Successful Strategies for Tobacco Control for Mental Health and Substance Abuse Populations

Americans with mental illness smoke at higher rates and die on average 25 years earlier than the rest of the US population. They also often have substance abuse problems. People with mental illness often lack access to treatment, and those who do gain access often find themselves in programs that mistakenly believe using tobacco is an appropriate way to cope with and manage mental illness. While national recommendations for smoking cessation treatment for this population exist (e.g. those of the American Psychiatric Association), these recommendations are not routinely implemented. Moreover, little is known about the progress of state tobacco control programs (TCPs) toward addressing this population.

To help spread the word on innovative program models, CDC aimed to identify and describe the strategies used by TCPs in Oregon and Utah to support smoking cessation and tobacco-free environments in mental health and substance abuse facilities. Both TCPs, Utah’s Recovery Plus and Oregon’s Tobacco Freedom, used 3 key strategies: being ready for opportunity, having a sound infrastructure, and having a branded initiative with measurable outcomes.

Being ready for opportunity                                                      

TCPs in both states had been developing relationships with key partners for years before establishment of funding through the American Recovery and Reinvestment Act (ARRA) in 2010; both had an action plan, and both were ready to implement activities that would further the plan’s progress among mental health and substance abuse populations. One TCP stated, “When the ARRA FOA [funding opportunity announcement] came out, it was the right fit, and we were ready to take advantage of the opportunity.” The other TCP had already been training quitline coaches to work with people with mental illness; the additional funding improved the ability of the quitline to identify and collect data on this population.

Having a sound infrastructure

Both TCPs discussed the importance of having sound infrastructure, which included support and buy-in from leadership at all levels and across agencies, champions (i.e., strong supporters and promoters), ability to collect and use data to assess tobacco-free policies and staff attitudes toward policies, and the ability to communicate and share success stories.

Having a branded initiative

Both TCPs had branded initiatives that gave their project a recognizable name with identified strategies. Recovery Plus aimed at promoting health and wellness among people with mental illness or substance abuse. Tobacco Freedom aimed to improve access and participation in tobacco cessation treatment plans as part of mental health and addiction services. One TCP met 3 objectives of their initiative: 1) creating 100% tobacco-free campuses for addiction or mental health treatment centers and clinics, 2) having a policy that requires a cessation plan upon client discharge, and 3) having a policy that prohibits staff members from providing tobacco to clients. The other TCP enacted a 100% tobacco-free campus policy for publicly run treatment facilities.

Although the effectiveness of these strategies has not been assessed, Utah and Oregon provide program models that could be used among high-need populations in which best practices are not yet documented or evaluated. Moreover, the experience and lessons learned in Utah and Oregon provide an opportunity to share what has been done and the aim to reduce tobacco-related morbidity and mortality among those with mental illness or substance abuse disorders.

Visit Preventing Chronic Disease to read the study mentioned in this post.

By Darryl Konter

Health Communications Specialist

McNeal Professional Services

Centers for Disease Control and Prevention

Office on Smoking and Health