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The Tobacco Recovery and Wellness Initiative (TRWI) is a project that helps behavioral health providers incorporate evidence-based tobacco dependence treatment into their clinical and community practice.
For Behavioral Health Professionals
Behavioral health professionals can make a significant impact on patients who are smokers. Even brief advice and encouragement from a behavioral health professional can help smokers quit successfully.
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Frequently Asked Questions
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- People with behavioral health conditions have a right to wellness and recovery, including being free from nicotine addiction.
- Smoking rates among those with behavioral health conditions are significantly higher than the general population. In Philadelphia, 41 percent of residents with behavioral health conditions are smokers and 69 percent of those with a history of substance abuse are smokers.
- People with severe behavioral health problems live, on average, 25 years fewer than those without such conditions. Much of this disparity is due to cardiovascular disease and smoking.
- Tobacco use adversely affects all aspects of behavioral health: wellness, resilience, and recovery.
- People in behavioral health settings are less likely to be told about the negative health effects of smoking; less likely to be advised to quit; less likely to be offered help with quitting; and less likely to be provided access to smoke-free treatment settings.
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Public health detailing is an effective method of reaching providers to deliver key prevention messages, feasible for public health agencies and acceptable to practices. For example, the City of Philadelphia’s Department of Public Health’s SmokeFree Philly’s detailing program has reached over 200 physicians and increased prescription writing and referrals to the PA Quitline among 400 physicians since its inception. This translates to more successful quit attempts by approximately 200,000 Philadelphia smokers.
The expanded detailing program to behavioral health providers seeks to provide:
- Treatment decision supports
- Safe and effective use of FDA-approved pharmacotherapies
- How to effectively counsel and follow-up with consumers who use tobacco
- Making referrals to key cessation resources, prescribing pharmacotherapies
- Relevant articles on providing tobacco treatment for behavioral health populations
- Online continuing medical education
- Addressing biases and frequently asked questions that can present a barrier to offering consistent tobacco treatment
To date, over 167Â diverse behavioral health professionals across seven Community Behavioral Health agencies have been detailed through the initiative. Of those staff detailed:
- 94 percent found the information to be very useful
- 88 percent of staff identified a specific change that they could make to improve tobacco dependence treatment at their agency
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Please visit Rx for Change: Clinician-Assisted Tobacco Cessation.
Rx for Change is a comprehensive, turn-key, tobacco cessation training program that equips health professional students and licensed clinicians with state-of-the-art knowledge and skills for assisting patients with quitting.  Rx for Change was developed by University of California San Francisco.
Teaching strategies are varied and include selected readings, lecture with animated PowerPoint slides, videotape (an introductory segment, trigger tapes, counseling sessions), and role playing with case scenarios.
Tailored versions are available for behavioral health providers and mental health peer counselors.
Free registration is required for access to program materials.
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Materials & Resources
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- Nicotine Replacement Therapy Overview
- Treatment of Tobacco Dependence: A Critical Component of Behavioral Health (60 minutes): Review of the biologic genesis of tobacco dependence and basic pharmacology principles, relevant to the Behavioral Health setting and appropriate to practitioners of any discipline within the field.
- The Tobacco Epidemic Feeds The Opioid Epidemic! – The Biological Basis for Overlap in Dependence Syndromes (60 minutes): Why does addressing the opioid epidemic absolutely require a simultaneous approach to treating tobacco? Doing a better job treating the opioid epidemic implicitly means doing a better job with the tobacco epidemic at the same time. The biological basis for the overlap between these two important public health crises is explained.
- Developing More Effective Communication Strategies (35 minutes): Of course we would like to do a better job getting our message across to the people who could most benefit from our services. Sometimes, it can feel like it’s hard to know just what to say. Maybe, it’s not what we say, but how we say it that gets our message across.
- Informing Clients of Upcoming System Change (15 minutes): What’s the best way to inform clients about upcoming plans for a smoke-free space? How do we do the best job we can ensuring both clients and staff have the best information possible? The nature of the problem is reviewed, and alternative non-confrontational strategies are explored.
