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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.

Vancouver's Butt Out Stop Smoking Program

Tom Heah, OT

Reprinted from "Tobacco" issue of Visions Journal, 2007, (3) 4, pp. 33-34.

The Butt Out Stop Smoking Program is a Vancouver Community Mental Health Services initiative funded by the Tobacco Reduction Strategy and two mental health teams of Vancouver Coastal Health. Since its beginning in February 2005, just under 80 people have attended one of the eight groups that are co-facilitated by an interdisciplinary team that includes mental health consumers, occupational therapists and a psychiatrist. The groups are offered on both the east and west sides of Vancouver. Group attendees are given the option of attending at a community agency, the Coast Foundation Resource Centre or at two community mental health teams.


The Butt Out program provides education, nicotine replacement therapy (NRT) and behavioural techniques to assist people who have serious mental illnesses to quit smoking.

  • Education includes topics such as the dangers and benefits of smoking, how tobacco addiction works, lifestyle changes and strategies on quitting and staying quit.

  • Nicotine replacement is provided free of charge to clients based on their Fagerstrom Nicotine Tolerance Scale scores.1 Participants are provided an optional combination of up to 24 weeks of nicotine gum and patch, and this regime is monitored by their psychiatrist or physician. Some clients are also provided the nicotine nasal inhaler, a relatively new NRT product. Participants require a doctor’s agreement to monitor them while on NRT, as NRT may affect the levels of medication uptake by clients.

  • Our NRT practices are consistent with the research on smoking cessation that highlights the importance of supplying NRT to people who have serious mental illnesses, to help them to quit smoking.2-3 We also follow the recommendations of the BC Doctors Stop Smoking Program4 and other findings, such as those of the Ontario Medical Association.5

  • Behavioural techniques include mindfulness and relaxation techniques in each session. Clients are encouraged to attend stop smoking support groups, and to use BC’s QuitNow service, offered by the BC Lung Association.


To date, the Butt Out program has helped nearly 40% of attendees with serious mental illness to stop smoking. A significant number of other people who haven’t quit smoking have greatly reduced their cigarette consumption. In one of the most recent groups, with 18 attendees, 10 people attended more than 75% of sessions, and of these, four people have quit for more than five months each. A further two people, who attended fewer than three sessions, quit for more than six months each. In addition, five other people reduced their smoking from an average of one and a half packs a day to an average of half a pack or less a day.

Beyond the quitting and reductions, clients who have successfully quit smoking also report experiencing increased self-esteem and being proud of their achievement at overcoming a vicious addiction. Other outcomes include improved health, getting a job or continuing their education, an easier time breathing, resolution of certain lung and physical health conditions, and having extra money.

Some clients, as a result of quitting smoking, have increased their participation in personal activities that they value, as well as their involvement in family life. One group member who, prior to starting smoking, was a marathon runner, has now stopped smoking and, as a result, is considering returning to running. This same member reports that attending the Butt Out program and quitting smoking “was a life changing event.” Another group member reports meeting new friends because he now has more time.

Contingent on continued funding, this evidence-based smoking cessation program will continue to be offered in 2007.


About the author
Tom is an Occupational Therapist with the Northeast Mental Health Team of Vancouver Coastal Health’s Vancouver Community Mental Health Services<
  1. The Fagerstrom Nicotine Tolerance Scale measures the degree of nicotine addiction, and enables us to determine what level of nicotine replacement therapy to recommend. It asks questions such as how soon after waking up a person smokes their first cigarette, how much a person smokes a day, which cigarette they would hate most to give up, and whether they smoke if they are ill most of the day.

  2. Johnson, J.L., MacDonald, S., Reist, D. et al. (2006). Tobacco Reduction in the context of mental illness and addictions: A review of the evidence. Vancouver: Provincial Health Services Authority.

  3. Thompson, D. (2006, September). Smoking cessation: Issues and challenges. Presentation to BC Lung Association. Vancouver.

  4. BC Doctors Stop Smoking Program. (n.d.). Stop smoking medications: Nicotine gum, nicotine patch and bupropion (Zyban). Vancouver: Society for Clinical Preventive Health Care.

  5. Ontario Medical Association. (1999). Rethinking stop-smoking medications: Myths and facts. Toronto: Author.


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