Helping Smokers with Severe Mental Illness Who Do Not Want to Quit

ABSTRACT

Background: People with a severe and persistent mental illness are far more likely to smoke than others. While a large portion would like to quit, they are less likely to make quit attempts and succeed. Objective: This study used an Randomized Controlled Trial (RCT) to test an intervention designed to increase engagement in cessation treatment, quit attempts, and quitting in smokers who did not want to quit in the next 30 days. It also compared these smokers with those who were motivated to quit in the next 30 days. Methods: Participants (N = 222), were smokers with significant mental illness receiving intensive outpatient care from Wisconsin Community Support Programs who were not interested in quitting in the next 30 days. They were randomly assigned to either an intervention group or an attention control group. The intervention, administered during four weekly sessions, included a motivational element, components designed to prepare the smoker for a quit attempt, and pre-quit nicotine patch. Additionally, 48 smokers motivated to quit in the next 30 days served as a comparison group. Results: Compared to control participants, smokers receiving the intervention were more likely to be abstinent at the three month follow-up (biochemically verified, intent to treat, 8.5% vs. 1.0%, respectively, p = .01). They were also more likely to accept four more quitting preparation sessions (intent to treat, 50.8% vs 29.2%, respectively, p < .001) but were not more likely to call a telephone tobacco quit line. Conclusion/Importance: Brief motivational interventions increased engagement in cessation treatment and abstinence among smokers with signification mental illness.

KEYWORDS:

• Nicotine dependence
• severe and persistent mental illness
• quit smoking
• preparing to quit
• motivation to quit

Glossary

• Intent to treat—a method of addressing missing data in which all missing data is assigned a value that reflects a failure to achieve the desired outcome.

• Completer analysis—analysis based on only those study participants who completed data collection up to a specified time point.

• Sensitivity testing—testing outcomes under a variety of assumptions about the nature of missing data to assess the robustness of an observed effect.

• Community Support Program—intense outpatient treatment programs providing wrap round services (mental health care, physical health care, and social services) for individuals with disabling mental illness.

• Certified Peer Specialists—people in recovery from mental illness that provide support for others by sharing their lived experience after receiving training and certification.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.