Smoking’s Terrible Toll on People with Mental Health Challenges

Chuck Blog

The decision to transform the campuses of McLeod Centers for Wellbeing into tobacco-free facilities was a no-brainer.

“When you look at the data, you quickly understand the terrible impact of smoking on people with mental health or substance use challenges,” said Mary Ward, president of McLeod, which has nine facilities throughout North Carolina.

The intersection of tobacco use and behavioral health warrants greater attention because smoking, the leading cause of disease and death in the U.S., is twice as prevalent among individuals with mental health or substance use challenges than the general population.

Today, the National Behavioral Health Network for Tobacco and Cancer Control, a project of the National Council for Mental Wellbeing, is making a new push to support organizations in going tobacco-free, including providing them with technical assistance to help them make the journey.

Tobacco-free Doesn’t Mean Clients Leave

Here’s one of the most important things we’ve learned since we began working with organizations to implement tobacco-free policies: Tobacco-free policies do not cause people to leave organizations providing mental health and substance use treatment and care. Studies show that no individuals report leaving treatment prematurely after implementation of a tobacco-free policy, and eliminating tobacco use in residential treatment programs leads to zero decline in patient interest and program utilization.

“Clients don’t walk away from programs once an organization transitions to a tobacco-free facility,” Ward said. “It doesn’t cause clients or employees to leave. Can it be a bumpy road? Yes. But it’s the right thing to do. It’s in the best interest of clients, and it elevates the quality of care. It’s about creating an environment where people can be well.”

It’s also important to note that many clients within mental health and substance use treatment settings want to quit smoking and are able to successfully quit tobacco similar or equal to the rates reported for the general population with the proper environment (smoke-free) and care (cessation supports).

Tobacco cessation treatment in substance use treatment settings has shown success in reducing cessation rates by as much as 23%. Additionally, client relapse rates are reduced for alcohol or other drug use if they attempt to quit tobacco simultaneously. This could be huge for overall treatment impacts.

Why Now?

Let’s step back and look at the big picture.

Tobacco use remains the leading cause of preventable disease, disability and death in the U.S. According to the Centers for Disease Control and Prevention (CDC), 11.5% of U.S. adults (28.3 million) smoked cigarettes in 2021, yet smoking was more than double that (23.1%) among individuals with a mental health challenge. And smoking is the leading cause of early death of individuals with a mental health or substance use challenge.

Implementing tobacco-free policies, in addition to enhancing smoking cessation supports, gives mental health and substance use treatment organizations an opportunity to create a recovery-rich and supportive environment that’s proven to reduce overall tobacco use rates and improve overall recovery rates.

“Providing smoking cessation programs in a substance use care setting makes sense for clients and employees,” Ward said. “We know clients want to quit smoking, so in 2021, we integrated nicotine into our substance use treatment services because nicotine is a substance. Clients told us they were ready.”

Where to Start?

Making the commitment to go tobacco-free is the hardest part, but no organization has to start from scratch or embark on the journey alone.

“We have resources and funding to help organizations — not just National Council members — design and implement successful tobacco-free policies,” said Taslim van Hattum, senior director, Practice Improvement and Consulting, at the National Council. “We also have people with the expertise to provide organizations with the guidance they need to develop meaningful and sustainable programs.”

About 50% of mental health treatment organizations in our country have made the life-saving transition to a tobacco-free facility, and we are excited to support the other half. All our resources are informed by evidence-based research, the experiences of our members and feedback through open dialogue.

Has your organization implemented a tobacco-free policy or enhanced smoking cessation supports? How did it go? Are you thinking about becoming a tobacco-free facility? What’s holding you back? Let us know, so we can all learn from each other and find more ways to support you in this important work.


Charles Ingoglia, MSW
(he/him/his) President and CEO
National Council for Mental Wellbeing
See bio