Introduction: Brain injury in childhood has been shown to increase the risk of becoming a smoker (Ilie, et. al. 2015). In addition to the many health-related risks of smoking, tobacco use presents particular risks for ABI survivors. Tobacco use is understood to interact with many psychotropic medications, causing a need for increased doses, and therefore increased motor and cognitive side-effects. Unsafe smoking as well as cigarette-seeking behavior are common barriers to housing and care. We were unable to find any examples of smoking cessation programs designed for adults living with the lasting effects of brain injury. This pilot presents a novel approach to smoking cessation based upon an evidence-based, Ontario-wide program designed for the general population. 
Method: The STOP program, designed by the Center for addictions and mental health includes 26 weeks free nicotine replacement therapy (NRT) offered at an escalating dose, determined by patient response, along with patient education. Key modifications for TBI included an increased frequency of counselling meetings, the addition of treatment completion incentives and the use of carbon monoxide breathalyzer monitoring. The approach included motivational interviewing, and emphasized functional goal setting designed to support coping with cravings and activity to complete with smoking-related behaviours. The intervention was administered by an interdisciplinary team which included a case manager, neuropsychologist, and behaviour therapist, with consultation from a neuropsychiatrist. Participants were provided with the STOP intervention over a 10 month period.
Setting: Community-based brain injury support service (Community Head Injury Resource Services of Toronto).
Results: Participants were 9 adult survivors of severe brain injury, who smoked from 15 to 50 cigarettes per day, with an average of 22 years of smoking history. Most had experienced adverse health consequences as the result of smoking and/or had put their housing at risk as the result of dangerous use of cigarettes. At the time of this writing, all had substantially reduced their use of cigarettes and along with the associated harms of smoking. Five had achieved abstinence of at least 6 weeks within 8 weeks of starting NRT. Key findings, are that a modified smoking cessation protocol is feasible and effective for individuals living with the impact of severe brain injury when implemented in a community-based setting. The authors will provide follow-up data for the 9 individuals included as a part of this pilot project, along with insights about service delivery including recommendations for programming and policy.

Smoking Cessation After Brain Injury:  A case series using nicotine-replacement and behavioural  intervention for people living with neurocognitive impairment.