Tobacco control efforts are a public health success story. Actually, almost a success story. While the overall trend is dramatic and positive, a grave inequity remains. A growing number of mental health advocates are talking about the next steps to take to change the culture of the field and offer more options to help smokers with mental illness who are ready to quit.
According to CDC, 36% of Americans with mental illness are smokers. The overall rate for the Americans is 20%.
Why do so many people with mental illness smoke? A few reasons, based on research:
- 80% of smokers begin using tobacco during adolescence.
- Adolescents with depressive symptoms seem to have increased receptivity to tobacco advertisements.
- The stimulant effects of nicotine can mask certain symptoms of mental illness.
- The tobacco industry has historically marketed cigarettes to persons with mental illness.
Tobacco use is never an asset to treatment and management of mental illness. In fact, it can shorten lifespan as much or more than an untreated mental health disorder.
Still, when a smoker enters treatment for mental illness or addiction, support for tobacco cessation is seldom offered. Some treatment providers believe tobacco cessation is too risky, with potential to compromise other treatment. Current research, however; suggests the opposite is true. Stopping tobacco use is associated with better outcomes for stopping other kinds of drug use.
It’s not that people with mental illness can’t quit. Research has found high rates of success with the same evidence-based programs as other smokers. Cessation services may need to be more intense or longer in duration. These should be personalized for each individual.
Of course, none of this is to say that people with mental illness can, or should, be made to stop smoking. But we do need a culture change within the field so that nicotine dependence is treated as what it is – a chronic, relapsing disorder likely to be fatal without cessation. We need to balance encouragement to quit with acceptance. And we need to make a full range of tobacco cessation treatment available and accessible.
Advocates, providers, and family members all have a role to play in dispelling these harmful myths around mental illness and smoking. We must continue to raise awareness with the public, policymakers, and health care providers. With alignment of tobacco control, clinical, and public health efforts we can ensure all smokers have the opportunity to enjoy the health benefits of living tobacco-free.