Topekan Mary Greiner began smoking when she was about 16 years old, and 30 years later, she lit her last cigarette.
"It was mainly a health issue," she said. "I wanted to live, and I didn't want to walk around with an oxygen tank behind me."
But Greiner is a recovering addict and suffers from depression, and that puts her in a group of people who tend to have higher smoking rates.
Data from the
In her work as a certified peer support analyst at
The number of people who smoke and also have mental illnesses is high, and it's a population that
NAMI Kansas received a
"This is not really adequately recognized in the mental health community," he said. "Someone asked, 'Why should we be doing this?' And fundamentally, it's that our people are dying as result of persistent, chronic tobacco use. I think you have tobacco use rates going down overall nationally, but the one population that's sticking out like a sore thumb are individuals with serious mental illness.
"It's not just that our population is smoking at a higher rate and that those numbers aren't going down, but it's also the fact that they're using more tobacco products," Cagan added. "Not just that they're smoking at a higher rate, but they're smoking more and over an extended period of time."
Cagan said it's a myth that it's too difficult for people with serious mental illness to stop smoking.
"Part of this project is to explode those myths. A lot of those myths are perpetrated by family members, by individuals themselves with mental illness and by provider organizations. It's not that many years ago where people were encouraged to smoke as kind of a coping mechanism," he said.
Those myths include the idea that stopping smoking will exacerbate symptoms and add anxiety.
"I think there's ways to get around that," he said. "Plus, the bottom line is, it's going to kill you, plain and simple."
Managing quitting and mental illness
Sometimes people become more aware of anxiety or depression symptoms as they quit smoking because they were managing those symptoms with nicotine, she said. They must learn coping skills before they quit smoking, and at the
"We try out some reduced use, and see what they're experiencing," she said. "From schizophrenia to general anxiety, the symptoms may have been managed with nicotine use. Any type of substance dependence is considered resistance to pain, that's the way we view it in the cognitive behavioral concept. It's also about understanding the user's resistance, so that maybe they can find meaning in experiencing the pain of abstinence."
Prescott pointed to a study that showed that people with mental disorders who smoke die 25 years earlier than Americans overall.
"Twenty-five years earlier. It is shocking," she said. "That's a whole lifetime."
It was that thought that pushed Greiner to make the move. She was pushed forward by her doctor, as she prepared for two hip replacement surgeries, who said the chance of infection would be decreased if she quit smoking.
"I tried to quit with my one hip before I got it replaced," she said. "I tried but I couldn't quite do it. I was in the hospital for four days and after my surgery, they put me on the patch. I just made up my mind that I wasn't going to pick up afterwards. I just continued on the patch when I got home."
Greiner said she made up her mind that she wanted to be a good influence to the patients she worked with at
"The key for me mainly was just making my mind up," Greiner said. "I tried several times before in the past to quit, but I wasn't really sure if I wanted to. This time, I decided that I needed to, I wanted to, and it was time, and I just made my mind up not to pick up another cigarette. I didn't."
Greiner said she was home six weeks recuperating from surgery, and that helped her stick with it. She was able, every time she was tempted to smoke, to instead pick up her phone and play a game.
"I needed to do something with my hands," she said.
The work being done by
In the months since the grant was announced in June, Cagan said
Although the goal is to increase smoking cessation benefits offered through insurance, Cagan said there were issues with that thought initially, primarily because insurance organizations pointed to the low utilization of smoking cessation benefits already in place.
"In fact, there's been a downturn for some reason since the beginning of the managed care operation known as KanCare in the utilization of tobacco benefits," he said. It's unclear exactly why that is, but
"When there's uncertainty about that, they certainly don't want to provide a service that they can't get paid for," he said. A survey is being conducted to determine what providers are already doing and what some of the issues might be, which will help determine
His hunch, he said, is that providers have a "pretty low" utilization of smoking cessation programs in their work.
Increasing benefits could mean things like paying for the nicotine patch or other nicotine replacement therapies for a longer period of time.
"It takes multiple quit attempts to be successful, and that through our insurance plans, we need to have coverage for multiple quit attempts and coverage for multiple prescription support for those who need nicotine replacement therapy," he said.
Smoking cessation very important
But in talking with providers statewide at a variety of programs, Cagan said interesting information is already surfacing. One addiction counselor at a recent event said in 30 to 40 years of work, that he's determined smoking cessation is not a sideline to treatment but is a critical component.
"His statement in our session was this, that for individual's working on recovery from mental illness and addiction tobacco use is the greatest barrier to individual's achieving recovery," Cagan said. "Tobacco cessation is not ancillary in the least, but central to the recovery of individuals from these behavioral health disorders."
Cagan said tobacco use can interfere with the uptake of medications for individuals with serious mental illnesses, and if they are able to eliminate tobacco, they may be able to lower the level of medication they use.
"A lifetime of taking psychotropic medications is one of many factors that reduces longevity for people with serious mental illness compared to the general population," he said. "The surgeon general noted a number of years ago that people with serious mental illness died 25 years younger and that's for a variety of reasons. One of the reasons is the toll that taking so much potent medication over a lifetime has on the body.
"This seems like a no-brainer," Cagan said. "If people can successfully give up tobacco use, which extends their life, and reduce their intake of these potent psychotropic medications, that's kind of a double whammy."
Some discussions have occurred about whether the smoking cessation training should be a requirement for mental health and addiction treatment providers, but Cagan said, "we're not at the point of asking the
"I think we want to see if we can make some progress on (the voluntary guideline) first before we even open up the discussion for whether this should be a compulsory requirement of behavioral health providers," he said. "If we can get buy in from 50 percent of the addiction treatment centers and mental health providers, I think that's really the test and what we're shooting for."