Background and challenges to implementation:
The prevalence of smoking among mental health and addiction (MHA) patients is 2-4 times higher than it is in the general population, yet this patient population has received little help to combat smoking. Considering this, MHA care units are strategic locations for integrating tobacco dependence treatment (TDT) into existing treatment activities.

Intervention or response:
Our team trained the staff of MHA care units that have not been providing specialized TDT for smokers. Our curriculum included the following topics focused on the implementation of treatment for MHA smokers: management; epidemiology; medications; psychotherapy; and smoking/mental health assessment instruments.

Results and lessons learnt:
Our team trained the staff of MHA care units in Brazil and Portugal - which included more than 200 health professionals. There were many barriers encountered as we provided this training. A summary of problems we faced were: resistance to incorporating TDT in addiction/mental health care units; resistance to the implementation of cognitive-behavioral therapy (CBT) (psychodynamic therapy and harm reduction were preferred); treatment for smoking is already implemented in primary care network; resistance to the use of medication in addiction treatment (a preference for psychotherapy and psychosocial approach).

Conclusions and key recommendations:
We learned a number of important lessons as we worked to improve the delivery of TDT to MHA patients: provide clinicians an opportunity to explore how they feel/think about providing TDT to their clients before sat the very outset of the training; rather than focusing on a specific type of behavioral therapy for TDT (such as CBT), which some may find objectionable, use more generic descriptions of behavioral therapy such as “supportive counseling”; include in training professionals who open to other forms of behavioral therapy in addition to psychoanalysis; and discuss the important impact that MHA units can have in improving the quality of life for their patients who smoke.