Smoking and Mental Health: Five Things Every Psychiatrist Should Know

The facts may be familiar: people with mental illness are much more likely to smoke than people without mental illness and the consequences of smoking take a tremendous toll on these individuals. Unfortunately, this is an often over-looked area in mental health care. As psychiatrists we can play a vital role in helping people with mental illness quit smoking and significantly improve their quality of life.

Tobacco use among persons with mental health conditions can be prevented, and those who currently smoke can quit. APA is collaborating with the Centers for Disease Control and Prevention (CDC) to help people quit smoking. The following are key points and resources from CDC to help you help your patients quit smoking.

1. Cigarette smoking is more common among adults with mental health conditions than in the general population

People with mental health conditions smoke at twice the rate of the general population.1 CDC estimates that nearly one-third (31 percent) of all cigarettes consumed in the U.S. are smoked by people with mental health conditions.¹

The disproportionately high rates of smoking in this population are likely due to a combination of biological, psychological and social factors that work together to create a unique vulnerability for tobacco dependence.²

2. Smokers with mental health conditions get sick, become disabled and die early from smoking-related diseases

Smoking-related diseases such as cardiovascular disease, lung disease and cancer are among the most common causes of death among adults with mental health conditions.³

Despite the heavy disease burden, smoking cessation interventions are not routinely offered within mental health care settings. A national survey of mental health treatment facilities found that only about one-quarter provided services to help patients quit smoking.⁴

3. Many smokers with mental health conditions want to quit and are able to quit smoking

A common misconception is that smokers with mental health conditions either cannot or will not give up smoking.⁵ However, research has shown that adult smokers with mental health conditions—like other smokers—want to quit, can quit and benefit from proven smoking cessation treatments. People with mental health conditions may face unique challenges in quitting smoking and may benefit from additional services, such as more intensive counseling and/or longer use or a combination of cessation medications. But with support, they can and do quit smoking successfully.^6,7

4. Quitting smoking will not interfere with mental health recovery, and may have mental health benefits

Another common misconception is that smoking has mental health benefits and helps patients cope with their psychiatric symptoms.5 On the contrary, smoking is associated with poor outcomes, such as greater depressive symptoms, greater likelihood of psychiatric hospitalization and increased suicidal behavior.^8,9 Furthermore, smoking can complicate treatment by accelerating the metabolism of certain psychiatric medications, resulting in the need for higher doses to get the same therapeutic benefit.⁵

A large body of clinical research has shown that patients can quit without worsening their psychiatric symptoms, if they are given the appropriate support (e.g., behavioral counseling, cessation medication and monitoring).^6,7 Evidence also suggests that quitting smoking is associated with mental health benefits, including reductions in depression and anxiety and lower rates of re-hospitalization and suicide.^8-12

5. Providing smoking cessation assistance is an important part of mental health treatment

Smoking cessation treatments work and it’s important to make them available to all people who want to quit, including people with mental health conditions. Make tobacco cessation part of an overall approach to treatment and wellness.

• Ask patients if they smoke cigarettes or use other forms of tobacco; if they do, strongly advise them to quit.
• For patients ready to quit, offer proven quitting treatments.
  • Refer patients to the CDC I'm Ready to Quit! page, 1-800-QUIT-NOW, www.smokefree.gov or other resources.
  • Provide counseling, support and stop-smoking medicines.
• Monitor and adjust mental health medicines as needed in patients trying to quit smoking.

More resources

• Information and downloadable tools from CDC to help patients quit smoking.
• Smoking cessation guides and toolkits from the Smoking Cessation Leadership Center at University of California, San Francisco.

References

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