- “Hey! That’s Not Why I’m Here…” (12 minutes): Constraining a person’s ability to smoke at-will is often experienced as a significant threat to well-being and can lead to anticipatory anxiety. How do we best manage clients’ initial reaction when facing unplanned abstinence from smoking? This talk incorporates practical tips for implementation of biological concepts introduced within the Biological Overlap discussion.
- “I’ve Got a RIGHT to Smoke!” (13 minutes): When it comes to tobacco, popular cultural assumptions have framed continued substance use as an expression of autonomous choice. This runs counter to the way we think about other substances of abuse, and the influence they can exert over autonomy. We discuss non-confrontational ways to discuss the concept of rights within the substance abuse recovery setting, focused on promoting an advocacy relationship, rather than an adversarial one.
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Master Tobacco Treatment Specialist: Integration of Tobacco Use Treatment Into Healthcare
Integration of Tobacco Use Treatment into Healthcare is a five-day, highly interactive development course for working healthcare professionals, designed to help providers develop directorship-level skills in tobacco dependence treatment.
The course is appropriate for healthcare providers from disciplines with both direct and indirect patient care responsibility. The syllabus is designed to be applicable to the needs of most professionals involved in the treatment of tobacco dependence, including but not limited to:
- Physicians
- Advanced Practice Nurses
- Physician Assistants
- Psychologists
- Nurses
- Addiction Counselors
- Community Educators
- Health System Administrators
- Insurance Industry Executives
- Public Health Officials
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- Tools for Treatment Professionals (coVita)
a resource for monitoring devices used by treatment professionals to help smokers stop smoking and in tobacco prevention education. - Breath Carbon Monoxide Monitor: The “Stethoscope” of Tobacco Treatment
- Breath Carbon Monoxide Monitor: Test Results Template
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- A Meta-Analysis of Smoking Cessation Interventions With Individuals in Substance Abuse Treatment or Recovery (Journal of Consulting and Clinical Psychology)
- Change in Mental Health After Smoking Cessation (The BMJ – formerly the British Medical Journal)
- Risk of Neuropsychiatric Adverse Events Associated with Varenicline: Systematic Review and Meta-Analysis (The BMJ – formerly the British Medical Journal)
- A Double-blind Placebo-Controlled Trial of Bupropion Sustained-Release for Smoking Cessation in Schizophrenia (Journal of Clinical Psychopharmacology)
- Achieving Smoke-Free Mental Health Services: Lessons from the Past Decade of Implementation Research (International Journal of Environmental Research and Public Health)
- A Molecular Basis for Nicotine as a Gateway Drug (The New England Journal of Medicine)
- A Comprehensive Model for Mental Health Tobacco Recovery in New Jersey (Springer Science & Business Media)
- Efficacy of Initiating Tobacco Dependence Treatment in Inpatient Psychiatry: A Randomized Controlled Trial (American Journal of Public Health)
- A Tobacco Reconceptualization in Psychiatry (TRIP): Towards the Development of Tobacco-Free Psychiatric Facilities (NIH Public Access)
- Effects of High Dose Transdermal Nicotine Replacement in Cigarette Smokers (NIH Public Access)
- A Randomized Placebo-Controlled Clinical Trial of Five Smoking Cessation Pharmacotherapies (NIH Public Access)
- Cardiovascular Toxicity of Nicotine: Implications for Nicotine Replacement Therapy (Journal of the American College of Cardiology)
- A Controlled Trial of Sustained-Release Bupropion, a Nicotine Patch, or Both for Smoking Cessation (Massachusetts Medical Society)
- Smoking and Mental Illness — Breaking the Link (The New England Journal of Medicine)
- Treating Tobacco Use and Dependence: 2008 Update (U.S. Department of Health and Human Services)
- Treatment of Tobacco Dependence (Journal of the American Medical Association)
- Varenicline, Smoking Cessation, and Neuropsychiatric Adverse Events (American Journal of Psychiatry)
- Varenicline, an Nicotinic Acetylcholine Receptor Partial Agonist, vs Sustained-Release Bupropion and Placebo for Smoking Cessation (JAMA-Express)
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- A Hidden Epidemic: Tobacco Use and Mental Illness
- Bringing Everyone Along: A Resource Guide for Health Professionals Providing Tobacco-Cessation Services for People with Mental Illness and Substance Use Disorders
- DIMENSIONS: Tobacco Free Toolkit for Healthcare Providers
- DIMENSIONS Supplement for Priority Populations: Behavioral Health
- Policies and Procedures for Tobacco-Free Facilities in Substance Abuse & Mental Health Treatment Programs
- Smoking Cessation for Persons with Mental Illness: A Tookit for Mental Health Providers
- Tobacco Free Living in Psychiatric Settings
- Tobacco-Free Toolkit for Community Health Facilities
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- Calendar of national events (Centers for Disease Control and Prevention)
- For local events, go to HealthyMindsPhilly.org.
