People with mental illness and substance use disorders want to quit smoking and can quit successfully. And mental health professionals can help. Until a few years ago, it was uncommon for people with mental illness or substance use disorders to be treated for their tobacco dependence, even though their smoking rates are 2-4 times higher than in the general population.
The 2006 Morbidity and Mortality in People with Serious Mental Illness report issued by the National Association of State Mental Health Program Directors, found that persons with serious mental illness die, on average, 25 years earlier and suffer increased medical co-morbidity. They often die from tobacco related diseases and are more likely to die from these diseases than from alcohol use.
The need to help this clientele quit tobacco is clear. Some strongly held myths have stood in the way of progress in this area. Fortunately, a growing body of research is debunking these myths, making way for new interventions.
- Myth #1: Persons with mental illness and substance use disorders do not want to quit smoking. Research argues that the majority of persons with mental illness and substance use disorders want to quit smoking and want information on cessation services and resources. Among hospitalized psychiatric patients who smoke, one study found that 79% were not only interested in quitting, but agreed to participate in a clinical study to help them quit (Prochaska, Hall, & Hall, 2009).
- Myth #2: Persons mental illness and substance use disorders are unable to quit smoking. In fact, a review of 24 studies, the recorded quit rates of patients with mental illness or addictive disorders were similar to those of the general population.
- Myth #3: Smoking cessation worsens psychiatric symptoms. On the contrary, smoking cessation can actually improve psychiatric symptoms. This myth has historical ties to the tobacco industry which has directly funded, or monitored, research supporting the idea that individuals with schizophrenia were less susceptible to the harms of tobacco and that they needed tobacco as self-medication. One randomized trial found that actively depressed smokers who quit reported a significant decline in depression symptoms and a reduction in alcohol use compared with participants who continued smoking (Prochaska et al., 2008).
- Myth #4: Smoking cessation can threatens recovery for persons with substance abuse issues. Smoking cessation can actually enhance long-term recovery for persons with substance use disorders. A systematic review of 17 studies found that concurrent tobacco cessation treatment with individuals in addictions treatment was associated with 25% increased abstinence from alcohol and illicit drugs six months or longer after treatment (Prochaska, Delucchi, & Hall, 2004).
Clinicians are encouraged to talk with their patients and offer them assistance in quitting. Many of the treatment strategies that work for smokers without behavioral health issues (e.g., cessation pharmacotherapy and behavioral counseling) can work for this clientele as well.
The California Smokers' Helpline has developed a free toolkit for you to help your patients quit smoking. To download the kit now, click below: