Background: Smoking rates for people with severe mental illness have remained high despite significant declines in smoking rates in the general population, particularly for residents of community supported residential facilities (SRFs) where smoking has been largely neglected and institutionalized. Methods: Two studies undertaken 10 years apart (2000 and 2010) with SRFs in Adelaide, Australia looked at historical trends to determine whether any progress has been made to address smoking for this population. The first study was ethnographic and involved narrative description and analysis of the social milieu of smoking following multiple observations of smoking behaviours in two SRFs. The second study involved an eight-week smoking cessation group program providing tailored support and free nicotine replacement therapy to residents across six SRFs. Changes in smoking behaviours were measured using pre and post surveys with residents, with outcomes verified by also seeking SRF staff and smoking cessation group facilitator qualitative feedback and reflection on their observations of residents and the setting. Results: The culture of smoking in mental health SRFs is a complex part of the social milieu of these settings. There appears to have been little change in smoking behaviours of residents and attitudes and support responses by staff of SRFs since 2000 despite smoking rates declining in the general community. Tailored smoking cessation group programs for this population were well received and did help SRF residents to quit or cut down their smoking. They did challenge staff negative attitudes to residents’ capacity to smoke less or quit. Conclusions: A more systematic approach that addresses SRF regulations, smoke-free policies, staff attitudes and training, and consistent smoking cessation support to residents is needed.

Employment has been indicated as a contributor to positive outcomes for both people with substance use disorders and those with disabilities. However, there is a disconnect between vocational rehabilitation services and substance use treatment. This paper will present a new theoretical framework for working with individuals with both a substance use disorder and a disability. This new framework (The CDCAS Framework) integrates the Stages of Change Model for working with individuals with addictions and the INCOME framework for working with individuals with a disability to inform a new treatment modality for people with a substance use disorder and a disability.

Employment has been indicated as a contributor to positive outcomes for both people with substance use disorders and those with disabilities. However, there is a disconnect between vocational rehabilitation services and substance use treatment. This paper will present a new theoretical framework for working with individuals with both a substance use disorder and a disability. This new framework (The CDCAS Framework) integrates the Stages of Change Model for working with individuals with addictions and the INCOME framework for working with individuals with disability to inform a new treatment modality for people with a substance use disorder and a disability.