From the Sidelines to the Frontline: How the Substance Abuse and Mental Health Services Administration Embraced Smoking Cessation

Smoking is a major contributor to premature mortality among people with mental illness and substance abuse. Historically, the Substance Abuse and Mental Health Services Administration (SAMHSA) did not include smoking cessation in its mission.We describe the development of a unique partnership between SAMHSA and the University of California, San Francisco’s Smoking Cessation Leadership Center. Starting with an educational summit in Virginia in 2007, it progressed to a jointly sponsored “100 Pioneers for Smoking Cessation” campaign that provided grants and technical assistance to organizations promoting cessation. By 2013, the partnership established 7 “Leadership Academies,” state-level multidisciplinary collaboratives of organizations focused on cessation.This academic–public partnership increased tobacco quit attempts, improved collaboration across multiple agencies, and raised awareness about tobacco use in vulnerable populations.Smoking rates are much higher among those with mental illnesses, substance abuse disorders, or both. In 2000, this population accounted for 44% of all cigarettes sold in the United States, despite constituting only 22% of the general population.1 A 2013 report revealed that this population, which represented 24.8% of adults in the United States, consumed nearly 40% of all cigarettes.2 This is in contrast to recent US Centers for Disease Control and Prevention (CDC) reports of a record-low adult smoking prevalence of 18% in the overall population (45.3 million smokers).3Not only are behavioral health patients twice as likely to smoke as the general population, they also smoke more heavily because of a complex interplay of biological, social, and psychological factors.4,5 Recent data from the National Surveys on Drug Use and Health further corroborate the strong association among cigarette use, mental illness, and substance abuse across gender and age.6 Smoking contributes to premature death and disability in all populations, and those with mental illness and substance abuse disorders are at particular risk.7,8 Williams et al. argue that these populations should be designated a “tobacco use disparity group” to garner more national resources to address the long-standing disproportionate impact of smoking.5The Substance Abuse and Mental Health Services Administration (SAMHSA), a Department of Health and Human Services agency, is the principal federal agency charged with safeguarding the health of people with mental illness and substance abuse disorders. However, despite the disproportionate prevalence of tobacco use in the population it serves, SAMHSA did not include smoking cessation as part of its mission; its tobacco control activities were limited to the 1992 Synar Amendment, which stated that states could not receive SAMHSA block grants unless they enforced laws prohibiting cigarette sales to minors. Recently, SAMHSA has leveraged activities to help smokers quit, aided by a partnership with the Smoking Cessation Leadership Center (SCLC) at the University of California, San Francisco.