Treatment of Tobacco Dependence in Mental Health and Addictive Disorders

Abstract

People with mental health and addictive (MHA) disorders smoke at high rates and require tobacco treatment as a part of their comprehensive psychiatric care. Psychiatric care providers often do not address tobacco use among people with mental illness, possibly owing to the belief that their patients will not be able to quit successfully or that even short-term abstinence will adversely influence psychiatric status. Progress in the development of treatments has been slow in part because smokers with current MHA disorders have been excluded from most smoking cessation trials. There are several smoking cessation treatment options, including psychological and pharmacological interventions, that should be offered to people with an MHA disorder who smoke. Building motivation and readiness to quit smoking is a major challenge, and therefore motivational interventions are essential. We review the treatment options for people with tobacco dependence and MHA disorders, offer recommendations on tobacco assessment and tailored treatment strategies, and provide suggestions for future research. Treatment efficacy could be enhanced through promoting smoking reduction as an initial treatment goal, extending duration of treatment, and delivering it within an integrated care model that also aims to reduce the availability of tobacco in MHA treatment settings and in the community.

Outcome predictors of smoking cessation treatment provided by an addiction care unit between 2007 and 2010

“…Psychotherapy based on cognitivebehavioral concepts and/or motivational interviews and pharmacotherapy integrated with ongoing psychiatric/ addiction treatment has shown the best success rates. 5 Treatment for smoking in MHA patients seems to have no adverse effects on psychiatric symptoms, and a patient's clinical condition may even improve during treatment, regardless of smoking abstinence. 5 …”

“…5 Treatment for smoking in MHA patients seems to have no adverse effects on psychiatric symptoms, and a patient's clinical condition may even improve during treatment, regardless of smoking abstinence. 5 …”

“…CAPS-AD units provide access to MHA patients, who generally are not treated for nicotine dependence. 5 Because CAPS-AD staff teams include professionals specialized in mental health or addiction, smoking cessation treatment can be integrated with ongoing treatment of psychiatric disorders and other addictions. Professional care is available during business hours, which allows for the close monitoring of MHA patients who are undergoing smoking cessation treatment, as recommended in a recent study.…”

“…3 The prevalence of smoking among patients with mental health and addictive disorders (MHA) is 2-4 times higher than in the general population. 4 The treatment of smoking in MHA patients appears to be beneficial, and recent studies 5 have highlighted treatment as a variable related to smoking cessation in this population. 6 Several studies have addressed smoking among MHA patients.…”

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…229,230 The impact of brief advice in special populations (e.g. pregnant women, 216,231,232 adolescents, 233 patients with mental health problems, [234][235][236] ) is less clear. Providing support during a quit attempt increases the chance of success up to five-fold.…”