ABOUT
US
The Ohio Tobacco and Recovery (TR) Project is a technical-assistance program that helps service systems, organizations, and direct-service providers implement the Tobacco and Recovery (TR) model. TR is a stages-of-change model that helps people with severe mental disorders and substance use disorders—and service providers—reduce and eliminate the use of harmful tobacco products. The model is implemented at community-based behavioral healthcare organizations (mental health and addiction services). Some core components of the model are also being implemented at select consumer-operated services.
The TR Project is a program of the Center for Evidence-Based Practices (EBPs) at Case Western Reserve University. With continuing evaluation over time, the project partners (see below) intend to create a best practice for tobacco recovery.
OUR
SERVICES
The Ohio TR Project helps service systems, organizations,
and providers implement and sustain the Tobacco and Recovery (TR) model,
maintain fidelity to the model, and develop collaborations
within local communities that enhance the quality of life
for consumers and their families. The Project provides
these services:
- Service systems
consultation
- Program consultation
- Clinical consultation
- Training and education
- Evaluation
(fidelity and outcomes)
- Research
Consulting, Training, & Evaluation
The consultants, trainers, and evaluators of the Ohio TR Project are experienced
administrators, service providers, and researchers who
offer personal attention and customized consulting
and training throughout the implementation process. We understand that
every service system and organization exists within a
unique cultural, political, and economic context. Therefore,
we work closely with you to adapt the Tobacco and Recovery (TR) model to the unique culture
of your community, while maintaining fidelity to the model.
CUSTOMERS
The Ohio TR Project is providing technical assistance
to healthcare organizations and behavioral healthcare
organizations (mental health and addiction services) throughout the State of Ohio for implementation of the TR model. These organizations are located in urban,
suburban, and rural communities.
Individuals from service systems and service organizations
who wish to implement the TR model should contact the
following:
Patrick E. Boyle, MSSA, LISW, LICDC
Director of Implementation Services
Center for EBPs at Case
patrick.boyle@case.edu
CONSUMER-OPERATED SERVICES
Individuals from consumer-operated services who wish to
utilize the TR model should contact the following:
TBD
TR
OVERVIEW | THE PROBLEM
Research shows a strong link among tobacco addiction/dependence,
people with severe mental illness, and negative-life outcomes.
Tobacco Addiction/Dependence
- More than 70 percent of people with a mental illness and/or a substance use disorder use tobacco (compared with 21 percent of the general population).
- Over 44 percent
of cigarettes smoked in the United States are consumed
by people with psychiatric disorders.
Negative Health Outcomes
- Smoking claims up
to 400,000 lives annually.
- Other substance
abuse claims over 100,000 lives annually.
- People with severe mental illness die, on average, 20 to 25 years earlier (from potentially tobacco-related illnesses).
Negative Effects upon Medication
- Smoking tobacco may interfere
with the body’s ability to metabolize psychiatric
medications, potentially leading to higher doses needed
to control psychiatric symptoms and to prevent psychotic
episodes.
Negative Effects upon Relapse
- People with an addiction
to alcohol and/or other drugs who also use tobacco
experience a higher rate of relapse to substance use.
Negative Effects upon Income
- People with schizophrenia
spend an average of 27 percent of their income on
cigarettes.
TR MODEL | THE SOLUTION
Quitting smoking is associated with an increase in recovery rates and adherence to substance abuse treatment.
The Tobacco and Recovery (TR) model includes core principles of the
Integrated Dual Disorders Treatment (IDDT) model as well
as tested pharmacological approaches to reducing tobacco
dependence among people with substance use and/or mental disorders. Specific
components of the TR model include the following:
- Consumer choice is paramount
- Stage-wise approaches
- Motivational interventions
- Education
- Strong connection with medical profession, psychopharmacology (medication interventions)
- Focus on health and well-being
Stages-of-Change
The TR model takes a stages-of-change approach to helping people with severe mental disorders and substance use disorders and direct-service providers embark on a tobacco recovery journey: it even addresses the needs of those who are not yet ready or reluctant to begin. Most cessation programs are designed primarily for individuals who are willing and able to take action.
