1. Presenter: Tina Chapman
Healthy Maine Partnership of Greater Waterville

2. 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.

3. 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

4. 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 %
Bipolar %
Depression %
Anxiety %
Substance Abuse to 100%
General Population %

5. 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?

6. 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

7. 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.

8. 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

9. 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

10. 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”

11. 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

12. 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

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

14. Set of 5 Companion Handbills
Front
Back

15. 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

16. 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

17. 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

18. 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

19. Summit held for BH leaders & providers in June 2007

20. 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

21. 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…

22. Education & Outreach – offering statewide tailored intervention treatment

23. 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

24. Contact Information
Tina Chapman
Healthy Maine Partnership of Greater Waterville
PO Box 91
105 Kennedy Memorial Drive
Waterville, ME 04901 or