using an EHR by empowering medical assistants to promote tobacco cessation and providing electronic referral options.
Benefits of quitting smoking outpace risk of modest weight gain. This NIH-funded study finds post-cessation weight gain does not elevate cardiovascular risks for former smokers.
Tobacco Use and Mental Illness
Legacy’s A Hidden Epidemic: Tobacco Use and Mental Illness calls attention to the high prevalence of tobacco use and nicotine dependence among people with mental illnesses and highlights barriers to effective tobacco cessation for this population. This publication also features examples of five projects that demonstrate how organizations across America are addressing tobacco-related disparities faced by people with mental illnesses.
Using data from the 2009–2011 National Survey on Drug Use and Health (NSDUH), the new report from the CDC, "Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years with Mental Illness," provides the most recent estimates of cigarette smoking among adults aged ≥18 years with a mental illness.
The New England Journal of Medicine article, “Smoking and Mental Illness — Breaking the Link,” addresses prevailing myths that perpetuate tobacco use among people with behavioral health problems. The article also discusses ways to address smoking cessation with patients.
The Association for the Treatment of Tobacco Use and Dependence's Integrating Tobacco Treatment within Behavioral Health aims to inspire providers to encourage active intervention for people who smoke.
Tobacco Use interventions in behavioral health settings
Telephone counseling, or “Quitlines,” can be particularly helpful for individuals with serious mental illness, according to research presented by Marc L. Steinberg, PhD, assistant professor of Psychiatry at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School.
The American Journal of Psychiatry article, “Successful Tobacco Dependence Treatment in Schizophrenia,” presents a clinical case study of tobacco dependence treatment for a patient with schizophrenia.
Interventions for smoking cessation and reduction in individuals with schizophrenia. This review evaluates the benefits and harms of different treatments for nicotine dependence in schizophrenia. The authors found that bupropion increases smoking abstinence rates in smokers with schizophrenia, without jeopardizing their mental state.
Tobacco Cessation and Substance Use
The article, “Anxiety and Smoking Cessation Outcomes in Alcohol-dependent Smokers,” from Nicotine and Tobacco Research examines the anxiety sensitivity and trait anxiety of alcohol-dependent smokers who are engaged in the assessment and treatment of nicotine dependence.
The Center on Alcoholism, Substance Abuse and Addictions at the University of New Mexico’s “Smoking cessation during substance abuse treatment: What you need to know” provides a literature review and shares successful cessation interventions.
Establishing Smoking Cessation Initiatives in Health Centers
FDA Consumer Health Update on Approved Changes to Nicotine Replacement Therapy (NRT) Labels contains a chart with the changes the US Food and Drug Administration is allow¬ing for NRT labels. The changes that FDA is allowing to these labels reflect the fact that although any nicotine-containing product is potentially addictive, decades of research and use have shown that NRT products sold OTC do not appear to have significant potential for abuse or dependence.
Tobacco: Recovery Across the Continuum (TRAC) is a stage-based motivational service model designed specifically to help people diagnosed with severe mental illness and/or substance use disorders to reduce and eventually eliminate the use of tobacco products. TRAC integrates tobacco treatment with existing behavioral healthcare approaches.
The Tobacco Dependence Program (TDP) out of the University of Medicine and Dentistry of New Jersey is dedicated to reducing the harm to health caused by tobacco use. The TDP particularly aims to provide expertise on quitting smoking for those who need it most. This is done through education, treatment, research and advocacy. Resources on the website include training opportunities, past newsletters, and consumer materials.
The University of Massachusetts Medical School’s Addressing Tobacco Through Organizational Change (ATTOC) is a 10-step model designed to help an organization systematically improve their tobacco addiction treatment for patients/clients and change their culture to better address tobacco. ATTOC has been demonstrated to be an effective approach in helping many addictions, mental health, hospital and other clinical settings. Their extensive website also features an array of resources, including manuals, tools, and information on CO monitors.
the University of Massachusetts Medical School’s Center for Tobacco Treatment Research and Training is committed to promoting state of the art, evidence-based tobacco dependence treatment in healthcare and community settings through training, research, and public service. The Tobacco Treatment Specialist (TTS) Training and Certification Program is the cornerstone of the educational activities in the Center.
