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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Breathing Easy Smoking Cessation

A CMHA Simon Fraser Branch program for people with mental illness

Rona Wilkman, BA, CPRP and Rodney Baker, MA, CPRP

Reprinted from "Tobacco" issue of Visions Journal, 2007, 3 (4), pp. 34-35

The risks of smoking are well documented. It is the single most preventable cause of death in the world, but statistics show that tobacco-related diseases kill one out of two tobacco users.1 This issue is highly relevant for people with mental illness, who are about twice as likely to smoke as the general public.2 Those living with schizophrenia are three to four times as likely to smoke.2

Fortunately, the same researchers who have documented these high rates have also found that this population can, with the right program, also have a quit rate similar to people without mental illness.2

Many people with mental illness, especially those taking neuroleptic (antipsychotic) medications, have an increased risk of nicotine addiction. This is due to complex chemical actions in the brain that seem to lessen some symptoms of schizophrenia and bipolar disorder. As a result, many mental health consumers appear to derive extra “benefits” from smoking, such as increased concentration, increased sense of ‘well-being’ and reduction in auditory hallucinations. These ‘benefits’ can make smoking a very hard habit to quit.

Many consumers who quit smoking report an improvement in their daily nutrition, in addition to the usual benefits to heart and lung health. Many people with mental illness also live in poverty, so, to support their tobacco addiction, they will choose to purchase cigarettes rather than food. They may also purchase foods that fill them, but have little or no nutritional value. When consumers are no longer purchasing cigarettes, they then have money to buy a wider variety of foods.

The Breathing Easy program

Breathing Easy3 is an education and support program designed to help people with a psychiatric diagnosis face the extra challenges of quitting smoking. Seed funding through Health Canada, from 2003 to 2006, allowed the Canadian Mental Health Association’s Simon Fraser Branch (CMHA-SF) to develop a comprehensive smoking cessation program for people with mental illness.

The program combines nicotine replacement therapies with cognitive-behavioural and psychosocial approaches to quitting smoking. It was formulated from existing information in the public domain, including work done by the Canadian Cancer Society4 and information supplied by Dr. Debbie Thompson of Surrey North Mental Health Centre on the effect of nicotine on the brain and interactions with pharmaceutical drugs, as well as research on social and healthy lifestyle alternatives to smoking.2,5-6

By March 2006, eight Breathing Easy groups in seven cities within the Fraser Health region were in operation. Thanks to additional Health Canada funding from 2005 to 2006, CMHA-SF was able to educate and provide program materials to other mental health agencies. After March 2006, Fraser Health began to incorporate this program as a smoking cessation option for the mental health and addictions population in the Fraser North area.

The 12-week program is, ideally, facilitated by consumers who are reformed smokers. A course workbook serves as both a facilitator’s guide and a participant resource.

Throughout the program, participants are encouraged to understand why they smoke and what triggers their smoking. They then learn to develop alternate healthy habits, behaviours, thoughts and social circles, to replace their current smoking patterns.

Group participants often form strong bonds with each other, and consequently provide mutual support and encouragement throughout the process of quitting smoking.

Breathing Easy results

From January to June 2006, 113 consumers—69 female and 44 male—participated in the Breathing Easy program. Each participant attended three or more sessions of the 12-week smoking cessation program. People who registered for this program but attended two or fewer of the sessions were assigned to a control group for comparison.

Table 1 below indicates how many participants were active in each of the locations, the number of these participants who quit smoking in each group, the percentage of people who quit in each group, and the percentage reduction for each group at completion of the program. These results are given in percentages, with a negative number indicating that the overall cigarette consumption went down during the course of the program, and a positive number indicating that the number of cigarettes consumed increased during the course of the program.

With additional funding, we would be interested in evaluating the long-term impact of the program.


# people in group

# quit

% quit

% reduction in cigarettes smoked by program completion

New Westminster










Tri- Cities





Maple Ridge

























All groups





Control group






Interested in Breathing Easy? The participant workbook7 is available from CMHA-SF for a fee of $18.00 per copy. Facilitator guidance and training is also available, on a fee-for-service basis. Organizations who wish to start their own Breathing Easy smoking cessation groups can contact Rodney Baker at [email protected] for more information.


About the authors

Rona originated the Breathing Easy program at the Canadian Mental Health Association’s Simon Fraser branch. She is also the primary author of the Breathing Easy participants’ workbook. Currently, Rona is a community living support worker with CMHA.

Rodney is Executive Director of the Canadian Mental Health Association’s Simon Fraser Branch

  1. World Health Organization. (2006) Facts and figures about tobacco. Geneva: Author.

  2. Lasser, K., Boyd, J.W., Woolhandler, S. et al. (2000). Smoking and mental illness: A population-based prevalence study. JAMA: The Journal of the American Medical Association, 284(20), 2606-2610.

  3. The Breathing Easy program was formerly called Breathe Easy.

  4. Canadian Cancer Society. (2002) For smokers who want to quit: One step at a time.

  5. Addington, J., el-Guebaly, N., Campbell, W, et al. (1998). Smoking cessation treatment for patients with schizophrenia. American Journal of Psychiatry, 155(7), 974-976.

  6. George, T.P., Ziedonis, D.M., Feingold, A. et. al. (2000). Nicotine transdermal patch and atypical antipsychotic medication for smoking cessation in schizophrenia. American Journal of Psychiatry, 157(11), 1835-1842.

  7. Wilkma, R. & Holland, W. (2005) Breathing Easy: Participant's workbook. New Westminster, BC: Canadian Mental Health Association - Simon Fraser Branch.


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