Presenter: Tina Chapman Healthy Maine Partnership of Greater Waterville

Background A dramatic reduction in tobacco use in the general population has occurred during the past 40 years, however, there has been almost no decrease in the smoking rate among those with behavioral health diagnoses.  This population has been largely excluded from the greater societal movement toward minimizing smoking.

Central Maine Collaborative Formed in 2003 Identify and address barriers to effective tobacco treatment for people with behavioral health diagnoses Increase the capacity of Behavioral Health providers and organizations to encourage and support tobacco-free living

Statistics Discovered Psychiatric patients are two to three times more likely to smoke than the general population; 44% of cigarettes smoked are by those who will at some time have a psychiatric disorder: Prevalence of smoking Schizophrenia 80% Bipolar 80% Depression 60% Anxiety 45% Substance Abuse 75 to 100% General Population 20-25%

Let the Research Begin Who is our audience? People with a mental health or substance abuse diagnosis (or both) Where do they live, work, socialize? How much and how often do they smoke? Who provides services to them? Are they encouraged or discouraged to attempt tobacco treatment – why??? By whom do they want to hear messages about tobacco treatment? How? What do the messages look like?

Key Early Findings People with mental illness and substance abuse are interested in quitting and do quit smoking Individuals addicted to alcoholic who quit smoking are more likely to succeed in alcoholism treatment; continued smoking is a risk factor for relapse Successful treatment of underlying mental illness increases quit rates

Important Considerations for the BH Population Nicotine like other stimulants may relieve symptoms of depression and attention deficit and hyperactivity disorder. Though used less by people with anxiety disorders, smoking is often perceived by them to be calming. Nicotine may be used to self medicate as a stimulant, a relaxant or both.

Important Considerations for the BH Population Smoking speeds up the rate at which some medications are metabolized Some anti-psychotic medication is associated with an increase in smoking, while others are associated with a decrease in smoking Physical activity can help manage withdrawal symptoms and combat depression

Important Considerations for the BH Population 2000 PHS Clinical Guidelines “Numerous effective pharmacotherapies now exist… these should be used with all patients attempting to quit” Combination therapies are effective for this population Quitting smoking does not cause abstinent alcoholics to relapse Concurrent tobacco treatment results in better overall substance abuse outcomes

Fall 2005 - Focus Group Findings Need to acknowledge how difficult it is to quit Need more resources for consumers and providers “where they live and socialize” Okay for providers to be proactive 1-800 Maine Tobacco HelpLine not very helpful for this population Need to address their environments Focus on increasing self-esteem Messaging should use people who don’t look “perfect”

Key findings, continued Focus on the “stages of change” Provide strategies to re-purpose time spent smoking Focus on second-hand smoke dangers Be straight-forward about dangers Develop peer-to-peer support Develop support of day-to-day care providers Work on state-wide policy issues

Myths Discovered Myth 1 – Client doesn’t really want to quit Myth 2 – Client - “don’t bother me about my smoking” Myth 3 – A client needs to quit all at once Myth 4 – Quitting smoking is not as important as addressing other substances Myth 5 – A smoking relapse is better than an alcohol or drug relapse Myth 6 – The client is incapable of quitting (even if they say they want to) Myth 7 – A staff person who is a smoker, can’t support their client being tobacco-free Myth 8 – The only thing the client does for herself is smoke

Next Step – Developing Tools Posters - Developed with input from clients

Set of 5 Companion Handbills Front Back

Tool Kits Designed Introduction (Tobacco facts, treatment strategies for tobacco using stages of change) 5 Stages of Change folders Resources Policy & Environment including smoke-free Housing info Current Treatment Options Research

Pilot Sites – Received Training Tested Materials Received Training on: Tobacco dependence & BH Population Tobacco intervention (stages of change) Motivational Interviewing specific to tobacco Using a systems-wide approach to tobacco treatment

Phoenix House ~ Residential Substance Abuse Treatment for Adolescents Became a tobacco-free campus Integrate tobacco into Intake, Treatment, Discharge documents and plans Staff trained in tobacco treatment Tobacco education for youth

Phoenix House Teens expected to be tobacco free on and off campus - with consequences Working w/ staff to personalize treatment Library of materials available * however lack of best practice materials/methods for this population Family engaged through sessions on Saturday family days

Summit held for BH leaders & providers in June 2007

Formation of Maine BH Task Force Goal – provide statewide support for successful tobacco treatment among people with behavioral health issues to: Change policies Create supportive environments Provide training, education and awareness throughout the State

Maine BH Task Force Objectives Insurance – address discrepancies around reimbursements – to whom and for what Licensing – seek to include tobacco treatment training in curriculum for LSW and substance abuse counseling Innovative Support – look for ways to support people with BH issues in new ways…

Education & Outreach – offering statewide tailored intervention treatment

What’s Next? Showcase and distribute materials across the state and nationally Continue to feature partner successes Increase the capacity of providers to integrate tobacco treatment into their settings Work on state level policy changes to support tobacco treatment for the BH population

Contact Information Tina Chapman Healthy Maine Partnership of Greater Waterville PO Box 91 105 Kennedy Memorial Drive Waterville, ME 04901 207-873-0686 or tinac@unitedwaymidme.org