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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

Surgeon General’s Report Points to Anti-Smoking Needs in Mental Health

January 27, 2014 | Tobacco Cessation | Comments
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Anti-Smoking Needs in Mental Health

“The Health Consequences of Smoking – 50 Years of Progress” was released by the Surgeon General January 17, and as the title suggests, it’s full of good news about smoking declines since the 1964 landmark report. But the report underscored something those of us who work with people with behavioral health problems have known for many years: our patients are continuing to smoke at high rates.

Out of the report’s 978 pages, people with mental illness and substance use disorders get eight mentions, usually in connection with other vulnerable populations. The tobacco industry has even tried to show that its products can help our patients. Tobacco industry studies by Prochaska et. al. showed a desire to influence scientific attitudes on the role of smoking in schizophrenia. The Surgeon General’s report noted that the industry funded research that sought to show smoking improves symptoms of schizophrenia, and should be allowed for hospitalized psychiatric patients.

Nicotine doesn’t have any established role in treating mental illness either, the report said, adding that nicotine itself should not be perceived as a cognitive-enhancing substance as it has the potential to have long-term effects on fetal and adolescent brain development.

A study published in the January 8 issue of the Journal of the American Medical Association found that the main reason that smoking has not declined among people with mental illness the way it has in the general population is that anti-smoking efforts have not been directed toward people with mental illness. In other words, our patients have been left out of anti-smoking initiatives. The study also found, however, that people with mental illness who had received treatment in the past year were slightly more likely to quit. Thirty-seven percent of those who received treatment quit, compared to 33 percent of those who didn’t.

Doesn’t this make you wonder: why did 63 percent of people with mental illness who were in treatment for it, keep smoking? If it had anything to do with costs of treatment and coverage, we can expect that to change now, with healthcare reform, but motivation is still a part of the equation. But we may need to look deeper within ourselves.

People with psychiatric disorders are 2-4 times far more likely to smoke than the rest of the population, and also more likely to die from smoking-related diseases. Yet how accessible do we make smoking cessation in our treatment plans for addiction and mental illness? How many of us have looked at a patient and felt that taking away the cigarette would be plunging them into withdrawal and mood swings? How many times do we rationalize the smoking by saying “It’s their choice.”

The Centers for Disease Control and Prevention recently awarded the National Council for Mental Wellbeing two projects to reduce tobacco use and cancer among people with substance use disorders and mental illnesses:

  • The National Council will support a consortium of national networks to increase capacity and infrastructure to address health disparities identified by CDC’s National Tobacco Control Program and National Comprehensive Cancer Control Program prevention. The National Council will empower and prepare community behavioral health treatment organizations and other stakeholders at the state, county, and local levels to prevent and reduce tobacco use and cancer among adults with mental illnesses and addictions.

I’m proud that the National Council is partnering with the CDC on this important mission. As I wrote in this space last year, I know about smoking. My father and grandfather both died from lung cancer. I smoked for 25 years. My husband still struggles with it. Nicotine is addictive, and it’s hard enough for anyone to quit. As we work toward behavioral wellness, let’s help our patients get there, too.