CONTINUE THE GOOD

Behavioral Health Recovery and Tobacco Use: The Importance of Treating Tobacco Dependence with Your Patients

You work hard to help your patients feel better and get better. You help them deal with alcoholism, substance use, depression, anxiety and more. Yet sometimes treating tobacco use gets put on the back burner. Studies show that helping patients to quit tobacco use at the same time as you’re treating other behavioral health conditions helps with long-term recovery.  And most patients really want to quit smoking and want your help to do it.1,2

Watch now: Dr. Galiatsatos, Assistant Professor at the John’s Hopkins School of Medicine; Dr. Khanna, Professor of Family Medicine at the University of Maryland; and Kathy Murphy, Occupational Therapist at Mosaic Community Services, speak on the benefits of talking to your patients about smoking cessation alongside current treatment plans. Then hear from a local Marylander, Joann, express her desire to live a healthier life and complete her quit journey. Click here to listen to the stories of other Maryland residents and their efforts in recovery.

 BEHAVIORAL HEALTH AND QUITTING

PEOPLE WITH BEHAVIORAL HEALTH CONDITIONS:

  • Are more likely to smoke.
    • Individuals with a behavioral health condition are more likely to smoke than people without such a condition, and smoking rates are even higher among individuals with serious mental health disorders and addictions. 3
  • Are heavier smokers.
    • Individuals with behavioral health conditions smoke more cigarettes than people without these conditions who smoke. 4,5
  • Want to quit smoking.
    • Many individuals with behavioral health conditions want to quit smoking but may face extra challenges in successfully quitting and may benefit from extra help. 1,2

The Maryland Department of Health offers effective tools and resources to assist you in helping your patients quit smoking. Remember, many patients want to quit smoking and want your help to do so.

Use the 5As:

  1. Ask about tobacco use: “Do you currently smoke or use other forms of tobacco?” 6
  2. Advise the patient to quit: “Quitting tobacco is one of the best things you can do for your health. I strongly encourage you to quit.” 6
  3. Assess readiness to quit: “Are you interested in quitting tobacco?” 6
  4. Assist the patient in quitting by offering them resources and information necessary:
    1. If ready to quit: Provide brief counseling and medication if appropriate. Refer patients to other support resources that can complement your care (e.g., Maryland Tobacco Quitline 1-800-QUIT-NOW, SmokingStopsHere.com, group counseling through local health department programs or healthcare systems).
    2. If not ready to quit: Strongly encourage patients to consider quitting by using personalized motivational messages. Let them know you are there to help them when they are ready.
  5. Arrange for follow up: Follow up regularly with patients who are trying to quit.

A study showed that using the 5As was effective at helping people with severe mental illness increase abstinence or reduce cigarettes smoked. Repeated follow-up and encouragement may be necessary to support change in tobacco users with severe mental illness.7

THE MARYLAND TOBACCO QUITLINE

Here’s how it works:

The Maryland Tobacco Quitline is a phone, web and text-based program that offers highly trained coaches who will work one-on-one with your patients. Services are confidential and provided in English, Spanish and other languages.

  • Free service provided by the Maryland Department of Health Provides tobacco treatment to Marylanders over age 13 to quit all tobacco, including electronic smoking devices (e-cigarettes/vapes)
  • Available 24 hours a day, 7 days a week by phone, web, and text
  • Offers free Nicotine Replacement Therapy (NRT) for those 18 and older, while supplies last, and refers to all 24 local health departments in Maryland for tobacco treatment services
  • When a Maryland resident calls the Quitline, they’ll talk with a professional trained to help them quit using tobacco. The Maryland Tobacco Quitline offers specialized programs for those with behavioral health conditions, including substance use. In fact, approximately half of all Quitline participants calling the Quitline have self-reported one or more behavioral health conditions
  • Additionally, the Maryland Tobacco Quitline offers specialized programs for those with chronic conditions, pregnancy, and youth ages 13-17
  • The Maryland Tobacco Quitline has a 7x higher quit rate than quitting on your own and over a 93% satisfaction rate.

Visit SmokingStopsHere.com or call 1-800-QUIT-NOW (1-800-784-8669) to learn how the Quitline can benefit your patients. Refer patients to the Quitline by fax, web, or electronic referral.

  • Patients can enroll for services online at The Maryland Tobacco Quitline
  • Patients can enroll in the text-to quit service by texting “READY” to 200-400

Other smoking cessation resources and programs can be found at Smokefree.gov, SmokefreeTXT, and BeTobaccoFree.gov.

Behavioral Health Provider Toolkit

Click on the links below to download all Provider resources as PDFs. Materials include a letter from the Maryland Department of Health, a Provider Guide, a Patient Brochure and posters for your office or clinic space.

