Smoking Cessation for Veterans in Outpatient Mental Health

Veterans with comorbid mental health issues, such as Post Traumatic Stress Disorder (PTSD) and Generalized Anxiety Disorder, have a higher use of cigarette and tobacco use. The Veteran Affairs Medical Center (VAMC) offers smoking cessation groups, which consist of 6-week sessions recommended by the VA handbook cessation guidelines. Primary care givers noted that veterans' attendance and success were low in these smoking cessation groups, especially among those with mental health issues. The purpose of this Doctorate of Nursing Practice project was to establish smoking cessation groups in the VA outpatient mental health clinic, tailored to the needs of veterans with mental health diagnoses. The project used evidence-based standards of practice. A smoking cessation group was established at an urban VA medical center in their outpatient mental health clinic blending mental health therapy techniques with established smoking cessation behavioral techniques. The groups were conducted by specially trained mental health providers in conjunction with an outpatient PharmD, providing evidence based pharmacological treatment options to participants. Sessions were held weekly for 1 hour and open to veterans enrolled in outpatient mental health with an interest in smoking and tobacco cessation. Veterans were given questionnaires pre- and post- group and cessation tracking sheets to assess cigarette and tobacco use. The group had 4 veterans with comorbid mental illnesses such as PTSD, military sexual trauma and anxiety disorders. There were 3 veterans with sporadic attendance and 1 with complete attendance of all groups. The group had an overall 60% decrease in smoking and tobacco usage. These veterans also noted improved coping mechanisms to decrease their smoking or tobacco use. The veteran who successfully completed all the smoking cessation courses reported complete abstinence from cigarettes and tobacco along with high group satisfaction. Smoking cessation groups integrated with mental health techniques and skill development, demonstrated better outcomes for veterans interested in smoking and tobacco cessation. Larger group numbers and ongoing data collection would provide better statistical data and improve current VA smoking cessation classes. Compliance and attendance were issues encountered by group leaders. Smoking cessation group leaders and mental health providers could increase attendance and compliance through referrals, incentive programs, campus media, and veteran word of mouth.