People with Behavioral Health Conditions Encounter Barriers to Quitting Successfully
Most people who smoke want to quit, and more than half of them try to do so each year. Adults with mental health conditions who smoke want to quit, are able to quit, and have a better chance of quitting successfully when they have access to treatment.37
Proven treatments, such as FDA-approved medicines and behavioral counseling, make it more likely people will quit smoking successfully. People with behavioral health conditions can have challenges when trying to find and use these treatments:
- In 2016, about half of mental health facilities (49%) and two-thirds of substance use treatment facilities (64%) screened patients for commercial tobacco* use.9 However, fewer than half of mental health and substance use treatment facilities in the United States offered proven treatments to help people quit smoking.9,38
- Psychiatrists and other mental health professionals are less likely to talk about quitting smoking with patients who have behavioral health conditions. This may be due to misperceptions about patient’s willingness or ability to quit.39
Connecting every person who wants to quit with treatment proven to help them quit for good is important for improving people’s health.
Examples of strategies that states and communities can use are:
Provide barrier-free, widely promoted, coverage for all evidence-based cessation treatments by all types of health insurance.
For example, as of 2018, only 15 state Medicaid programs fully covered tobacco cessation (quitting) services for all traditional Medicaid enrollees.40
Integrate clinical screening and treatment for commercial tobacco use in all health care settings and with all types of patients.
Talking to people about commercial tobacco use and quitting as a regular part of health care visits in all care settings will help make sure that all groups can get effective treatment to help them quit.41
Increase access to culturally tailored cessation services.
When it comes to health issues, one size does not fit all. Different people and communities have varying needs and make decisions in different ways. People with behavioral health conditions may need more intensive treatment, or need treatment for a longer time, to quit smoking.18
Make all behavioral health care settings tobacco-free, with no exceptions.
Tobacco-free campus policies that prohibit use of all commercial tobacco products can support people who want to quit, make tobacco-free places the norm, and stop exposure to secondhand smoke.41 On campuses that are not entirely tobacco-free, management can put in place rules to prevent staff from smoking with residents or providing cigarettes as an incentive or reward.29,41
Share health messages that feature people with behavioral health conditions and their experiences.
Mass media campaigns are proven to increase smoking cessation, prevent tobacco use initiation, and reduce the prevalence of tobacco use.24,42 Anti-commercial tobacco messaging and mass media campaigns, like CDC’s Tips From Former Smokers® (Tips®), are effective in reaching many groups. Tips ads feature testimonials from people with behavioral health conditions. Positive reactions to Tips ads have been shown to lead to more quit attempts.43
- Best Practices User Guide: Health Equity in Tobacco Prevention and Control [PDF–5.05 MB]
- What We Know: Tobacco Use and Quitting Among Individuals With Behavioral Health Conditions [PDF – 937 KB]
- DIMENSIONS: Tobacco Free Toolkit for Healthcare Providers [PDF–1.7 MB]
- Enhance Your State’s Tobacco Cessation Efforts Among the Behavioral Health Population: A Behavioral Health Resource [PDF–0.99 MB]
- National Behavioral Health Network for Tobacco and Cancer Control
- Smoking Cessation Leadership Center
- Million Hearts in Municipalities: Tobacco Cessation in a Mental Health Clinic in Albany County, New York [PDF – 128 KB]
- National Partnership on Behavioral Health and Tobacco Use (hosted on SCLC site, which also has a link to multiple resources.)
- SAMHSA Tool Kit: Implementing Tobacco Cessation Programs in Substance Use Disorder Treatment Settings: A Quick Guide for Program Directors and Clinicians
- Focusing on People with Mental Illness
- Substance Abuse and Mental Health Services Administration. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2017 [accessed 2022 Feb 25].
- Center for Behavioral Health Statistics and Quality. (2020). Results from the 2019 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration [accessed 2022 Feb 25].
- Druss BG, Zhao L, Von Esenwein S, Morrato EH, Marcus SC. Understanding Excess Mortality in Persons With Mental Illness: 17-Year Follow Up of a Nationally Representative US Survey. Medical Care 2011;49(6):599–604 [accessed 2022 Feb 25].
- 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 [accessed 2022 Feb 25].
- 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 [accessed 2022 Feb 25].
- Tam J, Warner KE, Meza R. Smoking and the reduced life expectancy of individuals with serious mental illness. American Journal of Preventive Medicine. 2016; 51(6):958–966 [accessed 2022 Feb 25].
- Apollonio DE, Malone RE. Marketing to the marginalised: tobacco industry targeting of the homeless and mentally ill. Tob Control. 2005;14(6):409-415 [accessed 2022 Feb 25].
- Campbell BK, Le T, Andrews KB, Pramod S, Guydish J. Smoking among patients in substance use disorders treatment: associations with tobacco advertising, anti-tobacco messages, and perceived health risks. Am J Drug Alcohol Abuse. 2016;42(6):649-656 [accessed 2022 Feb 25].
- Marynak K, Vanfrank B, Tetlow S, et al. Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities—United States, 2016. Morbidity and Mortality Weekly Report, 2018;67(18):519-23 [accessed 2022 Feb 25].
- Jamal A, Phillips E, Gentzke AS, et al. Current Cigarette Smoking Among Adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(2):53-59 [accessed 2022 Feb 25].
- Cook BL, Wayne GF, Kafali EN, Liu Z, Shu C, Flores M. Trends in Smoking Among Adults With Mental Illness and Association Between Mental Health Treatment and Smoking Cessation. JAMA. 2014;311(2):172–182 [accessed 2022 Feb 25].
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- NIH State‐of‐the‐Science Panel. National Institutes of Health State‐of‐the‐Science conference statement: tobacco use: prevention, cessation, and control. Ann Intern Med. 2006;145:839‐844 [accessed 2022 Feb 25].
- Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, National Association of County Behavioral Health & Developmental Disability Directors, National Institute of Mental Health, The Carter Center Mental Health Program. Attitudes Toward Mental Illness: Results from the Behavioral Risk Factor Surveillance System. Atlanta (GA); Centers for Disease Control and Prevention; 2012 [accessed 2022 Feb 25].
- Prochaska JJ, Hall SM, Bero LA. Tobacco use among individuals with schizophrenia: What role has the tobacco industry played? Schizophr. Bull. 2008;34:555–67 [accessed 2022 Feb 25].
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- Cummings JR et al. Addressing public stigma and disparities among persons with mental illness: the role of federal policy. American Journal of Public Health. 2013;103(5): 781-5 [accessed 2022 Feb 25].
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- Patient Protection and Affordable Care Act, 2010, Pub. L. No. 111-148, 124 Stat. 119 [accessed 2022 Feb 25].
- Carson NJ, Rodriguez D, Audrain-McGovern J. Investigation of mechanisms linking media exposure to smoking in high school students. Prev Med. 2005;41(2): 511-20 [accessed 2022 Feb 25].
- Charlesworth A, Glantz SA. Smoking in the movies increases adolescent smoking: A review. Pediatrics 2005;116(6): 1516-28 [accessed 2022 Feb 25].
- U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2022 Apr 28].
- National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco Control Monograph No. 19. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. NIH Pub. No. 07-6242, June 2008 [accessed 2022 Apr 28].
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