CHOICES is a consumer-driven program for smokers with mental illness in New Jersey. The program’s goal is to increase awareness of the importance of addressing tobacco use and to create a strong peer support network that encourages mental health consumers to make a positive healthy lifestyle change by addressing smoking and tobacco use.
The Center for Practice Innovations (CPI), in partnership with the Office of Mental Health and the NYC Department of Health and Mental Hygiene has released Focus on Integrated Treatment (FIT) online training modules aimed at treating tobacco dependence. The FIT Tobacco Treatment Modules are available free of charge to practitioners in NYS agencies and programs that are enrolled in CPI's learning management system ("CPI Learning Community") through the FIT initiative.
The University of Colorado’s Behavioral Health and Wellness Program provides myriad resources for practitioners investing in helping patients quit smoking. The University of Colorado Denver created Tobacco Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers to guide providers and leadership in their efforts to help people with behavioral health problems quit smoking.
The Asian Smokers’ Quitline is a free nationwide Asian-language quit smoking service operated by the Moores Cancer Center at the University of California, San Diego. The Quitline offers self-help materials, referral to local programs, one-on-one telephone counseling to quit smoking, and a free two-week starter kit of nicotine patches. Quitline services have been proven in clinical trials to double a smoker’s chances of successfully quitting.
The National Native Network Keep It Sacred provides a forum for tribes and tribal organizations to obtain and disseminate evidence-based and culturally appropriate information in order to identify and eliminate health disparities related to commercial tobacco abuse.
Dr. Stephen Sroka is an internationally recognized motivational speaker, trainer, author, teacher, professor and consultant. He has spoken numerous times in schools (K-12), as well as in hospitals, colleges, Indian reservations, clinics, and various community settings. He has done tobacco prevention work with Native Americans.
Women.Smokefree.gov is a website that offers tobacco cessation resources for women and discusses topics that are often important to women in regards to tobacco cessation.
The Peer-to-Peer Tobacco Dependence Recovery Program promotes behaviors that lead to health and wellness by filling a critical gap in behavioral healthcare settings: peer support tobacco dependence services for persons with substance abuse and/or mental health disorders. Need to change the link; current link goes to sample agenda but is not very helpful.
Tobacco-Free Living in Psychiatric Settings: A Best-Practices Toolkit Promoting Wellness and Recovery was developed by the National Association of State Mental Health Program Directors (NASMHPD) and provides practical tips for converting facilities to smoke-free status.
How the Affordable Care Act Affects Tobacco Use and Control summarizes the main provisions of the Affordable Care Act (ACA) that impact tobacco use and control, including insurance coverage for tobacco cessation treatment.
Communities Putting Prevention to Work (CPPW) is an initiative supporting states and local communities to tackle obesity and tobacco use. Through this initiative, the Utah Tobacco Prevention and Control Program engaged partners to create systems change that prohibits tobacco use in all publically funded mental health and substance abuse treatment facilities by 2013 and incorporates cessation activities into treatment.
The Tobacco Control State Highlights 2012 report provides an overview of the implementation of strategies that reduce tobacco use in each of the 50 states and the District of Columbia. While states have made progress, the reduction of tobacco use nationwide has slowed. The report shows that more work needs to be done to end the epidemic of tobacco-related death and disease.
The Partnership for Prevention published “Increasing Access to Tobacco Cessation in States: Action to Quit Case Studies,” highlighting six states’ cessation plans.
SAMHSA and the Smoking Cessation Leadership Center hosted a Leadership Academies for Wellness and Smoking Cessation in Oklahoma to help state leaders develop an action plan to reduce smoking among adults with behavioral health problems, as well as professional staff, by 2015.
The American Society of Family Physicians developed a reimbursement code chart that highlights HCPCS, CPT, and ICD-9 codes related to tobacco cessation counseling reimbursable by Medicare and private payors.
The Centers for Medicare and Medicaid sent a letter to State Medicaid Directors, providing information to assist states’ tobacco reduction efforts. The letter includes guidance on implementation of section 4107 of the Affordable Care Act and on tobacco quitline activities.