Prior to hospitalization, participants averaged 19 (SD = 12) cigarettes per day only 16% intended to quit smoking in the next 30 days. We randomized participants (n = 224 79% recruitment rate) recruited from a locked acute psychiatry unit with a 100% smoking ban to intervention or usual care. We evaluated the efficacy of a motivational tobacco cessation treatment combined with nicotine replacement relative to usual care initiated in inpatient psychiatry.