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Learning About Healthy Living
The Learning About Healthy Living treatment manual provides a format to address tobacco for smokers with a serious mental illness who are either prepared to quit smoking or who are simply contemplating quitting in the future.
Quit Smoking Comfortably
The Quit Smoking Comfortably curriculum provides a framework for providing high-quality, evidence-based, longitudinal care to tobacco-dependent consumers, in a manner that is adaptable to the individual’s needs, and accessible to all segments of the population.
CHOICES
CHOICES employs mental health consumers, called Consumer Tobacco Advocates, to deliver the vital message to smokers with mental illness that addressing tobacco is important and to motivate them to seek treatment.
The Consumer Tobacco Advocates provide their peers with information about the consequences of smoking, issues regarding smoking and mental illness, and options available to make quitting easier.
Nicotine Anonymous (NA)
Nicotine Anonymous is a nonprofit 12-step fellowship of men and women helping each other live nicotine-free lives. Check website for local meetings.
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Rx for Change: Clinician-Assisted Tobacco Cessation
Rx for Change is a comprehensive, turn-key, tobacco cessation training program that equips health professional students and licensed clinicians with state-of-the-art knowledge and skills for assisting patients with quitting.  Rx for Change was developed by University of California San Francisco.
Teaching strategies are varied and include selected readings, lecture with animated PowerPoint slides, videotape (an introductory segment, trigger tapes, counseling sessions), and role playing with case scenarios.
Tailored versions are available for behavioral health providers and mental health peer counselors
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- Discharge Packet for RDA Providers (PDF)
- Discharge Packet for RDA Providers (Word document)
- Clinical practice guidelines (Twin Valley Behavioral Healthcare)
- Policy and procedure manual (Northcoast Behavioral Healthcare System)
- Tobacco assessment questions (New Jersey QuitCenters)
- Tobacco treatment order sets (UMass Memorial Medical Center / University of Wisconsin Hospitals)
- Model tobacco-free policy (Centura Health)
- Sample tobacco-free policy
- Tobacco-free policy checklist
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How to make an plan for creating a tobacco-free agency
Fact sheets about tobacco use and recovery
Children’s Hospital of Philadelphia
Friends Hospital
East House
OTHERÂ HEALTH PROFESSIONALS
Physicians, nurses and other health professionals can make a significant impact on patients who are smokers. Even brief advice and encouragement from a health professional can help smokers quit successfully. Â
For the Public
Quitting smoking is one of the best things you can do to live a longer and healthier life, and it is never too late to try. Quitting with help can more than double your chances of quitting. The resources below can help make quitting easier and more successful. Remember, everyone who quits smoking gets back time, health, and money. Â A healthier tomorrow starts today!
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Quitting Help Resources & Tips:
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Talking with a trained quit coach can make you twice as likely to quit smoking for good.
A quit coach can give you advice on how to get ready to quit, how to deal with cravings, and how to avoid triggers.
The PA Free Quitline (1-800-QUIT-NOW) offers smoking cessation services to all Pennsylvanians 24 hours a day/7 days per week.
