Implementing evidence-based smoking cessation treatment in psychosocial care units (CAPS) in Brazil

Abstract

We learned a number of important lessons as we worked to improve the delivery of TDT to MHA patients in Brazil: provide clinicians an opportunity to explore how they feel/think about providing TDT to their clients at the very outset of the training, rather than focusing on a specific type of behavioral therapy for TDT (such as CBT), which some may find objectionable; use more generic descriptions of behavioral therapy such as 'supportive counseling'; include training professionals who are open to other forms of behavioral therapy in addition to psychoanalysis and discuss the important impact that MHA units can have in improving the quality of life for their patients who smoke.

Tobacco dependence treatment for special populations: challenges and opportunities

“…Unfortunately, such groups have been routinely left out of anti-smoking campaigns and the smoking cessation care network globally. 20,21,43,52,66,70,78 Where smoking cessation is concerned, even small modifications to traditional guidelines targeting the general population are welcome, especially for pregnant women and individuals with SMI and SUD. 20,21,66,70 Special populations also require more targeted clinical research on smoking cessation, since most of these special population groups are systematically excluded from clinical trials.…”

“…17,20 Smoking also complicates treatment of some mental disorders due to interactions with psychiatric medications. 17,21 In addition, progress toward developing tailored cessation interventions for people with SMI and SUD has been slow, in part because smokers with mental disorders are still excluded from most smoking cessation trials. 22,23 However, a growing body of literature shows that smoking cessation treatment can help smokers with mental disorders quit, and that neither quitting smoking nor tobacco dependence treatment have adverse effects on important health outcomes, such as death or hospitalization.…”

“…24,25 Evidence-based treatment of tobacco dependence for people with SMI and SUD should be integrated into ongoing psychiatric care and should include treatment with a combination of supportive counselling (motivational enhancement interventions) and pharmacotherapy. 20,21 Tobacco treatment is effective and retention rates are higher when patients with SMI and SUD are treated for tobacco dependence while they are undergoing psychiatric treatment. 17,26,27 However, even when patients with these conditions receive integrated care for tobacco dependence, they appear to achieve lower cessation rates than smokers in the general population.…”

“…20 Specialized mental health and addiction care units seem to be the ideal locations for implementing smoking cessation treatment for this special population. 21 Generally, these units employ multidisciplinary teams of professionals specializing in mental health treatment 20,21 (i.e., psychiatrists and psychologists). However, within mental health care units, the perception that smokers with SMI or SUD do not want to quit, or are unable to quit, is a major barrier to integrating tobacco dependence treatment into mental health treatment.…”

Implementing lung health interventions in low- and middle-income countries: a FRESH AIR systematic review and meta-synthesis

“…The studies resulting from our search were conducted in 17 different LMICs across five geographical regions: Latin America (Brazil [51][52][53][54][55], the Dominican Republic [56], Mexico [57], Surinam [58]), Africa (Malawi [59], South Africa [60][61][62]), the Middle East (Lebanon [63], Syria [64]), Asia (China [65][66][67][68][69], India [49,50,[70][71][72][73][74][75], Indonesia [73,76], Malaysia [77], Nepal [78,79], Pakistan [80], Russia [81], Thailand [82][83]) and Oceania (Fiji [85]) (table 1 and figure 3). Most studies were based in healthcare settings (n=17; primary care (n=9), secondary care (n=5), primary/secondary care combined (n=3)), followed by schools (n=13), and the community (n=6).…”