Key Points: 1. People in treatment for substance use and mental health disorders smoke at rates 3-5 times greater than the general population and suffer grave health impacts. They receive treatment in systems that have historically viewed tobacco dependence as a low priority. 2. Tobacco treatment/control advocates are collaborating with substance abuse/mental health treatment providers to bring about systems change. Staff training that is relevant and addresses underlying concerns such as negative consequences of quitting smoking and strategies for working with smokers with lower motivation promotes clinicians' self-efficacy. Statewide guidelines provide infrastructure and normalize inclusion of tobacco education, assessment and treatment, and the ability to deliver positive messages in a smokefree environment. Strategies for integrating tobacco treatment are numerous and congruent with current addiction treatment approaches. 3. Frameworks exist for conceptualizing and implementing systems change. Presenters from 4 states will describe systemic efforts at county, state, and national levels. Lessons learned will be shared, and participants will be encouraged to develop their own action plans.

Learning Objectives: Participants will learn through didactic presentations, review of handouts, questions and discussion.

Benefits: Participants will recognize the benefits, importance and feasibility of integrating tobacco treatment, and the important role they can play. Participants will gain new ideas and inspiration for fostering change through addressing systemic and staff barriers and building alliances with systems of services usually overlooked in tobacco control efforts.