NAMI State Conference

November 16, 2013

Carole Specktor, M.P.A.1

Presentation Overview

• About ClearWay MinnesotaSM

• Why tobacco is still a problem• Why it is important to address tobacco

use?• Smoking and persons with mental

illness• QUITPLAN® Services

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About ClearWay Minnesota

• Mission: Reduce the harm tobacco causes the people of Minnesota

• Grant-making, QUITPLAN stop-smoking services and statewide outreach activities

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ClearWay Minnesota’s Work

• Policy Changes

• Research

• Reducing Disparities

• Cessation Services

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Media Campaigns and Outreach

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Why is Tobacco Still a Problem?

#1 Reason:

The Tobacco Industry

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Tobacco Industry Adapts

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Masterful Consumer Marketing

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Targeted Marketing

• Tobacco industry has targeted populations to increase usage and loyalty

• Examples:– African Americans– American Indians– Latinos– Persons with mental

illness– LGBT community– Low-SES– Youth

E-Cigarettes

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• Untested and unregulated• Not proven as safe

alternative to smoking• Not an approved

cessation aid• Often candy-flavored

• CDC study: use of e-cigarettes among middle- and high-school students more than doubled between 2011 and 2012

Quitting is Hard

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• Nicotine is highly addictive

• Fundamental changes to the brain

• Behavioral and psychological aspects of addiction

Why Address Tobacco?

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Tobacco is a Killer Problem

• Smoking is the number one cause of preventable disease and death

• 443,000 tobacco-related deaths per year nationally

• On average, smokers die 13 to 14 years earlier than nonsmokers

Smoking in Minnesota

• 625,000 Minnesota adults smoke (16%)

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• Secondhand smoke exposure (2010):‒ Nearly 46% of adults exposed ‒ 282,000 Minnesota children exposed

• Majority of Minnesota smokers want to quitMinnesota Adult Tobacco Survey Tobacco Use in Minnesota: 1999-2010

4000 Chemicals in Cigarettes

Examples and where these chemicals are found:

– Acetone: nail polish remover – Acetic Acid: hair dye – Ammonia: household cleaner – Arsenic: rat poison – Butane: lighter fluid – Cadmium: battery acid – Carbon Monoxide: car exhaust– Nicotine: insecticide – Tar: pavement 15

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Impact of Quitting

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Smoking and Mental Illness

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High Prevalence

• Higher prevalence imposes heavy morbidity and mortality burden

• Thirty-one percent of all cigarettes are smoked by adults with mental illness

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• Why higher prevalence? − Targeted by tobacco industry− Biological, psychological and social factors− To date, not commonly addressed by providers

Vital Signs: Current Cigarette Smoking Among Adults Aged >18 Years with Mental Illness – United States, 2009-2011

Quitting and Persons with Mental Illness

• Can quit• Want to quit • Want information to help them quit• Some factors may make it harder to quit,

but . . . • Evidence shows cessation strategies work• Studies show that quitting smoking does

not worsen psychiatric symptoms20

Vital Signs: Current Cigarette Smoking Among Adults Aged >18 Years with Mental Illness – United States, 2009-2011; Tobacco Cessation for Persons with Mental Illness or Substance Use Disorders, Center for Tobacco Cessation

Understanding Higher Prevalence: Biological Factors

Persons with mental illness have unique neurobiological features that may:

– Increase tendency to use nicotine– Make it more difficult to quit; and– Complicate withdrawal symptoms

21Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers

Understanding Higher Prevalence: Psychological and Social Factors

• Psychological considerations:– Smoking relieves tension,

anxiety and stress– Daily routine

• Social considerations:– Smoke to relieve boredom– Smoke to feel part of a group

22Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers

Understanding Higher Prevalence: Myths and Barriers within Behavioral Health Care

Commonly stated reasons why mental health providers have not addressed smoking with clients:• They can’t or don’t want to quit• More pressing issues• Concerns about worsening symptoms• Lack of training • Don’t want to take away one of patients’ few pleasures• Shared smoke breaks build strong relationships

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Triggering a Paradigm Shift in Treating Patients with Mental Health and Addictive Disorders, Wisconsin Nicotine Treatment Integration Project (presentation, July 28 2011); Vital Signs: Current Cigarette Smoking Among Adults Aged >18 Years with Mental Illness – United States, 2009-2011; Building the Case to support Tobacco Cessation, National Council for Behavior Health, June 28, 2013

Training • Recent study found psychiatrists:

– Address tobacco less frequently than other physicians

– Reported receiving no or inadequate training on tobacco-related interventions

• Survey of Wisconsin mental health providers: – The majority (72%) support adding nicotine

dependence treatment skills to credentials– With training, the majority (66%) are willing to

provide treatment

24Physician Behavior and Practice Patterns Related to Smoking Cessation, Association of American Medical Colleges ; Wisconsin Nicotine Treatment Integration Project

Strategies to Reduce Smoking for Persons with Mental Illness

• Reframe expectations of success

• Integrate tobacco as part of an approach to mental health treatment and overall wellness

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• Provide mental health providers the training and tools they need to address tobacco with patients

• Utilize existing resources such as quitlines

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QUITPLAN® Services

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The Good News: Treatment Helps

• Evidence-based treatment can double or triple success

• Evidence-based treatment:– Counseling– FDA-approved medications– Both

• Best outcomes with both

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QUITPLAN Helpline Basics

• Free Services• Serves:

– Uninsured– Underinsured, including Medicaid Fee-for-

Service– Live or work in Minnesota

• Phone Counseling in English and Spanish– Partner with Asian Smokers’ Quitline – Other languages through translation service

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QUITPLAN Helpline Program

• Multi-call, one-on-one coaching program

• Integrated text messages• Print materials• Nicotine Replacement

Therapy • Two enrollments per year

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QUITPLAN: Mental Health

• Training for coaches– Training for individualized services – Substantial mental health training– Ongoing

• Intake questions • Monitor field and adapt approach

as appropriate31

Nicotine Replacement Therapy

• Patches, gum or lozenge

• Uninsured and underinsured• Four weeks per enrollment*

(eight weeks per Medicaid enrollment)

• Medical screening

• Age 18 and older

• Live or work in Minnesota

32*twice every12-months

quitplan.com

• English and Spanish

• NRT not available through quitplan.com

• Available to all Minnesotans, regardless of insurance status

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Materials• Order QUITPLAN Materials at:

www.clearwaymn.org (click “about”)– Brochures in English and Spanish– Smokeless tobacco brochure– Palm card

• Mailed to you free of charge• E-cigarette fact sheet available on

website

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