Implementing evidence-based tobacco dependency treatment in addiction/mental healthcare units in Brazil

Despite the availability of treatment for regular smokers through large national programs (such as the INCA and PROAD programmes) in Brazil, the population of mental health and addiction (MHA) pacientes has received little help to combat smoking. However, the prevalence of smoking among MHA pacientes is 2-4 times higher than it is in the general population (Morisano et al., 2009). The treatment of smoking in MHA patients appears to be beneficial, and recent studies (Hitsman et al., 2009) have highlighted treatment as a variable related to smoking cessation in this population (Reid et al., 2011). Much of this low levels of treatment due to a lack of information and false perceptions of health professionals regarding the treatment of smoking in this group of patients (Fagerström & Aubin, 2009). Recent studies show that success rates in quitting smoking and retention in the treatment are at least comparable to the general population (Castaldelli-Maia et al., 2013; Castaldelli-Maia et al., 2014), since the treatment of smoking is incorporated into ongoing treatment for mental disorder or other addiction. Considering this, units of specific outpatient treatment for treatment of mental disorders and addictions are strategic locations for such processing. However, in Brazil and in several other countries, such units that are engaged in the fight against smoking are the exception.

Psychosocial units (CAPS - Centros de Atenção Psicossocial) promote public comprehensive care for people with severe and persistent mental disorders in Brazil (Mateus et al., 2008; Nunes et al., 2008; Miranda & Campos, 2008). Psychosocial units for alcohol and drugs (CAPS-AD) are specifically designed for individuals with substance use disorders (Castaldelli-Maia et al., 2013; Oliveira et al., 2014), and are largely integrated with the regular CAPS units (designed for mental health disorders). These units (CAPS and CAPS-AD) have staff from multiple professions (Mielke et al., 2009), and represent interesting locations for treating smoking addiction (Castaldelli-Maia et al., 2013). Almost all of the recommendations made in previous studies (Hitsman et al., 2009; Morisano et al., 2009; Aubin et al., 2012) with focus on smoking treatment for patients with mental health and addiction disorders, could be implemented in these health units. Because CAPS and CAPS-AD staff teams include professionals specialised in mental health and addiction disorders, it is possible to perform smoking cessation treatment integrated with ongoing psychiatric and/or addiction treatment. Professional care is available during business hours (in some units, 24 hours a day) for any clinical demand from patients who are undergoing smoking treatment and other regular treatments, as recommended in recent studies for smoking cessation patients with mental health and addiction disorders (Hitsman et al., 2009; Morisano et al., 2009; Aubin et al., 2012).