Smoke Out

 

 

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Smoking Out the Truth: Tobacco Use & Behavioral Health

Based on an Interview with Catherine Saucedo, Deputy Director, Smoking Cessation Leadership Center

People with mental and substance use disorders are twice as likely to smoke as the general population, and they smoke 44.3% of all cigarettes in the U.S, according to a study in the Journal of the American Medical Association. Half of all smokers will die as a result of smoking — including those with mental and substance use disorders.
When it comes to tobacco cessation (i.e., quitting, reduction in use) efforts at community behavioral healthcare organizations, there are many myths shrouding the path to a smoke-free service population. And despite proven, cost effective, and accessible methods, there is a general sense of hopelessness among healthcare professionals that they cannot help clients quit. This is particularly problematic for community programs that aim to address an individual’s whole health through the integration of primary care and behavioral health.
To smoke out the truth, CIHS reached out to the Smoking Cessation Leadership Center at the University of California, San Francisco, which administered SAMHSA-funded State Leadership Academies for Wellness and Smoking Cessation and the 100 Pioneers for Smoking Cessation Campaign. Some of the facts may surprise you.

• People with behavioral health conditions want to quit — and they can. Their interest is equal to that of the general population (70%).
• Tobacco cessation is a high priority. Smoking is the biggest killer of people with behavioral health problems.
• Smoking bans (e.g., smoke-free campuses) have no negative effect on behavioral health symptoms or management. It can even improve mental health and can increase sobriety among people addicted to alcohol.
• It is better to quit all addictions, including tobacco, up front — not put off tobacco for later. Science substantiates that by doing so alcohol and other drug addiction outcomes improve by an average of 25%.
• Banning smoking will not affect your revenue. While some clients may threaten to leave if you ban smoking, many will welcome and commend you for it. While it is unlikely clients will leave, if they do, a number will choose your agency because you’re smoke-free.
• There is no reason to feel hopeless in the face of tobacco cessation for those your serve. Learn what you can do.

Editor’s Note: One of CIHS’ charges is to support innovative community providers participating in the PBHCI program to implement tobacco cessation efforts and to demonstrate the success of their efforts. Two-thirds of these grantees are in various stages of implementing tobacco cessation programs. The other third monitor and track patients’ carbon monoxide levels.

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Quick Tips: Six Ways to Foster Quitters

The 100 Pioneers for Smoking Cessation Campaign, an initiative jointly funded by SAMHSA and the Smoking Cessation Leadership Center, led efforts in behavioral health to discover tobacco cessation approaches that work and to share these strategies with other healthcare providers. The Leadership Center shared a few.

1. Embrace quitters. Your agency will be most successful if you work with people who want to quit, of which 70% say they do. Those that wish to quit are more likely to engage in your efforts. Educate and provide cessation tools to your clients, staff, and communities on the benefits of living a smoke-free life — it’s the first step.
2. Create simple, creative break alternatives. Instead of sanctioning “smoke breaks” for only the segment of your clients who smoke, create a break environment for all. For example, create a serenity garden where smokers and non-smokers alike each tend to a potted plan, or organize 10-minute yoga sessions or walks.
3. Adjust your mission. Most integrated healthcare providers have a mission to promote healthy lifestyles among clients. Adding tobacco cessation as one of the ways you mean to achieve this mission is an important guidepost.
4. Create or revise your agency’s smoking policy. After choosing to go smoke-free, write a policy that recognizes that while some clients and staff may smoke, they cannot do so in or near your agency.
5. Pull in all stakeholders. From the beginning, engage clients and staff who smoke, those who do not smoke, clinicians, and others in developing a new smoking policy and adopting and implementing cessation efforts. This will assuage much of the push back you’ll face.

The State Leadership Academies for Wellness and Smoking Cessation in Behavioral Health pioneers maintain a listserv with a steady dialogue on smoking cessation among people with mental illnesses and addictions. Visit the pioneers’ website to join. To join the national primary and behavioral healthcare integration conversation, join the CIHS listserv.