Dr. Judith Prochaska will be joining Dr. Galati this evening on Your Health First to discuss her recent article in the New England Journal of Medicine, titled "Smoking and Mental Illness-Breaking the Link", as well as rest of her research on smoking and its impact on health and wellness.
Dr. Prochaska is Associate Professor of Psychiatry, at the University of California, San Francisco. She has been published widely on the topic of smoking.
An excerpt from the article is posted below:
Five prevailing myths have contributed to continuing tobacco use among people with mental illness. The first is that tobacco is necessary self-medication for the mentally ill. The tobacco industry has fostered this belief by funding research and presentations on the self-medication hypothesis, supporting opposition to the JCAHO smoking ban, publishing articles in the lay press, and marketing cigarettes to people with mental illness.
Nicotine is a powerful reinforcing drug that transiently enhances concentration and attention, regardless of the smoker’s mental health status. But it has proved ineffective as an adjunctive treatment for mental disorders (e.g., depression, schizophrenia, and attention-deficit disorder), possibly because of the rapid decrease in drug response with repeated exposure. The reality is that tobacco is another problem, not a solution.
Myth number two is that people with mental illness are not interested in quitting smoking. Research argues otherwise: studies involving patients recruited from outpatient and inpatient psychiatric settings suggest that they are about as likely as the general population to want to quit smoking.1 In the United States, 20 to 25% of smokers report that they intend to quit smoking in the next 30 days, and another 40% say they intend to do so in the next 6 months. Furthermore, among smokers with mental illness, readiness to quit appears to be unrelated to the psychiatric diagnosis, the severity of symptoms, or the coexistence of substance use.
The third myth is that mentally ill people cannot quit smoking. Although treating tobacco dependence is challenging, several randomized treatment trials and systematic reviews involving smokers with mental illness have documented that success is possible. With a stepped-care intervention tailored to depressed smokers’ readiness to quit, a 25% abstinence rate at 18-month follow-up was achieved — a rate significantly higher than that in the group that received usual care (advice to quit and referrals for help doing so) and similar to cessation rates in the general population. A cessation intervention integrated into treatment for post-traumatic stress disorder (PTSD) doubled patients’ odds of quitting. And a meta-analysis of seven randomized controlled trials involving smokers with schizophrenia revealed a nearly threefold increase in abstinence rates 6 months after treatment among those who used bupropion.
Fourth, many people believe that quitting smoking interferes with recovery from mental illness, eliminating a coping strategy and leading to decompensation in mental health functioning. Five randomized tobacco-treatment trials in patients concurrently receiving mental health treatment have found that smoking cessation did not exacerbate depression or PTSD symptoms or lead to psychiatric hospitalization or increased use of alcohol or illicit drugs.
Finally, some argue that smoking, which is perceived as having distal effects, is the lowest-priority concern for patients with acute psychiatric symptoms. Yet people with psychiatric disorders are far more likely to die from tobacco-related diseases than from mental illness. Smokers know tobacco use has deadly consequences and expect health care professionals to intervene. Indeed, raising the issue of tobacco use with patients enhances the rapport between patients and clinicians.