Additional State Activities

States are also taking other innovative steps to help people with behavioral health conditions quit tobacco.

For example, in addition to providing cessation support to clients while they are receiving behavioral health treatment, state-funded and state-certified behavioral health treatment facilities in Oklahoma provide clients discharged from crisis, in-patient, and residential treatment facilities with a short-term supply of free NRT until they can obtain additional free NRT from the state quitline or another source. Behavioral health providers also check on clients’ progress in quitting tobacco during a follow-up call which takes place within 30 days of discharge.

To increase cessation support in the community, Kentucky empowered pharmacists to provide tobacco cessation counseling and medications. Previously, pharmacists could not provide cessation medications on their own to help people quit using tobacco. In 2016, the Tobacco Prevention and Cessation Program within the Kentucky Cabinet for Health and Family Services worked with the state Pharmacy Board to help pharmacists and doctors enter into collaborative care agreements¹ allowing pharmacists to recommend cessation medications and provide brief cessation counseling. In late 2017, the Kentucky Pharmacy Board changed its rules to further empower pharmacists, allowing pharmacists to provide cessation medications and more extensive cessation counseling on their own.^{2, 3} This will allow persons with behavioral health conditions—and others—increased access to cessation services.

Other evidence-based strategies to address tobacco use among people with behavioral health conditions include:

• Adopting or changing health systems’ screening processes and electronic health record systems to make sure that providers ask and counsel clients about tobacco use and, if appropriate, provide them with cessation medications.⁴
• Continuing to educate behavioral health providers about the evidence that people with behavioral health conditions who smoke want to quit and benefit from quitting, while acknowledging that they may require longer or more intensive cessation treatment than people without such conditions.^{4, 5}
• Working with state Medicaid programs to cover evidence-based cessation treatments (including individual, group, and telephone counseling and the seven FDA-approved cessation medications), to remove barriers to accessing these treatments, and to promote awareness of this coverage among Medicaid enrollees and their health care providers to increase use of these treatments. Removing barriers, such as copayments, prior authorization, limits on the number of treatments allowed per year, or limits on how long treatment can be provided, can make it easier for people to access cessation treatment and encourage smokers to follow through on a quit attempt.⁶
• Continuing to reduce the appeal, accessibility, and social acceptability of tobacco and tobacco use. Not only will this reduce tobacco use in the general population, it will also help support targeted efforts to reduce tobacco use among people with behavioral health conditions. Proven methods include implementing comprehensive smoke-free laws, increasing the price of tobacco products, and conducting high-impact media campaigns.⁷ Ideally these campaigns can feature messages and testimonials specifically geared to persons with behavioral health conditions, such as Rebecca’s story from the Tips from Former Smokers® Campaign.⁸

The activities described here and on the state highlights pages are examples of some of the strategies that tobacco control and behavioral health programs have taken as they have worked together to reduce tobacco use among people with mental and substance use disorders. Quitting smoking not only improves physical health but may also improve behavioral health outcomes in this population. For this reason, behavioral health treatment facilities are important settings for delivering evidence-based tobacco cessation interventions.

1. For more information about Pharmacist Collaborative Practice Laws, see Centers for Disease Control and Prevention. Advancing Agreements: A Resource and Implementation Guide for Adding Pharmacists to the Care Team. pdf icon[PDF – 3.72 MB] 2017.
2. State of Kentucky Administrative Regulations, Chapter 201, Section 2:380. pdf icon[PDF – 191 KB]external icon Accessed December 10, 2019.
3. Kentucky Board of Pharmacy. Board Meeting Minutes, December 20, 2018. pdf icon[PDF – 142 KB]external icon Accessed December 10, 2019.
4. Marynak K, VanFrank B, Tetlow S, et al. Tobacco Cessation Interventions and Smoke-Free Policies in Mental Health and Substance Abuse Treatment Facilities—United States, 2016. Morbidity and Mortality Weekly Report, 67(18):519—523, 2018.
5. Smoking Cessation Leadership Center and Substance Abuse and Mental Health Services Administration. Oklahoma leadership academy for wellness and smoking cessation.external icon 2016.
6. DiGiulio A, Jump Z, Yu A, et al. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments – United States, 2015-2017. Morbidity and Mortality Weekly Report, 67(13):390—395, 2018.
7. U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. Printed with corrections, January 2014.
8. Centers for Disease Control and Prevention. Tips from Former Smokers®: Rebecca’s Story.