Experts say that tobacco use among mental health patients account for nearly half of all cigarettes consumed in the United States.
A program developed by the division of addiction psychiatry at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School to address this addiction has received national recognition by the American Psychiatric Association (APA).
The program, called CHOICES – Consumers Helping Others Improve Their Condition by Ending Smoking – utilizes peer counselors to promote smoking cessation in mentally ill patients.
The counselors, who receive 30 hours of intensive training, are nonsmokers or former smokers who are moderately impaired or disabled by mental illness.
Their goal is not to provide treatment, but to assist smoking patients who are in mental health centers, psychiatric hospitals, group homes and self-help centers, by linking them to treatment, referrals, advocacy and support for smoking cessation in New Jersey.
“Peers are less threatening than professionals,” said Jill Williams, MD, associate professor of psychiatry at Robert Wood Johnson Medical School and co-founder and medical director of the program.
“CHOICES symbolizes empowerment and personal choice in recovery by involving persons with mental illness talking with peers with mental illness who smoke, and who may have low motivation to address their tobacco use.”
A salient feature of the CHOICES program is the unique peer-to-peer approach to promoting tobacco cessation.
In the October issue of its journal Psychiatric Services, the APA said, “The CHOICES program exemplifies many aspects of a successful wellness and recovery initiative. For example, it targets a group with a vital health care need; seeks to reduce tobacco’s harm in a vulnerable group; focuses its efforts in the community, which best accommodates the target population; employs peers to reduce educational and cultural barriers; and develops successful partnerships with key stakeholders for sustainability.”
According to Dr. Williams and co-founder Marie Verna, the program’s advocacy director and senior training and consultation specialist at UMDNJ-University Behavioral HealthCare’s Center for Excellence in Psychiatry, the CHOICES team has conducted more than 280 community visits, reaching more than 9,600 smokers with mental illness, since the program’s inception in 2005. The team also visits consumer conferences and health-related fairs.
An outcome study of the program showed success at reducing the number of cigarettes smoked by consumers each day and an increase in the number of quit attempts following individualized intervention.
Program participants reported that within six months after meeting with a peer counselor, they had talked to their mental health provider about getting help with quitting smoking. Patients also reported that peer counselors were extremely knowledgeable about tobacco and interested in their smoking. Seventy percent of those surveyed said that talking to a peer about their smoking was much easier than talking to a mental health professional.
Peer counselors also reported improvements of their own recoveries from mental illness as a result of participating in CHOICES. They reported on the achievement of personal milestones including participation in publications and conferences on wellness and recovery, and pursuing additional formal education.