Help to Quit Tobacco in Mental Health and Substance Use Treatment Facilities, 2023

People with mental health conditions or substance use disorders — behavioral health conditions — use commercial tobacco at disproportionately high rates and are more likely to suffer smoking-related illness. Smoking causes many diseases and is linked to worse behavioral health, while quitting brings major physical health benefits and is associated with better mental health and recovery.

Quitting is helped by evidence-based treatment — behavioral counseling and medication — and by smoke-free policies, especially together. Yet in 2016, fewer than half of U.S. substance use and mental health treatment facilities offered cessation treatment or banned smoking everywhere on their grounds. Reasons may include the historical normalization of smoking in these settings, tobacco industry influence (such as supplying cheap or free cigarettes to treatment facilities), and the persistent myth that quitting harms behavioral health outcomes.

CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) used the 2023 National Substance Use and Mental Health Services Survey, which covers all such facilities in the 50 states, territories and the District of Columbia (85% responded), to see where things stood. The sample included 9,856 mental health facilities and 14,620 substance use facilities (some offer both).

Services offered

Public agency-run facilities and hospital inpatient facilities offered these services most often. Availability varied widely by place — counseling in mental health facilities ranged from 30.3% in Idaho to 88.4% in South Carolina, and nicotine replacement in substance use facilities from 11.3% in Puerto Rico to 75.8% in New York.

Tobacco-free grounds

A tobacco-free policy bans both smoking and vaping everywhere indoors and outdoors.

Smoke-free policies ranged from 29.9% (Nevada) to 95.3% (South Carolina) among mental health facilities, and from 9.2% (Kentucky) to 87.9% (Oklahoma) among substance use facilities.

Among facilities with a tobacco-free policy, 64.4% of mental health and 81.8% of substance use facilities offered at least one cessation service. More than 70% did so in 23 jurisdictions for mental health facilities and 46 for substance use facilities.

Share of behavioral health facilities with a tobacco-free policy that offer at least one cessation service, by facility type, 2023. CDC figure.

Progress since 2016

In 2016, 48.9% of mental health and 64.0% of substance use facilities screened for tobacco use, and 37.6% and 47.4% offered counseling. The 2023 figures are higher, though a 2021 survey redesign limits direct comparison. Coordinated efforts likely helped:

• Since 2018, SAMHSA has funded a National Center of Excellence for Tobacco-Free Recovery.
• Since 2020, CDC's National Tobacco Control Program has required state health departments to address tobacco use among people with behavioral health conditions.
• South Carolina built interagency partnerships; all of its community mental health centers and 59% of local Alcohol and Drug Abuse Commissions adopted tobacco-free policies, and more providers now diagnose tobacco use disorder.
• Indiana used tobacco-free recovery grants and learning collaboratives; more than 80% of state-funded behavioral health agencies routinely built tobacco dependence treatment into care plans in 2023, up from about 40% in 2017.

What more can be done

With fewer than half of facilities offering quit-smoking medication, the authors suggested educating behavioral health professionals about cessation treatment and its benefits; using treatment protocols and clinical workflows to make screening and treatment routine without overloading staff; and state laws or regulations requiring tobacco-free policies or cessation treatment in these facilities.

Many people with behavioral health conditions want to quit and can. Quitting is associated with less anxiety, depression and stress and better recovery from substance use, and it doesn't interfere with treatment or recovery — though some people may need longer or more intensive treatment.

Limitations: responses were self-reported; there was no adjustment for facilities that didn't respond; and the survey didn't measure whether services were actually delivered or policies enforced.

Sources

• VanFrank B, Pasalic E, Oliver B, et al. "Tobacco-Related Clinical Services and Tobacco-Free Policies in Behavioral Health Treatment Facilities — United States, 2023." Morbidity and Mortality Weekly Report 74(14), Centers for Disease Control and Prevention.