Advancing Commercial Tobacco Treatment to Improve Mental Health in Minnesota

May is Mental Health Awareness month and in Minnesota, mental health providers are embracing a broader perspective that recognizes the intersectionality between mental health and the use of commercial tobacco.

“People with mental illnesses have the highest smoking rates but are rarely asked about quitting because ‘they have so much they are struggling with,’ but we are making shifts in the field to address this” said Sue Abderholden, Executive Director of NAMI MN . “Not only have people with mental illness been targeted by the tobacco industry, but they have also traditionally been left out of tobacco treatment opportunities, so now they are one of the highest disparity groups still using tobacco, and consequently die 20 years younger than the general population.”

For decades, the commercial tobacco industry has promoted smoking as a way to reduce stress and anxiety and using their deadly products to self-medicate. The result has been that commercial tobacco use is the number one cause of death in people with mental illness and substance use disorders.

People with mental health challenges such as depression and anxiety smoke at higher rates than the general population , and have a higher level of dependence. Research shows that when people stop using tobacco, their levels of anxiety, depression and stress actually decrease, while quality of life and positive mood improve. In a systemic review of meta-analysis of studies, the benefit of stopping smoking was equal or more effective than antidepressant medication for mood and anxiety disorders.

African American Survivor Services (AASS) and Touchstone Mental Health are two Minnesota treatment organization that have been taking steps to integrate tobacco recovery support into their mental health services.

“The people we serve have been disproportionately affected by trauma, and one way that shows up is with more mental health challenges and more smoking,” said Ivan Nelson, Executive Director of African American Survivor Services. “To abate the trauma-related anxiety our young people have a temptation to reach for a cigarette or vape. We are offering healthier ways to deal with the trauma.”

AASS educates people about tobacco treatment medicines and uses a carbon monoxide (CO) monitor to give people immediate feedback about the impact of smoking on their health. CO is a poisonous gas in tobacco smoke. CO levels go down within days of reducing or stopping smoking.

“We’ve used the CO monitor to give people an idea about how much smoking is affecting them,” recounts Nelson. “With this information they move from contemplating quitting to actually making some changes. When they see their CO number go down, their self-esteem goes up. We have helped people quit smoking.”

Touchstone has provided education to all mental health staff about the importance of addressing tobacco use, supports key staff in becoming Tobacco Treatment Specialists, and provides Nicotine Replacement Therapy (NRT) gum, lozenges and patches on site. Touchstone has three tobacco-free sites currently and are working with housing partners at the remaining sites to develop tobacco free polices.

“We are helping our clients understand that if they feel relief after smoking, it isn’t because smoking helps anxiety or stress. Rather it is because they are getting a dose of nicotine that relieves their symptoms of withdrawal which mimic their mental health symptoms,” said Michele McGee, Touchstone’s Director of Operations.

“New residents at our Intensive Residential Treatment sites are immediately screened for tobacco use upon arrival and, if needed, provided with NRT to assist with symptoms of nicotine withdrawal and help curb the desire for a cigarette. Weekly Tobacco Cessation groups are held to support our clients in their journey to reduce or eliminate tobacco use.”

Currently in Minnesota 70% of mental health treatment facilities screen for tobacco use, up from 52% in 2016; 46% provide tobacco counseling (up from 39%); 43% offer nicotine replacement therapy (up from 26%); and 47% have a smoke-free campus (up from 44% in 2016).

The Lung Mind Alliance (LMA) is working to keep raising these numbers by providing education, technical assistance and material resources to organizations like Touchstone and AASS.

“Our goal is to eliminate disparities related to the impact of commercial tobacco on people with mental illness and/or substance use disorders,” said Reba Mathern-Jacobson, Senior Manager in Advocacy at the American Lung Association in MN, and LMA Project Manager. “I used to be the social worker who told people ‘go have a cigarette, calm down, and then we can talk.’ But now we know better and the treatment world is shifting.”

“Providing tobacco treatment aligns perfectly with Touchstone’s mission to provide person-centered services that foster hope, health, and well-being,” said McGee.

Abderholden adds “with systemic support, we can help more Minnesotans achieve tobacco-recovery and improved mental health.”

To learn more about efforts to promote tobacco recovery and create tobacco-free substance abuse and mental health treatment, sign up for the LMA newsletter or visit https://www.lung.org/local-content/mn/lung-mind-alliance .

* Commercial tobacco refers specifically to the use of manufactured tobacco products, and not to the sacred, medicinal, and traditional use of tobacco by Indigenous peoples.

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