Click here to order patient brochures for delivery to your home or office.

 

CITATIONS AND RESOURCES

(1) Richter KP, Arnsten JH. A rationale and model for addressing tobacco dependence in substance abuse treatment. Substance Abuse Treatment, Prevention, and Policy. 2006;1(1):23.Centers for Disease Control and Prevention. Vital Signs Fact Sheet: Adult Smoking Focusing on People With Mental Illness. Accessed August 31, 2017.

(2) Centers for Disease Control and Prevention. Vital Signs Fact Sheet: Adult Smoking Focusing on People With Mental Illness. Accessed August 31, 2017.

(3) Prochaska JJ, Das S, Young-Wolff KC. Smoking, Mental Illness, and Public HealthExternal. Annu Rev Public Health. 2017;38:165–185.doi: 10.1146/annurev-publhealth-031816-044618. Smoking Cessation Leadership Center. Fact Sheet: Drug Interactions With Tobacco Smoke. San Francisco: Smoking Cessation Leadership Center, University of California; 2015.

(4) Schroeder S A, Morris CD. Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. Annual Review of Public Health, 2010;31:297–314. Druss BG, Zhao L, Von Esenwein S, Morrato EH, Marcus SC. Understanding excess mortality in persons with mental illness: 17-year followup of a nationally representative US survey. Medical Care. 2011;49(6):599–604.

(5) Prochaska JJ, Das S, Young-Wolff KC. Smoking, Mental Illness, and Public HealthExternal. Annu Rev Public Health. 2017;38:165–185.doi: 10.1146/annurev-publhealth-031816-044618. Compton W. The need to incorporate smoking cessation into behavioral health treatment. The American Journal on Addictions.2018;27(1):42–43.

(6) https://www.cdc.gov/tobacco/campaign/tips/partners/health/materials/twyd-5a-2a-tobacco-intervention-pocket-card.pdf

(7) https://mdquit.org/cessation-programs/brief-interventions-5

(8) Prochaska JJ, Das S, Young-Wolff KC. Smoking, Mental Illness, and Public HealthExternal. Annu Rev Public Health. 2017;38:165–185.doi: 10.1146/annurev-publhealth-031816-044618. Compton W. The need to incorporate smoking cessation into behavioral health treatment. The American Journal on Addictions.2018;27(1):42–43. Schroeder S A, Morris CD. Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. Annual Review of Public Health, 2010;31:297–314. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ. 2014;348:1151. Substance Abuse and Mental Health Services Administration. Tobacco and Behavioral Health: The Issue and Resources Cdc-pdf[PDF–247 KB]External. Maryland:SAMHSA; 2017.

(9) Weinberger AH, Platt J, Esan H, Galea S, Erlich D, Goodwin RD. Cigarette smoking is associated with increased risk of substance use disorder relapse: a nationally representative, prospective longitudinal investigation. The Journal of Clinical Psychiatry. 2017;2(78):e152.

(10) Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence study. JAMA. 2000;284(20):2606–2610. Glasheen C, Hedden SL, Forman-Hoffman VL, Colpe LJ. Cigarette smoking behaviors among adults with serious mental illness in a nationally representative sampleExternal. Ann Epidemiol. 2014;24(10):776–780. doi:10.1016/j.annepidem.2014.07.009. Schroeder SA, Clark B, Cheng C, Saucedo CB. Helping smokers quit: the smoking cessation leadership center engages behavioral health by challenging old myths and traditions. Journal of Psychoactive Drugs. 2018;50(2):151–158.

(11) Emma Hitt, PhD, Smoking Thwarts Positive Outcomes in Opioid Addiction – Medscape – Apr 29, 2012. https://www.medscape.com/viewarticle/762931

(12) https://www.nami.org/learn-more/mental-health-public-policy/tobacco-and-smoking

(13) Prochaska JJ, Das S, Young-Wolff KC. Smoking, Mental Illness, and Public HealthExternal. Annu Rev Public Health. 2017;38:165–185.doi: 10.1146/annurev-publhealth-031816-044618. Compton W. The need to incorporate smoking cessation into behavioral health treatment. The American Journal on Addictions.2018;27(1):42–43. Schroeder S A, Morris CD. Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. Annual Review of Public Health, 2010;31:297–314. Richter KP, Arnsten JH. A rationale and model for addressing tobacco dependence in substance abuse treatment. Substance Abuse Treatment, Prevention, and Policy. 2006;1(1):23. Centers for Disease Control and Prevention. Vital Signs Fact Sheet: Adult Smoking Focusing on People With Mental Illness. Accessed August 31, 2017.