Incorporating Tobacco Cessation
Activities in a Psychosocial
Rehabilitation Clubhouse
Colleen McKay, M.A., C.A.G.S.
The Program for Clubhouse Research
Center for Mental Health Services Research
Department of Psychiatry
University of Massachusetts Medical School
Extent of the Problem
Many people with Severe Mental Illness (SMI) use smoking
to manage symptoms, stress, or increase social contact
and consume nearly half of all tobacco sold in the United
States.
Compared with the general population, individuals with
SMI are at greater risk of co-morbid health problems and
premature death.
Often individuals with SMI are unaware that services like
Quitlines, Nicotine Anonymous (NIC-A) meetings, and/or
NRT exist.
Health Promotion Activities Currently
Provided by Clubhouses1
Percent
1. McKay, C.E. & Pelletier, J.R. (2007). Health Promotion in Clubhouse Programs: Needs,
Barriers, and Current and Planned Activities. Psychiatric Rehabilitation Journal, 31, 155-159.
Our Project
Academic community partnership that joins experts in
tobacco dependence treatment for adults with SMI from
UMass with leaders in the Clubhouse Model from Genesis
Club in Worcester, MA.
Expand member involvement & develop peer tobacco
leaders
Adapt & integrate tobacco interventions for clubhouse
settings:
Learning About Healthy Living (LAHL)
Addressing Tobacco Through Organizational Change (ATTOC)
Consumers Helping Others Improve Their Condition by
Ending Smoking (CHOICES)
Create new materials based on these interventions, and
Disseminate findings
Our Team
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Colleen E. McKay, MA, CAGS, UMass
Douglas Ziedonis, MD, MPH, UMass
Gregory Seward, MSHCA, UMass
Valerie Williams, MA, MS, CMHSR; UMass
Robert Orwin, Ph.D., Westat
Kevin Bradley, MED, Genesis Club, Inc.
Jennifer Colburn, AA, Genesis Club, Inc.
David Rocheleau, BA, Genesis Club, Inc.
Emily Sawyer, BA, Genesis Club, Inc.
Jim Damiano, BA, Genesis Club, Inc.
Genesis Members – Laura, Jane, Paul, April
The Clubhouse Model
Originated at Fountain House in 1948.
Worldwide network of clubhouses affiliated with the
International Center for Clubhouse Development (ICCD)
328 clubhouses - 27 countries & 32 states.
Clubhouses - therapeutic communities composed of people
diagnosed with Severe Mental Illness (SMI) and paid staff
Participants are referred to as members
Clubhouse staff and members work side-by-side as peers in
a rehabilitative environment
Members are encouraged to participate in all aspects of
clubhouse operations
Clubhouses are typically open 365 days a year.
Basic Clubhouse Components
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Membership
Choice
Work-Ordered Day
Community Supports
Employment
Supported Education
Housing
Outreach
Wellness or Health Promotion Activities
Evening, Weekend & Holiday Programs
Genesis Club
Free standing clubhouse established in 1988
ICCD training center
120 members per day
Active monthly membership of 300
Membership: 47% male, 25% non-Caucasian, and average
age 43 years.
Approximately half the clubhouse members have a
diagnosis of schizophrenia, and 1/3 have major
depression or bipolar disorder.
Many clubhouse members struggle
with substance misuse:
17% have severe to moderate substance abuse,
10% have mild substance abuse, and
24% are currently abstinent.
Genesis Club: Extent of Tobacco Use
Among Members
82% of members (N=114) said they
endorse smoking related behaviors
Many members (49%) want support
with reducing tobacco use
38% want to quit using tobacco
Other members want support with
relapse prevention
Addressing Tobacco Through
Organizational Change (ATTOC)
Guides a technical assistance process utilizing specific
steps and organizational change processes:
selecting leaders, leadership team, and workgroups;
determining goals;
assessing agency readiness for change;
creating a change plan;
developing implementation teams to address the specific
client/patient, staff, and organizational goals;
develop communication plans, and
provide ongoing supervision for the integration of evidence based
practices, educational curriculums, and agency policies
to address tobacco.
ATTOC in the Clubhouse
Develop an organizational change plan with
regard to tobacco use
For clubhouses, goal areas focused on:
1) Organization-Clubhouse,
2) Service Providers-staff, and
3) Service Recipients-members
ATTOC Goals and Activities
Program level:
Short-term goals: ongoing education about the effects
of smoking and tobacco use,
Pilot and modify tobacco cessation interventions for
the clubhouse
Long-term goal: tobacco cessation becomes part of the
health promotion activities at Genesis.
ATTOC staff / member goals:
participation in tobacco cessation training,
intervention development,
developing education and recovery resources, and
a reduction in tobacco use.
Learning About Healthy Living (LAHL)3
Developed to help smokers at any motivational level to quit
Training Manual - 8 Sections
Introduction to Learning About Healthy Living
General Structure of a Treatment Group
Tobacco Dependence Treatment Medications
Group I (Motivational Group for lower motivated)
Facilitator’s Guide
Consumer’s Handouts
Group II (Quit Group for higher motivated)
Facilitator’s Guide
Consumer’s Handouts
Appendix/Forms, Resources, and References
3. Williams, J.M., Ziedonis, D.M., Speelman, N., Vreeland, B., Zechner, M., Rahim, R., & O’Hea, E. Learning
about Healthy Living: Tobacco and You Manual. Revised June 2005.
