Tobacco Recovery: Separating Fact From Fiction

You probably know that smoking remains the nation’s leading cause of preventable death, responsible for nearly 500,000 deaths annually, according to the U.S. Surgeon General.

You probably also know that people with mental health or substance use conditionsuse tobacco at higher rates than people without a mental health or substance use condition. According to the 2024 National Survey on Drug Use and Health, adults with a serious mental illness or any mental illness were more likely to have used tobacco products or vaped nicotine in the past month (41.4% and 33.9% respectively) than adults with no mental illness were in the past year (20.5%).

But you may not know that many people with a mental health or substance use conditionwho use tobacco do want to quit.

There’s a lot we as behavioral health organizations can do to help people quit using tobacco. By implementing tobacco-free policies and enhancing smoking cessation tools, organizations that provide mental health and substance use treatment and care can create the type of supportive environment that’s proven to reduce tobacco use and improve recovery from other substances.

Implementing approaches like this isn’t as difficult as you might think, but first we should separate the facts from the myths.

Myth: People receiving treatment for a mental health condition or a substance use disorder don’t want to stop smoking.

Fact: You’ve probably heard or seen this one before — the idea that people surely need some outlet for their cravings. That might be true for some individuals, but it’s not necessarily true at a population level. Among a group of patients receiving substance use treatment, “70%-80% report an interest in quitting smoking […] and 75% report willingness to participate in a smoking cessation intervention if one were made available,” one study found.

Myth: People who need substance use treatment or recovery support won’t go to a facility if it’s tobacco free.

Fact: While many people remain convinced that tobacco-free policies cause people to leave organizations that provide substance use treatment and care, there’s no credible evidence that tobacco-free policies harm behavioral health facility operations. In fact, growing evidence suggests they support clinical quality, safety and operational stability.

“Contrary to common concern, a tobacco-free policy implemented in an inpatient residential addictions treatment setting did not negatively affect [patient] census rates,” declared a study that followed an inpatient addiction treatment center for the two-year period before and after it went tobacco free.

There’s also evidence that tobacco-free policies are becoming more common. In Indiana, “more than 80% of state-funded behavioral health agencies reported routinely incorporating tobacco dependence treatment into their treatment planning processes in 2023,” a near doubling from 2017 numbers, according to a Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC).

Myth: Organizations that provide mental health and substance use treatment and care can’t get staff buy-in for smoking cessation programs.

Fact: This is where leaders have to get creative. It’s important to remember that our mission as organizations is to help people recover and to improve health outcomes. Compared to people with a mental health condition who do not smoke cigarettes, those who do smoke have double the risk of premature death, according to the CDC.

The most common causes of death among people with behavioral health conditions can be connected to smoking: heart disease, cancer and lung disease. It just makes sense for organizations to embrace tobacco recovery programs, which can be integrated into other substance use recovery programs and presented in tandem.

Organizations can’t overlook staff: They should provide smoking cessation programs for employees, too.

Tobacco recovery programs also are good for the health and welfare of staff members because it eliminates exposure.

I know you’re all juggling a lot. But no organization has to do this alone. The National Behavioral Health Network for Tobacco and Cancer Control (NBHN), a project of the National Council for Mental Wellbeing, is here to help. NBHN holds monthly office hours, and the May 12 session will explore interventions for young people who use tobacco.

Check out these Success Stories from NBHN members that have implemented tobacco-free policies. We’ve also prepared these two resources to help: Taking Your Facility Tobacco-free: A Brief Overviewand Plant a SEED: Four Approaches to Grow Your Tobacco Cessation Services.

Has your organization implemented a tobacco-free policy or enhanced smoking cessation support? If so, how did it go? Or are you thinking about becoming a tobacco-free facility? If so, what’s holding you back?

If your facility has gone smoke-free, please share your story and help us separate fact from fiction. I’d love to hear your thoughts on tobacco recovery efforts and their importance in a client’s substance use recovery journey. Please leave a comment below and like, share and repost this column, so others can share their thoughts.