National Council Magazine - Winter 2009 - 50

Wellness Smoking Cessation Along the Road to Recovery Chad D. Morris, PhD, Director, Behavioral Health and Wellness Program An analysis of data from the National Comorbidity Study, a nationally representative survey of psychiatric disorders in the United States, found that 41% of people with a psychiatric disorder smoke, about twice the rate (22.5%) seen in those without psychiatric diagnoses. People with psychiatric disorders consume 44.3% of all cigarettes smoked in this country. The high rate of smoking is an important factor in increased rates of physical illness and mortality in people with psychiatric disorders. T obacco use is potentially the most modiﬁable risk factor for decreasing the excess mortality and morbidity persons with mental illnesses face (NASMHP, 2006; U.S. Department of Health and Human Services, 2004). Behavioral health systems have a tremendous opportunity, by integrating smoking cessation into integrated health and wellness initiatives, to assist consumers to live longer, healthier lives. We know that people with mental illnesses can successfully quit using tobacco (Evins et al., 2005; George et al., 2002), and there are low-burden burden means of successfully assisting interested mental health consumers quit. With brief training, behavioral health providers have the ability to successfully intervene. Moreover, stopping tobacco use does not negatively affect either mental health or substance abuse treatment, and may actually enhance other treatments (Prochaska et al., 2004). A DEADLY EPIDEMIC Persons with mental illnesses die up to 25 years earlier and suffer increased medical comorbidity when compared to the general population (Brown, Inskip, & Barraclough, 2000; Colton & Manderscheid, 2006; Joukamaa et al., 2001). Tobacco use causes and/or exacerbates medical comorbidities such as cardiovascular disease. Persons with mental illnesses and substance abuse disorders use over 30% of cigarettes and comprises 44% of the entire U.S. tobacco market (Grant et al,. 2004; Lasser et al., 2000). Nationally, tobacco use prevalence among persons with mental illnesses is over 40% (Lasser et al., 2000), twice that of the general population. Although exact numbers are unknown, perhaps as many as 200,000 of the 435,000 annual deaths from smoking in the U.S. occur among persons with mental illnesses and substance abuse disorders (Schroeder, 2007; NASMHPD, 2006; Williams & Ziedonis, 2004). Smokers with mental illnesses also have more psychiatric symptoms, increased hospitalizations, and require higher dosages of psychiatric medications (Dalack & Glassman, 1992; Desai, Seabolt, & Jann, 2001; Goff, Henderson, & Amico, 1992; Williams & Ziedonis, 2004; Ziedonis et al., 1994). WHAT IS THE CAUSE? Neurobiological, psychological, social, and societal variables are all associated with the high tobacco use prevalence among persons with mental illnesses. For instance, tobacco use is a coping strategy for anxiety and boredom (Goldberg, Moll, & Washington, 1996; Gurpegui et al., 2007; Morris et al., in press; Smith, 1996). Although becoming less accepted, many behavioral health institutions also continue to utilize smoking privileges as a behavioral intervention (NASMHPD, 2006). It is true that nicotine (not tobacco) provides some temporary beneﬁt to persons with mental illnesses such as schizophrenia. Nicotine may improve sensory processing and concentration, and offer temporary relief from some medication side-effects (Desai et al., 2001; Forchuk et al., 2002; Ziedonis, Williams, & Smelson, 2003), but the cost is steep. The potential beneﬁts are transitory, while the long term cost is often disease and early death. Continued on page 49 46 / NATIONAL COUNCIL MAGAZINE • WINTER 2009

National Council Magazine - Winter 2009

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