November 2012: Smoking Cessation

eSolutions: Smoking Cessation

Feature: Smoking Out the Truth
Quick Tips: Six Ways to Foster Quitters
Grantee Profile: Trilogy Goes 100% Smoke-Free
Webinars
Featured Resource: Tobacco Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers
Hot Topics   

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.

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.

Grantee Profile: Trilogy Goes 100% Smoke-Free

Trilogy, a Chicago-based SAMHSA Primary and Behavioral Health Care Integration grantee in Chicago, learned that 56% of their clients smoked. While this number is notably lower than the national average for people with behavioral health disorders, Trilogy sought to aggressively promote tobacco cessation among clients and staff. This past summer, they began a notable campaign that included going 100% smoke-free — extending the smoking ban beyond their building to include picnic areas, parking lots, and other outdoor areas. Trilogy also instituted a variety of other tobacco cessation efforts.

Before beginning their smoke-free campaign, two efforts provided a springboard. Trilogy staff asked each client at each visit about their smoking status and frequency, and encouraged them to learn about cessation and to consider quitting. If a client was open to using a carbon dioxide (CO2) monitor, staff checked their exhaled air to determine current CO2 levels regularly, even during psychiatric visits. The agency also started a “Morning Habit Group” to discuss a wide range of health issues, including the impact of smoking. 

Trilogy engaged its entire staff, including the CEO. At first, the idea of going smoke free was met with mixed reactions. Some staff worried it would incite additional stress among clients; others erroneously believed that smoking helps with clients’ symptoms. To air concerns, Trilogy began a “Breakfast & Learn” staff meeting. They found it important to address people’s concerns. In addition, Rush University nursing students developed a presentation on smoking cessation and trained some staff. The trained staff helped to spread ideas about the smoke-free campus initiative and smoking cessation more broadly. 

To gain momentum for their smoke-free campus, Trilogy displayed a large countdown to going smoke free in the foyer and hosted a reception 100 days out. The “Cessation Station” — a dedicated room for smoking cessation that provides clients with a dedicated phone line to the Illinois Tobacco Quit Line, smoking-cessation materials, and free nicotine patches — played a large role in the smoke-free campaign. In July 2012, Trilogy welcomed the state senator, Chicago Health Commissioner, and other dignitaries to a kick-off ceremony for the Cessation Station. 
Since instituting its smoke-free campaign, Trilogy has heard no staff concerns and can even tout a few staff members in each department who quit smoking, which Trilogy supports with its “The Courage to Quit” smoking cessation group for staff.

Clients are also pleased with the changes. Staff have heard clients say that the effort is helpful as it prevents them from seeing others smoking outside the building. They’ve even heard from entrenched smokers contemplating quitting techniques. The staff thinks that asking clients about smoking at each visit helps normalize a stop-smoking culture. Not smoking within is becoming the norm. Now, they see those who have quit encouraging their peers to do the same. 

Of course, Trilogy has encountered challenges. The most formidable is that Medicaid does not cover the full length of time that clients need nicotine replacements (e.g., gum, lozenges, patches). Yet, their success has been tremendous. 

To encourage similar success among other integrated healthcare providers, Trilogy says that organizations should involve stakeholders (i.e., staff, clients, and providers) early and often. They suggest bringing everyone to the table to voice concerns in lieu of the top-down approach in which leadership mandates a change. In addition, they recommend offering clients a variety of support services (e.g., group and individual approaches).

For more information on Trilogy, Inc. visit www.trilogyinc.org. To learn more about SAMHSA’s PBHCI program, visit www.integration.samhsa.gov/about-us/pbhci.

Webinars

CIHS hosts ongoing webinars on topics of greatest importance to integrated care providers. Visit www.integration.samhsa.gov often for upcoming schedules. You can also access all past webinars on the CIHS website, including the most recent “Integrated Care within the Patient Centered Medical Home: The Health Center Perspective” and “How to do the Managed Care Dance: What You Need to Know to Participate in Networks.”

Featured Resource

The University of Colorado Denver created Tobacco Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers to guide efforts to help people with behavioral health problems quit smoking.

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