Although the number of cigarette smokers has declined significantly since the mid-1960s, about 16% of the U.S. adult population still smokes. A far larger percentage of people with certain mental disorders smoke cigarettes. A recent viewpoint by Robert Kleinman and Brian Barnett published in JAMA Psychiatry examines important information about cigarette use among patients with mental disorders and concludes that psychiatrists should make smoking cessation a priority for their patients. We would go further and extend this advice to all psychologists and psychotherapists.
Data from the 2019 U.S. National Survey on Drug Use and Health show that 24% of people who have had an episode of major depressive disorder in the past year smoke. According to a study published in 2018, about 62% of people with schizophrenia and 37% of people with bipolar disorder smoke. Similarly, two to three times as many people with alcohol or other substance abuse disorders smoke as the general adult population.
Why is this important? According to the 2020 “Tobacco, Nicotine, and E-Cigarettes Research Report” published by the National Institute on Drug Abuse (NIDA), “smoking is the leading preventable cause of premature death in the United States,” killing approximately 480,000 people annually. Cigarette use is a major reason for the shortened life expectancy of people with mental disorders.
Data on the harmful effects of smoking on physical health have motivated many to quit smoking. People with mental health disorders are no different, and many say they would like to quit smoking. However, smoking cessation is often not addressed by their medical team, including mental health clinicians. Visits to GPs are often brief, but mental health clinicians typically spend more time with patients and may interact with them more regularly than GP teams, so they are in a key position to help this patient group.
Pharmacological and psychological approaches can help people, including those with mental disorders, to quit smoking. One approach to assessing and supporting patients to quit smoking is known as the 5A’s: questions about smoking, advise about the benefits of quitting, evaluate Motivation, help when quitting and arrange Follow-up care. Such an approach can be implemented by all mental health professionals. Non-physician clinicians can provide psychological care and coordinate with a psychiatrist or primary care physician for drug treatments such as varenicline or bupropion. Psychiatrists and primary care teams can provide both pharmacological and psychological care.
Although many of these concepts are similar to those used by psychologists to treat patients with psychiatric disorders, Kleinman and Barnett point out that many psychiatrists do not have extensive experience in smoking cessation. The authors suggest that clinicians take advantage of the American Psychiatric Association’s smoking cessation training programs. They also recommend continuing education programs to ensure that trainees gain experience using smoking cessation strategies with their patients.
Mental health professionals try to help patients reduce their symptoms and improve their daily functioning and quality of life. Some clinicians may not consider treating their patients’ cigarette addiction as part of their job. However, by addressing smoking cessation, mental health professionals can help significantly reduce the long-term morbidity and mortality associated with psychiatric disorders. Shouldn’t this be part of their job when providing comprehensive care?
This article was written by Eugene Rubin MD, PhD and Charles Zorumski MD
