Transcript Myths and facts about smoking in people with mental

6 myths and facts about tobacco use
disorder in people with mental health
and substance use disorders
[email protected]
Associate Professor Psychiatry, Geisel School of Medicine
2015
MYTH #1
• MYTH: People must smoke to manage symptoms of
mental illness or substance use disorder
• FACT: People with mental illness do not need to smoke to
manage their mental illness. People with substance use
disorder do not need to smoke to avoid using other
substances.
• FACT: People with mental illness smoke in response to the
urge to smoke and to reduce withdrawal symptoms
WITHDRAWAL SYMPTOMS
• Nicotine withdrawal can occur after
• Daily use of tobacco/nicotine for at least a few weeks
• If daily nicotine users (more than 5 cigarettes/day) abruptly
stop or reduce tobacco/nicotine, withdrawal symptoms can
occur and peak in 1-4 days
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Dysphoric or depressed mood
Irritability, frustration, anger
Anxiety
Insomnia
Difficulty concentrating
Restlessness
Decreased heart rate
Increased appetite or weight gain
MYTH #2
• MYTH: People with mental health and substance use disorders
don’t want to quit
• FACT: Most smokers with these disorders know that
smoking is bad for them and try to quit, but they they have
more difficulty quitting, so they feel discouraged and
ambivalent. Treatment improves their outcomes.
• FACT: Many studies show that people with mental illness
and addiction respond to education and motivational
counseling with improved motivation to quit and use
treatment for cessation
Brunette 2013; Prochaska 2014’
MYTH #3
• MYTH: Motivational interviewing doesn’t work
• FACT: Motivational counseling that helps people
weight the pros and cons of smoking increases their
interest in quitting and willingness to try cessation
treatment.
MYTH #4
• MYTH: People with mental illness and addiction can’t quit
• FACT: Research shows they can quit when they use cessation
treatment (medication and counseling)
• 14 studies in schizophrenia
• 6 studies in bipolar disorder
• Dozens studies in depression and anxiety disorders
• Dozens in substance use disorders
• Cold turkey efforts are not very successful; meds and nicotine
replacement therapy with counseling improves outcomes
• People have the most success if they are at their baseline for mental
illness symptoms and are starting to get clean from substances
MYTH #5
• MYTH: Nicotine replacement therapy is harmful
• FACT: Nicotine replacement therapy used as indicated is
not harmful.
• FACT: Nicotine replacement therapy reduces
uncomfortable withdrawal symptoms while people change
their smoking habit
• FACT Smoke from tobacco, not nicotine, contains many
chemicals that cause multiple diseases
IT’S THE Toxins in smoke THAT cause CVD,
cancer, lung disease, diabetes
MYTH #6
• MYTH: Only primary care providers are equipped to
treat tobacco use
• FACT: Mental health and addiction providers are well
equipped. They have regular and more frequent
access to these smokers, training in motivational
and behavior change strategies. Also, Tobacco Use
Disorder is a DSM-5 diagnosis
REVIEW: 6 FACTS ABOUT SMOKING & PEOPLE WITH
MENTAL ILLNESS AND SUBSTANCE USE DISORDERS
1. People with mental illness and addiction smoke in response
to urges and nicotine withdrawal.
2. They can remain stable while quitting with treatment
3. People with mental illness and addiction want to quit, but
are often ambivalent and discouraged
4. Motivational counseling can help people get motivated to
quit and to use effective cessation treatment
5. Nicotine replacement therapy is safe, prevents nicotine
withdrawal symptoms, and improves people’s ability to give
up cigarettes and quit smoking altogether
6. Mental health and addiction treatment providers are well
equipped to help people quit smoking
REFERENCES
• Anthenelli RM, et al. Neuropsychiatric safety and efficacy of
varenicline, bupropion, and nicotine patch in smokers with and
without psychiatric disorders (EAGLES): a double-blind,
randomised, placebo-controlled clinical trial. Lancet. 2016. doi:
10.1016/S0140-6736(16)30272-0. PubMed PMID: 27116918.
• Thurgood SL, McNeill A, Clark-Carter D, Brose LS. A Systematic
Review of Smoking Cessation Interventions for Adults in Substance
Abuse Treatment or Recovery. Nicotine Tob Res. 2015. PMID:
26069036.
• Tidey JW, Miller ME. Smoking cessation and reduction in people
with chronic mental illness. BMJ. 2015;351:h4065. PubMed PMID:
26391240.
• Williams J, Stroup TS, Brunette MF, Raney L. Tobacco use and
mental illness: A wakeup call for psychiatrists. Psychiatric Services.
2014;65(12):1406-8.