Free quit smoking medications may be available for PA Quitline callers.
Quitline services are available in multiple languages.
One-to-one telephone coaching also may be available through your medical provider.
All callers receive:
- up to five coaching sessions by phone
- unlimited calls to the PA Free Quitline as needed
- free educational materials on quitting tobacco use
The Health Federation of Philadelphia offers face-to-face quit smoking programs at city health centers and selected community locations.
Smoking cessation counselors provide on-site group smoking cessation programs and individual follow-up to patients who are ready to stop or reduce their use of tobacco products.
Participants may self-refer or be referred by their medical provider.
- To learn more, please call Faith Simmons at (215) 567-8001 ext. 3017.
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Become an EX.org
The EX plan is an online smoking cessation program based on scientific research and practical advice from ex-smokers.
Smokefree.gov
Smokefree.gov provides free, accurate, evidence-based information and professional assistance to help support the immediate and long-term needs of people trying to quit smoking.
Be Tobacco Free.gov
BeTobaccoFree.gov provides information from various Department of Health and Human Services operating and staff divisions.
Nicotine Anonymous – a Non-Profit 12 Step Fellowship of men and women helping each other live nicotine-free lives.
Nicotine Anonymous welcomes all those seeking freedom from nicotine addiction, including those using cessation programs and nicotine withdrawal aids.
- 1-877-TRY-NICA (1-877-879-6422)
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SmokeFreeTXT
Text2Quit is an automated, personalized, and interactive mobile health program that sends text messages and e-mails timed around a participant’s quit date over the course of three months.
- To get started, text the word “QUIT” to I-QUIT (4-7848)
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Frequently Asked Questions
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Yes. Trained quit coaches can work with you over weeks and months to raise your chances of quitting.
They can provide advice on how to get ready to try to quit, how to deal with those moments that you really want to smoke, how to avoid those moments, and how to quit for good.
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Nothing. All of the resources listed above are free. If you have health insurance through Medicaid, you may get nicotine gum, patches, lozenges, or other medications to help you quit for as little as $1 a month.
If you have private insurance or Medicare, call your insurance company for more information
Under the Affordable Care Act, many insurance plans should cover smoking cessation services, including counseling and medications.
For more information, call the member services number on your insurance card.
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Generally, phone-based quit coaching services are provided once per week over 4-6 weeks.
When you first call the Quitline, an operator will ask for some information about you and then connect you to a quit coach.
This quit coach will then get more information from you about your smoking history and your past tries at quitting.
- In the first call, your quit coach will help you create a quit plan, set a quit date, and help you decide whether to use medications or not.
- In the second call, your quit coach will see how your quit try is going, will encourage you to continue, and will help you work through problems.
- In the third call, your quit coach will cheer for you if things are going well and will provide useful advice if things are not going well.
- In the fourth call, your quit coach will help you see how far you’ve come along and will help you plan to quit for good.
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Yes. In fact, people who use both ways of quit help are even more likely to quit than those who use only coaching or medications.
In addition, all classes sponsored by the Department of Public Health offer free quit medications.
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Si. Hay servicios por el teléfono y internet.
- LĂnea de ayuda telefĂłnica: 1-800-QUIT-NOW (1-800-784-8669)
- Página web: Estoy Decidido
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Success Stories
In 2013, the City of Philadelphia’s Ex-Smoker’s Hall of Fame Initiative honored City employees who successfully quit smoking. Their stories are an inspiration to other tobacco users to quit smoking for good. Read some of these inspirational stories here.
Just this year, DBHIDS launched the Ex-Smoker’s Hall of Fame Initiative department-wide to help inspire our fellow team members to become tobacco-free. Meet the Department’s Ex-Smokers and read their stories:
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Help Others Quit
Friends, family members, and significant others can play a big part in helping a person become smoke-free. Remember, everyone who quits tobacco gets back time, health, and money.
People who feel supported are more likely to quit smoking for good. Forty percent of smokers who quit say that support from others contributed to their success. Click here for tips to help you support the person in your life who is ready to quit smoking.
