People With Behavioral Health Conditions Are More Likely to Smoke. Psychologists Are Among Those Working to Understand Why and Helping Them Quit

For people with mental illnesses, just staying alive can be challenging: People with serious mental illness treated in the public health system die a startling 25 years earlier than those without mental illness, according to a 2006 article in Preventing Chronic Disease. The problem hasn’t improved in the years since, Morris notes, and all too often, smoking is part of that mortal equation.

Tobacco-related illnesses including cancer, heart disease and lung disease are among the most common causes of death in this population. And Americans with mental illnesses have a 70 percent greater likelihood of smoking than the general population, according to new findings from researchers at the Centers for Disease Control and Prevention (Morbidity and Mortality Weekly Report, Feb. 8). People with mental illnesses also smoke more often than smokers without mental illness, says Tim McAfee, MD, director of the CDC’s Office on Smoking and Health and a co-author of the report. “We can’t just ignore this population.”

In some cases, people with mental illness may be using tobacco to mask symptoms or medication side effects, McAfee says. Some might also be more affected by nicotine withdrawal. “People with panic attacks, for instance, may have a harder time quitting because the symptoms of withdrawal — such as increased heart rate — can trigger an attack,” he says.

Quitting smoking does not impair mental health recovery. On the contrary, tobacco use is associated with greater depressive symptoms, a greater likelihood of psychiatric hospitalization and an increase in suicidal behavior. Abstaining from cigarettes, on the other hand, can help people with other addictions maintain sobriety, as Prochaska reported in 2010 in Drug and Alcohol Dependence. And despite some misconceptions, mental health patients can stop smoking; studies have shown that people with depression, schizophrenia and post-traumatic stress disorder can quit without impairing their mental health recovery, Prochaska says. She works with smokers with a full range of psychiatric disorders, recruited from acute inpatient settings. Using a combination of motivational approaches, cognitive-behavioral therapy and nicotine-replacement medications, she says, “we’re seeing quit rates comparable to those you see in the general population.”

Not only can mental health patients quit, says Morris, many of them would very much like to. “If you ask them, people with behavioral health conditions want to quit at the same rate as the general population, but we were not giving them the same resources and affording them the same opportunities to change,” he says. “At the bottom line, this is a patients’ rights issue.”

By Kirsten Weir, American Psychological Association (APA)

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