A Tobacco Reconceptualization in Psychiatry: Toward the Development of Tobacco‐Free Psychiatric Facilities

Abstract

Tobacco dependence is the leading cause of death in persons with psychiatric and substance use disorders. This has lead to interest in the development of pharmacological and behavioral treatments for tobacco dependence in this subset of smokers. However, there has been little attention paid to the development of tobacco-free environments in psychiatric institutions despite the creation of smoke-free psychiatric hospitals mandated by the Joint Commission for Accreditation of Health Organizations (JCAHO) in 1992. This review article addresses the reasons why tobacco should be excluded from psychiatric and addictions treatment settings, and strategies that can be employed to initiate and maintain tobacco-free psychiatric settings. Finally, questions for further research in this field are delineated. This Tobacco Reconceptualization in Psychiatry (TRIP) is long overdue, given the clear and compelling benefits of tobacco-free environments in psychiatric institutions.

Redução do número de cigarros durante internação psiquiátrica: intervenção ou punição?

“…In a recent review of the scientific literature is questioned whether the smoking ban in mental health services is a violation of patients' rights or simply a restriction of privilege (8) . In the United States, advocate of the smoking ban for some time, lawsuits filed by patients against the smoking restriction in health services are common.…”

Do smoking assess in psychiatric outpatients?

“…Sigara kullanımının sorgulanması, sigarayı bırakma düşüncesi olmayanların motivasyonunun artmasına yardımcı olmak, motivasyonu olan ancak desteğe ihtiyaç duyanların tedaviden yararlanmasını sağlamak için oldukça önemlidir. Özellikle psikiyatri hastalarının sigara bırakma konusunda öncelikle motivasyona ihtiyaç duyduğu düşünüldüğünde bu aşamanın oldukça önemli olduğu söylenebilir (12).…”

“…Öncelikle hastaların sigarayı bırakma motivasyonlarının oluşturulması ve bırakmaya hazır hale gelmeleri bu konuda en önemli basamaktır ve bu nedenle motivasyonel görüşmeler çok önemlidir (11). Tedavi sırasında öncelikle sigara sayısının azaltılmasının hedeflenmesi, tedavi süresinin uzatılması, bu tedavinin diğer psikiyatrik tedavi hizmetleriyle entegre edilmesi ve psikiyatri servislerinde sigaraya ulaşımın zorlaştırılması tedavi etkinliğini arttırmaktadır (12,13).…”

Treatment of Comorbid Tobacco Addiction in Substance Use and Psychiatric Disorders

“…Moreover, staff members who are smokers themselves may contribute to the barriers of tobacco use disorder treatment, as they are less likely to encourage their patients to quit compared with staff who are nonsmokers [25]. Although most staff members feel that tobacco use should be treated, they are less agreeable to implementing smoke-free policies that improve smoking cessation rates [26,27]. Educating staff members about the positive effects of integrating smoking cessation into mental health and addiction treatment is an important aspect of treating tobacco use disorder.…”

“…Providing tobacco treatment free of charge raises awareness of the benefits of and promotes smoking cessation [38]. In addition, routine screening for tobacco use and tobacco-free policies can contribute to successful tobacco treatment efforts in people with comorbid SUDs and PDs [6,26].…”