July 10, 2007

Do as I say not as I do…

Efforts to Stop Smoking Target Mental Health Agencies


Behavioral health staffs that need to take a smoke break might have some relief from their tobacco habits as they start tobacco cessation programs along with their mental health and substance abuse clients.

The Center for Evidence Based Practices, a joint program of Case Western Reserve University's Mandel School of Applied Social Science and the psychiatry department at the School of Medicine, have received a grant to design and implement tobacco cessation programs that target clients and staffs at behavioral health agencies.

The $517,000 grant for fiscal year 2007-08 through Ohio Tobacco Prevention Foundation funds to the Ohio Departments of Mental Health and Alcohol and Drug Addiction Services is expected to reach up to 15 agencies over the next year as the state implements programs that focus on health and well-being.

"Smoking is a major health problem, and it impacts recovery for substance abusers and mental health clients," said Lenore Kola, co-director at the center. She is working with the center's co-director Robert Ronis, the Douglas Lenkoski Professor and interim chair of the psychiatry department.

"The thinking is that you cannot talk to clients about stopping smoking if the staff is running off for a smoke or smelling of smoke" said Kola. "We want a commitment from everyone that they are interested in stopping."

Some statistics are that more people die from smoking (400,000 annually) than from substance abuse (10,000). Approximately 55 percent of people with tobacco addictions also have mental health problems.

Kola explained that, "Research shows that substance abusers who smoke have a higher rate of relapsing."

Since 1995, the National Association of Social Workers has recognized tobacco as a drug, but Kola said teaching tobacco cessation methods has not made its way yet into many social work school teachings. Kola will begin introducing it into courses on dual disorders at the Mandel School in the coming year.

Kola said tremendous changes have taken place over 30 years from the time when she came to Case and ashtrays were on classroom tables, to the current situation where smoking isn't allowed in or near buildings.

"If we've had this kind of progress in 30 years, imagine where we will be in another 30 years," she said.

The center is an umbrella entity for the Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence (Ohio SAMI CCOE), which is a technical-assistance organization that promotes knowledge development and the implementation of evidence based practice centers for the treatment and recovery of people with mental illness.

The new smoking-cessation models will be designed for use in organizations that specifically reach out to clients with mental illness and substance use disorders.

Already Ohio has tried this organizational-wide approach in a 2005 pilot study in eight agencies. The researchers plan to revisit data from that study to see what worked and incorporate those strategies in the new program they are developing.

They hope to tap the expertise of Jill Williams, a physician from the Washington, D.C., area who has developed practices to stop smoking, and Carlo DiClemente, a researcher who has studied cessation practices and assisting agencies with developing programs in a general population. DiClemente and his colleagues were the first to develop the stages-of-change approach for health and behavioral health interventions. This approach emphasizes that big changes such as abstinence from alcohol, tobacco and other drugs occur through stages, which may occur slowly or quickly, depending upon each individual's readiness, willingness and ability to change.

Two key elements may become part of the center's smoking-cessation model: motivational interviewing and stages of change. These elements focus on working where the client is at in the process of personal change.

"This approach is different from tough-love models where you had to go cold turkey to give up an addiction. People will make big changes over time by taking small steps," said Paul Kubek from the center. He explained that motivational interviewing and stages of change help service providers make sure they are not too many steps ahead or behind their clients in the process of change.

The one-size-fits-all model is increasingly being replaced by the stages of change model. "It is an empowering model with the practitioner helping the client's self motivation," said Kola.

For more information contact Susan Griffith, 216.368.1004.

Posted by: Marsha Bragg, July 10, 2007 10:39 AM | News Topics: Collaborations/Partnerships, Grants, Healthcare, Mandel School of Applied Social Sciences, Provost Initiatives, Research, School of Medicine

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