Tobacco use and cessation in psychiatric disorders: National Institute of Mental Health report

Abstract

The National Institute of Mental Health (NIMH) convened a meeting in September 2005 to review tobacco use and dependence and smoking cessation among those with mental disorders, especially individuals with anxiety disorders, depression, or schizophrenia. Smoking rates are exceptionally high among these individuals and contribute to the high rates of medical morbidity and mortality in these individuals. Numerous biological, psychological, and social factors may explain these high smoking rates, including the lack of smoking cessation treatment in mental health settings. Historically, "self-medication" and "individual rights" have been concerns used to rationalize allowing ongoing tobacco use and limited smoking cessation efforts in many mental health treatment settings. Although research has shown that tobacco use can reduce or ameliorate certain psychiatric symptoms, overreliance on the self-medication hypothesis to explain the high rates of tobacco use in psychiatric populations may result in inadequate attention to other potential explanations for this addictive behavior among those with mental disorders. A more complete understanding of nicotine and tobacco use in psychiatric patients also can lead to new psychiatric treatments and a better understanding of mental illness. Greater collaboration between mental health researchers and nicotine and tobacco researchers is needed to better understand and develop new treatments for cooccurring nicotine dependence and mental illness. Despite an accumulating literature for some specific psychiatric disorders and tobacco use and cessation, many unstudied research questions remain and are a focus and an emphasis of this review.

A mixed-method systematic review and meta-analysis of mental health professionals' attitudes toward smoking and smoking cessation among people with mental illnesses

“…Mental health professionals (MHPs), broadly defined as those who received specialist training to offer services designed to improve an individual's mental health (such as clinical psychologists, psychiatrists, clinical social workers and psychiatric nurses), have a crucial role in reducing tobacco smoking among people with mental illness, as they are best placed to encourage and support smokers to quit 10. Indeed, UK clinical guidelines on smoking cessation in secondary care advise that all health and social care practitioners in in‐patient and community‐based mental health services identify smokers and offer advice and assistance to quit 11.…”

Diverging Trends in Smoking Behaviors According to Mental Health Status

“…1 However, survey data consistently highlight a higher smoking prevalence in people with mental health disorders, 2,3 though temporal trends in prevalence in this group have not been extensively studied. In one study from the United States, declines in smoking prevalence seen in the general population from 2004 to 2011 did not extend to those with indicators of mental disorder 4 and similar findings have been reported amongst adults living in New York State.…”

“…5 Any widening of the prevalence gap between people with and without mental disorders, such as that suggested by these American data, will increase existing health impacts and inequalities. 3,[6][7][8][9] This article presents data from the Health Survey for England (HSE) to describe trends over time in smoking behavior in England in people who do and do not report having a longstanding mental disorder or that they are taking a psychoactive medication.…”

Personality Disorders and the 3-Year Course of Alcohol, Drug, and Nicotine Use Disorders

“…Identifying consistent predictors of chronic SUDs in prospective studies has been difficult. Some factors suggested in the literature include family history of substance use disorders 8, 9 and Axis I disorders such as major depression 10-15 and anxiety disorders 11, 12, 16, 17 . However, not all studies have had consistent findings on these relationships 5, 17-19 …”