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A Real World Approach to Treating Tobacco Use in Mental Health Settings

A Real World Approach to Treating Tobacco Use in Mental Health Settings . Learning about Healthy Living Manual. Jill Williams, MD Associate Professor of Psychiatry and Director of the Division of Addictions Psychiatry. Disclosures. Grant support from NIDA, NIMH, Pfizer

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A Real World Approach to Treating Tobacco Use in Mental Health Settings

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  1. A Real World Approach to Treating Tobacco Use in Mental Health Settings Learning about Healthy Living Manual Jill Williams, MD Associate Professor of Psychiatry and Director of the Division of Addictions Psychiatry

  2. Disclosures Grant support from NIDA, NIMH, Pfizer Advisory Board Member- Pfizer

  3. Objectives 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. Identify challenges for group leaders in presenting information to mental health consumers. Describe the use and benefits of a valuable motivational tool – the carbon monoxide (CO) meter. Become familiar with strategies for teaching smokers with mental illness about the consequences of smoking

  4. Three Fourths of Smokers have a Past or Present Problem with or Addiction Mental Illness Lasser et al., 2000; Data from National Comorbidity Study

  5. 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

  6. SMI Smokers Most smokers enter here Preparation

  7. Goals of MI • Precontemplation • Contemplation • Preparation SUCCESS !

  8. Language is Important Tobacco Dependence Treatment vs. “Smoking Cessation” “Quitting” “Stop Smoking”

  9. 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

  10. Complete Wellness:Mental and Physical Health Mental Health & Recovery Plan Healthy Food Choices Regular Checkups Wellness & Recovery includes Addressing Tobacco Complete Wellness Addressing Addictive Behaviors Daily Physical Activity Balancing Relaxation & Stress

  11. 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

  12. Learning About Healthy Living TOBACCO AND YOU Jill Williams, MD Douglas Ziedonis, MD, MPH Nancy Speelman, CSW, CADC, CMS Betty Vreeland, MSN, APRN, NPC, BC Michelle R. Zechner, LSW Raquel Rahim, APRN Erin L. O’Hea, PhD AVAILABLE FREE ONLINE http://rwjms.umdnj.edu/addiction/

  13. Learning About Healthy Living is a collaborative project between which is funded by the  New Jersey Division of Mental Health Services

  14. 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.

  15. 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.

  16. 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

  17. Facilitator’s Guide • Accompanies each Chapter • Objectives • Suggested Approach • Additional Resources/ References • Group 1- 20 Sessions • Group II- 6 Sessions

  18. 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

  19. 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

  20. 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

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