Great American Smokeout includes people with serious mental illness, five tips for your practice

—by Debra R. Hrouda and Paul M. Kubek

The American Cancer Society's Great American Smokeout takes place on Thursday, November 15. This annual event encourages people to stop smoking cigarettes and using other tobacco products for one entire day. It also encourages people to use the day to make a plan to quit for good or to begin the process of quitting. This year marks the 37th anniversary of the Smokeout.

The Center for Evidence-Based Practices at Case Western Reserve University is using the Great American Smokeout to remind health and behavioral health professionals (e.g., doctors, nurses, social workers, addictions counselors, housing specialists) to encourage people with serious mental illness and substance use disorders to consider reducing and eliminating the use of tobacco products.


Begin helping people with mental illness and substance use disorders take important steps toward quitting tobacco:

  • Ask each person you see in your daily clinical practice if he or she uses cigarettes or other tobacco products.
  • Assess each person's readiness to quit. Use our Readiness Ruler along with motivational interventions such as Motivational Interviewing. 
  • If the person talks about wanting to quit, help him or her start to make a plan.
  • Sponsor an information forum at your organization which explores honestly and openly the pros and cons of tobacco use.
  • Post our Center's free Sending Tobacco Use Up In Smoke poster in your office, lobby, and hallways, and distribute our mini-poster version.

+ 1 More Thing ...

Include components of the "Tobacco: Recovery Across the Continuum" (TRAC) model in your plan to develop or expand integrated primary and behavioral healthcare services and Health Homes (see below).

For additional practical action steps, consult our Center's TRAC Getting-Started Guide.


Our Center encourages organizations to incorporate tobacco recovery into their integrated primary and behavioral healthcare initiatives and Health Homes, because systematic tobacco interventions are important for a number of reasons:

Tobacco Epidemic

  • Over 44 percent of all cigarettes sold in the United States are consumed by people with psychiatric conditions.
  • About 75 percent of people with behavioral health conditions smoke, compared to about 20 percent of people in the general population who do not have a mental illness.

Health Consequences

People diagnosed with serious mental illness die, on average, 25 years earlier than their non-mentally ill peers. Many of these deaths are caused by tobacco-related illnesses, such as cancer, heart disease, and emphysema and other lung diseases.

Treatment Consequences & Tips

  • Smoking can interfere with the metabolism of many medications, including psychotropic medications.
  • Addressing tobacco use simultaneously with alcohol or other drug treatment can actually increase the likelihood of abstinence by up to 25 percent.
  • Using pharmacological interventions for tobacco recovery (e.g. nicotine patch) can double the chance of success in quitting.


"Tobacco: Recovery Across the Continuum" (TRAC) is a stage-based motivational service model developed by our Center to help people diagnosed with serious mental illness and/or substance use disorders reduce and eventually eliminate the use of tobacco products. TRAC integrates tobacco treatment with existing primary and behavioral healthcare approaches. It equips service providers with strategies to connect with people in all "stages of change," including those who are either unaware of or ambivalent about the benefits of reducing and eliminating tobacco use as well as those who are ready to reduce and become tobacco-free.


According to the American Cancer Society website, tobacco use remains the single largest preventable cause of disease and premature death in the United States, yet about 43.8 million Americans still smoke cigarettes (nearly one in every five adults). As of 2010, there were also

Debra R. Hrouda, MSSA (’94), LISW-S, is director of quality improvement & TRAC project lead at the Center for Evidence-Based Practices. Paul M. Kubek, MA, is director of communications.