RALEIGH — As part of the ongoing focus on behavioral health and resilience, changes promoted by the North Carolina Department of Health and Human Services are improving health and saving lives among people in the state with mental health conditions and/or substance use disorders. New state level data is showing the lowest rate of tobacco use in more than a decade for people in North Carolina who struggle with their mental health or heavy drinking.

A NCDHHS initiative called Breathe Easy NC is responsible for this positive change, working in coordination with many community partners. Breathe Easy NC helps service providers integrate tobacco use treatment for those with behavioral health conditions, intellectual or developmental disabilities, and traumatic brain injuries, as well as take substance use disorder treatment campuses tobacco free.

New data shows the percentage of behavioral health programs providing tobacco use screening and treatment to clients increased by more than 60% across substance use and mental facilities since 2016. Between 2020 and 2021, the percentage of North Carolina substance use disorder facilities with a smoke-free campus policy also increased 30% — from 27% of facilities in 2020 to 36% of facilities in 2021.   

"While most tobacco users want to quit, it is very difficult to if people are smoking and vaping around you," said Dr. Susan Kansagra, Director of the NCDHHS Division of Public Health. "Due to concerted efforts over the last several years, tobacco use treatment and smoke-free campuses have been increasingly integrated into our behavioral health system."

Five years into the Breathe Easy NC campaign, the data shows a decrease that narrows the gap between the rate of smoking among all North Carolinians (14.4%), which is also declining, and the rates among those reporting struggles with mental health (22.5%) or heavy drinking (27.8%). Smoking among people with mental health and substance use disorders was as high as 40% when the Breathe Easy NC initiative began. 

Tobacco use is the number one preventable cause of death for North Carolinians and for those with behavioral health conditions, causing more deaths each year than alcohol, illegal drugs, suicides, homicides, HIV and car crashes combined. 

"The toll is even greater for people with behavioral health conditions who smoke, who lose 25 years of life on average," said Dr. Elizabeth Cuervo Tilson, State Health Director and NCDHHS Chief Medical Officer. "That’s more than the years of life lost by those who smoke and have no behavioral health condition. Studies estimate about half of all people who receive treatment for a substance use disorder will go on to die due to tobacco-related conditions."

NCDHHS has collaborated with local health departments and behavioral health providers on taking facilities tobacco-free and integrating treatment. This includes a successful pilot effort called the Change for Life Tobacco-Free Recovery, which connects behavioral health organizations with peer organizations that have already gone tobacco-free in 11 counties, including Mecklenburg County and surrounding counties in Public Health Region 4. NCDHHS also partners with the Duke-UNC Tobacco Treatment Specialist Training Program, providing nationally certified tobacco use treatment provider training. 

More behavioral health providers are also referring to QuitlineNC, North Carolina’s free tobacco quit services provider. QuitlineNC has been steadily increasing enrollment in its tailored program for people with a behavioral health condition. Last month this evidence-based program had its highest enrollment ever with more than a third of the QuitlineNC participants using the Behavioral Health Program.

For free help with quitting tobacco use or vaping, visit QuitlineNC.com or call 1-800-QUIT-NOW for live quit coaching via text, online, or by phone.