The stages-of-change approach is based upon research which demonstrates that change occurs incrementally over time. Thus, big changes like sobriety, mental health symptom management, and kicking the habit of smoking or chewing tobacco are built upon a series of small, incremental changes over time. There are five stages of change:
- Pre-contemplation (not aware of the need for change)
- Contemplation (aware of the need for change and thinking about it)
- Preparation (preparing to make change)
- Action (in process of making change)
- Maintenance (sustaining changes that have been achieved)
Organizational change inspires clinical change
The TR model recommends organizational structures that facilitate improved clinical outcomes. For instance, organizations that commit to implementation adopt workplace policies that promote health and well-being and prohibit direct-service providers from smoking during the workday and with consumers onsite at the organization and offsite in the community. The organization also adopts standardized screening and assessment for tobacco use among consumers. In addition, the model encourages organizations to develop partnerships with community stakeholders, such as health departments and lung, cancer, and heart associations. An analysis of Ohio's pilot tobacco cessation programs showed that organizations with such partnerships were among the most successful.
Resources:
Snyder, M. (2006). Serious mental illness and smoking
cessation. Issues in Mental Health Nursing. 27,
p635-645.
Williams, JM, Ziedonis, DM. (2006). Snuffing out tobacco
dependence: Ten reasons behavioral health providers need
to be involved. Behavioral Healthcare. 5, p27-31.
Fiore MC, Bailey WC, Cohen SJ, et al. (2000). Treating
tobacco use and dependence. Clinical practice guideline.
Rockville, MD: U.S. Department of Health and Human Services.
Public Health Service.
|
get resource |
Debra R. Hrouda, MSSA, LISW, and Barbara L. Wieder, Ph.D.
(In Press). Nicotine Dependence: The Forgotten Substance-Related
Disorder. Journal of Dual Diagnosis.
For more resources, consult the "tools-library" link at the top of this page.
PUBLIC-ACADEMIC
PARTNERSHIP
The Ohio TR Project is a partnership among the following:
Center for Evidence-Based Practices (EBPs) at Case Western
Reserve University
A partnership between the Mandel School of Applied
Social Sciences and the Department of Psychiatry at the
Case School of Medicine
www.centerforebp.case.edu
Ohio SAMI CCOE
A technical-assistance program of the Center for
EBPs
www.ohiosamiccoe.case.edu
Ohio Department of Mental Health (ODMH)
www.mh.state.oh.us
Ohio Department of Alcohol and Drug Addiction Services
(ODADAS)
www.odadas.state.oh.us
Ohio Department of Health (ODH)
www.odh.ohio.gov
OUR
HISTORY
April 2007
The Ohio Department of Mental Health (ODMH) and the Ohio
Department of Alcohol and Drug Addiction Services (ODADAS)
received a grant from the Ohio Tobacco Prevention Foundation
to develop a tobacco cessation model for people with
severe mental illness.
June 2007
ODMH and ODADAS awarded a contract to the Center for
EBPs at Case to design, implement, and evaluate a tobacco cessation model
through the Ohio SAMI CCOE—a technical-assistance
program of the Center. ODMH and ODADAS also awarded a
contract to Ohio Advocates for Mental Health (OAMH) to
address smoking cessation at consumer-operated services.
The Center’s model-development team began a planning process with
representatives from partnering organizations (see above).
Numerous Ohio stakeholders will be involved in shaping
the model implementation process through the project's advisory
council.
July 2007
The Center’s team began the process of model
development with consultation from Carlo DiClemente, Ph.D.,
of the University of Maryland, Baltimore County and Jill
Williams, M.D., of the UMDNJ-Robert Wood Johnson Medical
School. Both Drs. DiClemente and Williams are nationally
recognized for their research and program development
for tobacco cessation.
November 2007
The project team convened its advisory council for its
first meeting.
December 2007
The project partners hosted a Tobacco Cessation Kick-Off
Event in Columbus, Ohio on December 7 to describe the
initiative and to encourage behavioral healthcare organizations
to begin the process of model implementation.
| learn more |
January 2008
The project team begins to help service organizations in Ohio implement Tobacco and Recovery (TR), a stages-of-change model for people with severe mental disorders and substance use disorders.
ABOUT
MENTAL HEALTH SERVICES
A brief description of mental health services is posted
on the web site of the Ohio SAMI CCOE. The description
is written primarily for people who are new to the field
of mental health services. Therefore, it provides a general
overview in language that is easily understood by multiple
audiences. We hope you find it helpful.
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get resource | |
