Treatment of Tobacco Dependence in People With Mental Health and Addictive Disorders

Abstract

People with mental health and addictive disorders (MHADs) have higher rates of cigarette smoking, and less success in quitting smoking compared to the general population. Moreover, tobacco-related medical illness may be the leading cause of death in the MHAD population. We discuss the scope of this comorbidity, and approaches to the treatment of tobacco dependence in people with MHAD, including schizophrenia, mood disorders, anxiety disorders, and alcohol and substance use disorders. Finally, at the level of health systems, we emphasize the importance of integrated treatment of tobacco dependence in MHADs.

Differential Modulation of Brain Nicotinic Acetylcholine Receptor Function by Cytisine, Varenicline, and Two Novel Bispidine Compounds: Emergent Properties of a Hybrid Molecule

“…The incidence of smoking is twice as high in the mentally ill as in the normal population and four times higher than normal in schizophrenia. In the United States, 30% of all smokers suffer from mental illness (Mackowick et al, 2012). Although varenicline may be especially bad for such individuals because of its potent suppression of a7 activation, a bispidine-type drug lacking any a7 effects may not fulfill the secondary drive for nicotine selfdelivery that is not simply involved with dopamine-mediated reward.…”

Treatment of Comorbid Tobacco Addiction in Substance Use and Psychiatric Disorders

“…Clinicians assess tobacco use by obtaining a detailed profile of past smoking history (age at first use, pattern of use with time, type of tobacco products used) and current smoking habit and context (time to first cigarette, cigarette consumption rate, triggers to use) [1]. Perceived benefits such as psychological, physical, and social benefits of smoking can also be examined to generate a complete addiction profile [12].…”

“…The following section presents a review of tobacco treatment in co-occurring SUDs; see the review by Mackowick et al [1] for a review of tobacco treatment in specific psychiatric disorders. The 2 substances most frequently used alongside tobacco are cannabis and alcohol.…”

“…Despite declines in tobacco use in the general population (~20 % in the US population), a high prevalence of cigarette smoking is observed among those with comorbid substance use disorders (SUDs) and psychiatric disorders (PDs) [1,2]. For PDs and SUDs, tobacco is the most commonly used substance, followed by alcohol, cannabis, stimulants, and other drugs [3,4].…”

“…Unfortunately, efforts to assist individuals with dual diagnoses reduce or stop tobacco smoking are often unsuccessful. Tobacco use is often overlooked or minimized in clinical settings [1] despite it being a serious public health issue among people with concurrent SUDs and PDs [5]. A recent study showed that individuals with PDs have an average of 12 to 19 year reduction in life expectancy compared with the general population [8•], which has been largely attributed to tobacco-related illnesses [9••].…”