Learning About Healthy Living Group I
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Introduction to Healthy Living
Educational and Motivational
Accepts all smokers with SMI –
Clubhouse members, participants in Day
Program or other services
Tobacco and smoking education within
context of Healthy Living:
Exercise, Stress, & Diet, Health Risks, Chemicals in
Cigarettes/Smoke/Second Hand Smoke, Tobacco Addiction, Mental
Illness & Medication Effects, What Are My Smoking Patterns?, What is
Carbon Monoxide?
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Treatment Options
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Making a Decision to Quit, Cold Turkey, Nicotine Replacement Therapy
(NRT) & Other FDA Approved Medications
20 Weeks - Could change the order of the sessions and
some may take longer than 1 session
Monthly Budget as a Percentage of Median
Public Assistance Received*
Food
Shelter
Misc. Living Expenses
Cigarettes
*Source: Steinberg ML, Williams JM, Ziedonis DM. (2004). Financial Implications of
Cigarette Use in Smokers with Schizophrenia. Tobacco Control, 13, 206.
Session 6: How Much Does Smoking Cost?
Tobacco companies only spend 6 cents to make a pack
of cigarettes
Review how smoking is expensive
Average daily, weekly, monthly and annual amount spent
on cigarettes
A pack a day smoker can spend $3000 per year
Can be about 25% of a consumer’s income
Learn how much one will save if he/she quits smoking
Identify other things that could do with the money saved
How Much Does Smoking Cost You?
Approximate
Average
Average Cost Average Cost Average Cost Average Cost
Number of
Cost in Ten
Per Day
Per Week
Per Month
Per Year
Cigarettes Smoked
Years
½ pack (10 cigs)
$4.50
$31.50
$133.88
$1,638.00
$16,380.00
1 pack (20 cigs)
$9.00
$63.00
$267.75
$3,276.00
$32,760.00
1 ½ packs (30 cigs)
$13.50
$94.50
$401.63
$4,914.00
$49,140.00
2 packs
$18.00
$126.00
$535.50
$6,552.00
$65,520.00
2 ½ packs (50 cigs)
$22.50
$157.50
$669.38
$8,190.00
$81,900.00
3 packs (60 cigs)
$27.00
$189.00
$803.25
$9,828.00
$98,280.00
For 1 Pack Per Day: “In 10 years you will spend at least $32,760 …what else could
you have bought with that money?”
If YOU Quit Smoking… YOU WILL SAVE A LOT OF MONEY!
Carbon Monoxide (CO) Meter
CO Monitors yield accurate,
non-invasive readings of
carbon monoxide levels which
quickly and reliably tracks
tobacco use; tobacco use
reductions, and self-reported
smoking status.
Group II: Quit Smoking Group
Designed for the motivated individual
who wants to set a quit date and
attempt to stop
Six session group treatment –
recommend quitting between second
and third session – some may delay.
Encourage the use of NRT or FDA
approved medications with group
support
Inform primary therapist / psychiatrist
LAHL GROUP II: Session Outline
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Making a Quit Plan
Preparing to Quit
Seeking Support While You Quit
Refusing Cigarettes & other triggers
Dealing with Setbacks
Celebrating Quitting and a Tobacco-Free
Lifestyle
Preliminary Outcomes
Approximately 12 members and 3 staff attending
LAHL Group I meetings weekly
64 people have attended at least one LAHL
Group I meeting
20 members have attended LAHL Group II
23 members have made quit attempts, 4 without
relapse
Approximately 425 carbon monoxide readings
have been conducted for clubhouse members and
staff
Year 1 Accomplishments Include:
Establishing healthy living meetings
Creating peer tobacco leaders
Creating resources for members and staff with regard to health
promotion and consequences of tobacco use.
Genesis tracking members interested in tobacco cessation
Tobacco cessation part of rehabilitation plan
Genesis established an outdoor tobacco free area and held a ribbon
cutting ceremony in conjunction with World No Tobacco Day
Entire clubhouse grounds will be smoke free for the day for the Great
American Smoke Out on November 19, 2009.
Information regarding tobacco cessation activities is available via the
clubhouse’s newsletter, brochures, the tv monitor and web site.
Ongoing Activities
Continue with LAHL Group 1 and 2
Ongoing ATTOC
Creating a Clubhouse Wellness/Health
Promotion Toolkit
Piloting a new health promotion and
tobacco cessation training for clubhouses
with Genesis Club
How to integrate tobacco cessation activities
into the clubhouse
Lessons learned
Contact Information
Colleen McKay, M.A., C.A.G.S.
508-856-8471
colleen.mckay@umassmed.edu
The Program for Clubhouse Research
Center for Mental Health Services Research
Department of Psychiatry
University of Massachusetts Medical School
55 Lake Avenue North
Worcester, MA 01655