Lung Mind Alliance Convening in June 2023. Credit: Chelsey BadMoccasin

Commercial tobacco* use remains the leading cause of preventable death, disease, and disability in the United States, according to the Centers for Disease Control and Prevention (CDC). While rates of cigarette smoking have declined in the general population over the last five decades, smoking rates remain disproportionately high in marginalized communities that have been targeted by the tobacco industry. Black, Indigenous communities, along with members of the LGBTQ+ community, and individuals with mental illness or substance use disorder continue to be disproportionately impacted by the deadly harms of commercial tobacco.

Smoking is the leading cause of early death for individuals with a mental illness or substance use disorder. Seventy-five percent of adults with serious mental illness or substance use disorders want to quit smoking, but only 40 percent of Minnesota’s mental health treatment facilities and 31 percent of substance use disorder treatment programs offer tobacco treatment. The Lung Mind Alliance (LMA) is a statewide coalition working to change this. The LMA works collaboratively to reduce disparities related to the impact of commercial tobacco on people with mental illness and/or substance use disorders.

Adults with serious mental illness die an average of 25 years earlier than others, and commercial tobacco use is the number one cause of death in people with mental illness. Approximately 25% of adults in the U.S. have a mental health condition or substance use disorder, yet this population consumes 40% of all cigarettes sold. According to Reba Mathern-Jacobson, Project Manager at LMA, “People with a mental health condition or substance use disorder have been targeted by the commercial tobacco industry. Advertising has promoted the idea that smoking calms people down, helps anxiety, and makes a person enjoy life. This population has been incorrectly encouraged to smoke to support their mental health or substance use condition and been left out of traditional treatment approaches.”

Sadly, smoking is still normalized in many addiction treatment and mental healthcare settings. “Cigarettes have been given out in treatment settings. Still today, breaks are often cigarette breaks. It is finally becoming less common for staff and clients to smoke together,” said Mathern-Jacobson. Often, addressing commercial tobacco addiction is seen as less pressing when compared to other addictions or challenges, and not prioritized in treatment settings. Not offering tobacco treatment keeps smoking rates high and perpetuates the disproportionate negative health impacts of commercial tobacco use on this already vulnerable population.

Abstaining from commercial tobacco use can have significant benefits on mental health and long-term sobriety from drugs and alcohol. According to the LMA, when tobacco treatment is incorporated into addiction treatment, there is a 25 percent increased likelihood of long-term abstinence from alcohol and other drugs. When people transition to tobacco-free living, their mental health can greatly improve, including significant decreases in anxiety, depression, and overall stress.

LMA is working to increase the number of mental health and substance use disorder programs that offer tobacco treatment and that have tobacco-free grounds. By doing so, they can help individuals reach their recovery and wellness goals and add years to their lives.

Mental Health Resources, a nonprofit organization that offers community-based mental health and substance use disorder services to adults and youth recovering from serious mental illness, recently celebrated their 5-year anniversary of going commercial tobacco-free. The organization dedicated significant time to effectively integrate tobacco treatment and support throughout their agency, provide on-going tobacco recovery messaging to staff, and include tobacco education in all on-boarding of new staff. Mental Health Resources has seen a tremendous benefit to going commercial tobacco-free and become a statewide leader in this work. Mental Health Resources has contributed to LMA resource development and action teams, and now provides mentorship to new organizations taking up this work.

In the past year, LMA trained 43 new Tobacco Treatment Specialist in 26 different organizations. The organization is working to build capacity and confidence among Minnesota providers to offer tobacco treatment. “These are our friends, family members, colleagues and community members. Everyone deserves the chance to live at their highest potential,” said Mathern-Jacobson.

Recently, LMA had success in supporting a statewide policy that will make commercial tobacco treatment more accessible to providers and patients. A major barrier for partner organizations was that they were unable to be reimbursed for providing commercial tobacco treatment. Treatment has traditionally been provided in the primary care sector. As treatment shifts into the behavioral health sector, the payment mechanisms have not evolved.  Earlier this year, a bill passed that greatly expands the types of providers who can be reimbursed for providing tobacco treatment to people with Medicaid or MNCare.

To learn more about the LMA and efforts to create tobacco-free substance abuse and mental health treatment visit

* Commercial tobacco refers specifically to the use of manufactured tobacco products, and not to the sacred, medicinal, and traditional use of tobacco by Indigenous peoples.


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