Tobacco-Free Behavioral Health Initiative (TFBHI)

Treating Tobacco Dependence as a Priority of Behavioral Health

Individuals with serious mental illness or substance use disorder smoke at disproportionately high rates and represent a significant tobacco-related health disparity (PDF). Treating tobacco dependence with evidence-based cessation methods and implementing tobacco-free policies can help reduce this disparity.

The DOH Commercial Tobacco Prevention Program (including vaping products) (CTPP) is addressing tobacco use in a sub-population disparately impacted by smoking within behavioral health. Individuals in treatment for opioid use disorder. Smoking prevalence in this sub-population can be as high as 85 percent. Addressing smoking during treatment for other substances is associated with a 25 percent increase in long-term abstinence from substance use. In partnership with the Washington State Health Care Authority (HCA), CTPP is building capacity for co-treatment of nicotine addiction in State Opioid Response (SOR) grant-funded agencies.

State Opioid Response, Year 1: Referral to Treatment

To ensure that Opioid Treatment Network clients can access evidence-based tobacco use treatment, the CTPP worked with the Washington State Tobacco Quitline vendor to develop an enhanced benefit for network clients. Network providers are encouraged to refer clients interested in quitting to the state Quitline Tobacco Cessation Behavioral Health Program. Once referred, network clients are eligible for:

  • Seven telephone counseling calls
  • Up to 12 weeks of combination NRT (nicotine patch + nicotine gum or lozenge)*

CTPP – in partnership with the HCA, Educational Service District (ESD) 112, and the Behavioral Health & Wellness Program at the University of Colorado (BHWP) – hosted two trainings of providers and staff representing 16 networks.

The Tobacco Treatment Specialist training is an intensive, four-day training of providers on evidence-based treatment and other skills to become go-to resources for tobacco cessation in their organizations. Trainees are instructed and tested on various topics, including:

  • Tobacco fundamentals
  • Priority populations
  • Motivational interviewing
  • Assessment interviewing
  • Pharmacotherapy
  • Cognitive & behavioral interventions
  • Treatment planning

The first training was hosted September 9-12, 2019 in SeaTac, and 32 providers attended. Among those who completed both the pre- and post-training surveys, 92 percent reported that the training would help them implement cessation into their current practice.

The Tobacco-Free training is a one-day training of providers and staff with previous knowledge of addiction and treatment, and who can champion tobacco cessation in their agencies. Training content includes information about nicotine addiction, the latest cessation strategies, motivational intervention, and tobacco-free agency policy. The first Tobacco-Free training was held on September 13, 2019 in SeaTac, and 42 individuals attended. Seventy-five percent of post-training survey respondents reported learning new information in the training. In addition, 88 percent indicated that they would recommend the training to a colleague within their organization.

*All NRT provided to patients is over-the-counter medication, so the Washington State Quitline can send the NRT directly to patients (or their proxy) over the age of 18.

State Opioid Response, Year 2: Treatment Integration

In March 2020, we hosted another Tobacco Treatment Specialist training and two more Tobacco-Free trainings. The TTS training was held March 2-5 with 35 participants. The Tobacco-Free trainings were held March 6 and July 28 with a combined 57 participants.

Additionally, the CTPP and ESD 112 launched the Tobacco Freedom Community of Practice (CoP). The BHWP trainers facilitate knowledge and skill development among OTN clinical staff participating in the CoP, with the goal of more effectively serving the tobacco cessation needs of persons with mental illness and substance use disorders. CoP peer learning calls and webinars occur monthly on Mondays from noon to 1 p.m. and will continue through September 2020.

Webinar Recordings

Trained providers at SOR-funded agencies are now able to order over-the-counter NRT and directly distribute to clients at their treatment sites. If you are a provider at a SOR-funded agency, and are interested in incorporating “on-hand” NRT into your organization, please contact us.

Upcoming trainings

The Washington State Health Care Authority and Washington State Department of Health are excited to host summer webinars on integrating tobacco treatment in behavioral health. Expert speakers will share their experience, knowledge, and best practices on the topics of tobacco cessation, pharmacotherapy, intervention, youth and adult treatment including criminal justice populations, policy guidance, and integrating tobacco treatment into organizations.

Register for trainings

(all times are reflected in Pacific Standard time zone)

Date Time Webinar Topic/ Presenter
June 15 1:00 pm-2:30pm The Need for Addressing Tobacco in Behavioral Health Settings - Jill M. Williams, MD
June 29 1:00 pm-2:30pm Changing the Treatment System Environment to Better Address Tobacco - Jill M. Williams, MD
July 15 1:00 pm-2:30pm Quitline Services and Referral - Jessica Benson (Optum) and Nick Fradkin, MPH, MPA (DOH)
July 29 10:00am-11:30 am Evidence-based Tobacco Treatment Pharmacotherapy for Use in Behavioral Health Settings - Dr. Michael Steinberg
August 12 1:00pm-2:30pm Introduction to Motivation Interviewing for Tobacco Use Disorder - Dr. Michael Steinberg
August 24 10:00am-11:30am Treating Youth Tobacco Use - Krysten Bold, PhD
September 9 1:00 pm-2:30pm Treating Tobacco Dependence in Corrections Settings - Pamela Valera PhD,MSW,ACSW,NCTTP