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
• Advisory Board Member- Pfizer
Objectives
1.
2.
3.
4.
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
Three Fourths of Smokers have a
Past or Present Problem with
or Addiction
Mental Illness
Lasser et al., 2000; Data from National Comorbidity Study
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
• Maintenance
quit date
abstinent >6 months
SMI
Smokers
Preparation
Most
smokers
enter
here
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
Wellness &
Recovery
includes
Addressing
Tobacco
Mental
Health &
Recovery
Plan
Healthy
Food Choices
Regular
Checkups
Complete
Wellness
Addressing
Addictive
Behaviors
Daily
Physical
Activity
Balancing
Relaxation
& Stress
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
Learning
AVAILABLE FREE ONLINE
About
http://rwjms.umdnj.edu/addiction/
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
Learning About Healthy Living
is 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
91% Consumer Interest in Group Rated
as Excellent or Very good
8%
1%
46%
Excellent
Very Good
Satisfactory
Below Average
45%
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
89% Consumer Level of Participation in
Group Rated as Excellent or Very good
10%
1%
28%
61%
Excellent
Very Good
Satisfactory
Below Average
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