Medication-Based Smoking Cessation Program

Did you know?

  • About 70% of people who have a behavioral health disorder, including substance use disorders (SUD), and who use tobacco products, want to quit.
  • People who have a mental illness who quit smoking can reduce the amount of psychotropic medications needed to manage symptoms, which can also lower their risk for metabolic syndrome.
  • People who have a substance use disorder who quit smoking have a 25% lower rate of relapse compared to those with an SUD who keep smoking cigarettes.

For every Medicaid dollar spent on smoking cessation, such as prescribing your clients medications, the state of PA gets back about $1.23 in savings, mostly in reduced medical costs.

  • In other words, smoking cessation could be an extremely effective and valued behavioral health intervention within the health care field. Be the solution to the health care problem.
  • Why is that the case? Respiratory disease is the most common condition for a medical hospitalization for those with an underlying mental illness or SUD in the U.S.

Medications for tobacco use disorder (TUD) have the best impact, including nicotine replacement therapy (NRT), varenicline (referred to as Chantix®), or bupropion.

  • People who have a mental illness (including SMI) or an SUD are 3 to 4 times more likely to quit smoking with medications than those who attempt “cold turkey.”
  • The good news is that you can combine the medications for an even better impact.

You might be worried that a medication-based smoking cessation program can create more problems than solve on the unit or in your outpatient program, but:

  • Medication-based smoking cessation programs with varenicline are highly effective for people with an SMI, based on new research, and reduce psychiatric symptoms.
  • Medication-based smoking cessation can reduce (not increase) substance use for people who have an SUD. Two large meta-analyses found no evidence that smoking cessation increases relapse rates for alcohol or drugs, but one of the studies found a 25% reduction in relapse rates.

A recent meta-analysis of 35 randomized clinical trials highlighted the following results (Apollonio et al., 2016). Individuals with a TUD receiving:

  • Medications had an 80% increase in abstinence rates compared to those who attempted to quit “cold turkey”
  • A combination of mediations and counseling showed a significant increase in abstinence rates
  • Counseling only, without medications, did not show a significant increase in abstinence rates.

How to get started at your agency:

  • Start by establishing standing orders for medications and provide client-friendly handouts on the benefits of smoking cessation.
  • Weave smoking cessation into existing relapse prevention groups at your treatment facility.
  • Use established monitoring measures, such as the PHQ-2 or 9 or GAD-7, to see if your clients show an increase in depression or anxiety once they quit.

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