Study Debunks Myth That Smoking Is Helpful in Mental Health Treatment

People diagnosed with serious mental illness smoke much more often than the general population, and the high rate of smoking likely contributes heavily to the dramatically shortened lifespans of these individuals. Despite these facts, psychiatric facilities in the U.S. commonly allow their patients to smoke. According to the results of a new study published in August 2013 in the American Journal of Public Health, people who receive smoking cessation treatment while hospitalized for serious mental illness have significantly smaller chances of needing further inpatient psychiatric care at a later date.

Smoking and Mental Illness

U.S. adults affected by various kinds of serious mental illness are 70 percent more likely to smoke cigarettes than other adults. In addition, compared to other smokers, smokers with mental illnesses typically go through more cigarettes on any given day. The frequency and intensity of smoking among seriously mentally ill individuals enrolled in public health programs almost certainly play a primary role in the roughly 25-year reduction in these individuals’ average lifespan, the American Psychological Association reports. Still, psychiatric facilities commonly allow or (even encourage) smoking for hospitalized patients.

Reasons for the continuation of pro-smoking policies include the use of cigarettes as part of patient reward/discipline programs, use of nicotine as a coping mechanism for dealing with the stress of inpatient psychiatric treatment, and a belief that lack of access to smoking increases the likelihood that psychiatric treatment will fail.

Outside of any considerations regarding the policies of psychiatric hospitals, several factors appear to account for the increased rate and intensity of smoking in seriously mentally ill people. Physical/biological examples of these factors include the use of nicotine to ease or mask the symptoms of a given illness, the use of nicotine to mask medication side effects associated with psychiatric treatment, and the use of nicotine to improve general mental clarity. In addition, seriously mentally ill people are often exposed to known socioeconomic risk factors for tobacco use such as poverty, homelessness and lack of access to health insurance.

New Findings

In the study published in the American Journal of Public Health, researchers from Stanford University and UC San Francisco examined the effects of smoking cessation treatment in 112 nicotine-using patients residing in a locked, non-smoking psychiatric hospital. These patients previously smoked an average of 19 cigarettes a day and had a variety of serious mental illnesses, including schizophrenia, major depression and bipolar disorder; in addition, three-quarters of the patients had clear suicidal intentions. Forms of smoking cessation given to the participants included nicotine gum and nicotine patches. A comparison group of 112 patients in the same facility did not receive smoking cessation treatment.

Rather than having all of the smoking cessation participants start their treatment at the same time, the researchers gave them access to a 10-week supply of cessation aids, which could be used whenever the participants wanted to begin treatment. The patients in the program also had access to computer-based assistance, as well as written materials and brief sessions with an on-site counselor. The researchers interviewed each individual one week after he or she completed inpatient mental illness treatment, then followed up with additional interviews three months later, six months later, one year later and 18 months later.

After reviewing the results of their interviews and assessments, the researchers found that 20 percent of the participants who received smoking cessation treatment had stopped smoking. By comparison, slightly less than 8 percent of the participants who didn’t receive smoking cessation treatment had stopped smoking. Critically, enrollment in smoking cessation substantially decreased the likelihood that the participants had required additional hospitalization for their illness. While 44 percent of the smoking cessation enrollees had been rehospitalized, 56 percent of those not enrolled in smoking cessation had reentered an inpatient facility.

Considerations

Only 16 percent of the participants in the study published in the American Journal of Public Health initially had a desire to stop smoking. However, commitment to the treatment grew among the participants over time. The study’s authors believe that they are the first researchers to demonstrate that smoking cessation does not decrease the effectiveness of treatment for serious mental illnesses and, in fact, may make mental illness treatment more effective. However, they note the preliminary nature of their work and point toward a need for further research to confirm their findings. They are designing a follow-up study that will include over 900 participants.

Posted on August 29th, 2013

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