Although overcoming addiction to tobacco can be challenging for anyone who smokes and even more challenging for individuals with mental illness and addiction to other drugs, success is possible. Research clearly shows that individuals with mental illness and addictions can quit and achieve all of the benefits of living smoke free.
Overall, research indicates that individual and group counselling strategies that are successful in the general population are also effective for persons with mental illness and addictions. The most effective approach to quitting is through a combination of nicotine replacement therapy (NRT) or other medication supported by counselling.
All persons with mental illness and addictions can and should be encouraged to use the full range of cessation medications, including NRTs unless medically contraindicated.
Individuals with mental illness and addictions often have higher levels of addiction and smoke more heavily, thus they generally benefit from more intensive treatment. For example:
- an increased number of counseling sessions
- longer duration of treatment
- higher doses of NRT or medication
- a combination of smoking cessation medications
Here are some recommended strategies to encourage and support people living with mental illness and addictions to become smoke free.
- Remind the person that quitting smoking is a process. Many people require multiple quit attempts before they are successful in staying smoke free.
- Focus on small steps. The client may not be ready to set a quit day, cutting down before quitting may be more realistic. Switching from daily to non-daily use has also been found to be an effective first step.
- Address misconceptions about smoking and fears about quitting.
- Reassure the person that while you are encouraging them to take action to quit smoking, no one will force them to quit. A person may feel that smoking is an area of their life that they can control, so it is important that they are also in control of their quit plan. Respect the person’s decision on whether or not they smoke, and simply provide them with resources, information and support to help them when they are ready.
- Provide simple key messages. Lower cognitively functioning clients may have difficulty processing abstract concepts. Keep the focus on identifying a clear reason to quit and on planning specific strategies to deal with cravings and triggers. Gradual pacing, visual aids and repetition are helpful.
- Review past experience with quit attempts. This may help identify what was helpful in the past and will help the individual better prepare for obstacles.
- Offer tips on coping strategies to deal with stress.
- Incorporate resources which illustrate the tangible effects of tobacco use, such as the carbon monoxide monitor, and the rewards of quitting, such as the Savings Calculator. These tools promote key messages and may increase motivation to quit.
- Promote group programs to people who report they enjoy smoking while socializing. Group programs offer support from peers who may help overcome feelings of isolation. Having a client co-facilitate along with a staff member has been a strategy that has worked well in other smoking cessation groups.
- Include messages about smoking cessation within other programs that address health and wellness.
- Adjust use of NRT products to best meet individual needs. Individuals do not have to strictly follow NRT doses recommended by the manufacturer. To manage withdrawal symptoms, it is safe to use the product more frequently and for a longer time than recommended in product inserts.
- Use different NRT products at the same time, if needed. This is safe and can lead to higher success rates. For example, use of the nicotine gum and patch at the same time.
- Refer patients to their local pharmacist for more information on NRTs.
- Remind the person about the importance of counselling in combination with NRT or cessation medications.
- Ensure medication side effects are monitored closely. Components in tobacco smoke increase the metabolism of some antidepressants and antipsychotic medications resulting in lowered levels of medication in the blood. When a person quits, the levels of drug in the person’s blood may increase significantly and dosages may need to be adjusted.
CAN-ADAPTT. (2011). Canadian Smoking Cessation Clinical Practice Guideline. Toronto, Canada: Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment, Centre for Addiction and Mental Health