A Real World Approach to Treating Tobacco Use in Mental

Health Settings

Jill Williams, MDAssociate Professor of Psychiatry and Director

of the Division of Addictions Psychiatry

Learning about Healthy Living Manual

Disclosures

• Grant support from NIDA, NIMH, Pfizer

• Advisory Board Member- Pfizer

Objectives

1. Discuss a wellness-based group treatment approach that facilitates the adoption of a tobacco free lifestyle for mental health consumers with different levels of motivation.

2. Identify challenges for group leaders in presenting information to mental health consumers.

3. Describe the use and benefits of a valuable motivational tool – the carbon monoxide (CO) meter.

4. Become familiar with strategies for teaching smokers with mental illness about the consequences of smoking

Three Fourths of Smokers have a Past or Present Problem with

Lasser et al., 2000; Data from National Comorbidity Study

Mental Illness

or Addiction

Stages of Change Prochaska and DiClemente

• Precontemplation not thinking of stopping in next 6 months

• Contemplation thinking of stopping in next 6 months

• Preparation planning stop in next 1 month

• Action quit date

• Maintenance abstinent >6 months

Preparation

Most smokers enter here

SMI Smokers

Goals of MI

• Precontemplation

• Contemplation

• Preparation

SUCCESS !

Language is Important

Tobacco Dependence Treatment vs. “Smoking Cessation”

“Quitting”

“Stop Smoking”

Engaging Low Motivated Smokers

• Half of smokers with SMI have no plans of quitting in next 6 months.

• Less than 25% planning to quit in the next 30 days

• Need to increase motivational levels in clients before tobacco treatment can commence

Carosella et al., 1999; Addington et al., 1997; Hall et al., 1995; Etter et al., 2004

Complete Wellness:Mental and Physical Health

CompleteWellness

HealthyFood Choices

DailyPhysicalActivity

BalancingRelaxation& Stress

Addressing Addictive Behaviors

RegularCheckups

MentalHealth &Recovery

Plan

Wellness & Recovery

includes

Addressing Tobacco

Complete Wellness Approach

• LAHL developed to help low motivated smokers

• Mental health settings• Group format• Education on range of topics

– Healthy eating– Increasing activity– Awareness of tobacco addiction

 

LearningAbout

Healthy Living

TOBACCO AND YOU

Jill Williams, MDDouglas Ziedonis, MD, MPH

Nancy Speelman, CSW, CADC, CMSBetty Vreeland, MSN, APRN, NPC, BC

Michelle R. Zechner, LSWRaquel Rahim, APRN

Erin L. O’Hea, PhD

AVAILABLE FREE ONLINE http://rwjms.umdnj.edu/addiction/http://rwjms.umdnj.edu/addiction/

Learning About Healthy Livingis a collaborative project between

which is funded by the

 New Jersey Division of Mental Health Services

This manual was designed for several reasons:

1. To give information about the relationship of psychiatric symptoms and tobacco use/addiction.

2.  To give information about the recovery process from tobacco addiction.

3. To increase motivation about wanting to lead a tobacco-free lifestyle and quit smoking.

This manual was designed for several reasons (con’t)

4.   To develop skills that will assist in quitting and getting healthy.

5.   To teach specific relapse skills

6.   To use the group format to provide additional support and modeling experiences for the client struggling with a mental illness.

Learning About Healthy Living

• This treatment is designed as two groups.

• Group I - Learning About Healthy Living

• Group II - Quitting Smoking

• It is designed so that consumers can progress from Group I to Group II, when appropriate or desired

Facilitator’s Guide

• Accompanies each Chapter

• Objectives

• Suggested Approach

• Additional Resources/ References

• Group 1- 20 Sessions

• Group II- 6 Sessions

Group I: Learning About Healthy Living

• 20 Weeks

• Educational and Motivational

• Accepts all smokers with SMI

• Piloted in outpatients

• Smoking within the context of Healthy Living (Exercise, stress, & diet)

• Could change the order of the sessions and some may take longer than 1 session

Therapist Style of Delivering Treatment

• Client Check-in – tobacco and other activities– self-reported cigarettes per day last week & do

expired carbon monoxide (if possible)

• Be supportive, empathic Coach / Facilitator– Involve everyone in process– Ask them about their opinions / thoughts on the

topics – Be educational and motivational

• Provide repetition and assess comprehension

46%

45%

8% 1%

Excellent

Very Good

Satisfactory

Below Average

91% Consumer Interest in Group Rated as Excellent or Very good

Williams, J.M., et al. A wellness approach to addressing tobacco in mental health settings: Learning about Healthy Living. Am J Psychiatr Rehabil, 12:352-369, 2009

61%

28%

10% 1%

Excellent

Very Good

Satisfactory

Below Average

89% Consumer Level of Participation in Group Rated as Excellent or Very good

Williams, J.M., et al. A wellness approach to addressing tobacco in mental health settings: Learning about Healthy Living. Am J Psychiatr Rehabil, 12:352-369, 2009

LAHL in Psychosocial Rehab Clubhouses (NC)

• Staff and member surveys• Of the 271 participants (9 programs) 58%

completed surveys • Tested well: feasible and well-received• Group facilitators non-clinicians• Staff had been concerned about the viability of

the program at its start, but were later surprised,• The curriculum had provided a sense of

camaraderie among members and generated energy for other healthy changes in the clubhouse

Lee et al. BMC Public Health. 2011 Sep 14;11:702.

Conclusions

• LAHL is feasible and well-received in MH settings

• Increasing consumers readiness to change tobacco use behavior

• Easy to implement with limited training

• Let us know your experiences with it jill.williams@umdnj.edu