Overall smoking rates in Indiana and across the nation are on the decline, but not for people with psychiatric illnesses.
If you are a smoker and are under treatment for depression, anxiety, ADHD, bipolar or another mental disorder or addiction, ditching your cigarettes could not only add years to your life – it could improve your mental health.
“Twenty-two percent of adults have a psychiatric disorder, yet they consume 45 percent of cigarettes smoked in the U.S.,” said Dr. Eric Heiligenstein, clinical director of psychiatry at the University of Wisconsin’s University Health Services in Madison.
Heiligenstein, who is board certified in pediatrics and in adult and child/adolescent psychiatry, has made nicotine’s effects on people with mental-health or addictive disorders a major focus of research and advocacy.
Barriers to treatment
Heiligenstein was in Fort Wayne recently to speak to physicians, medical-school residents and mental-health professionals. He challenged them to assess their patients’ nicotine usage rather than ignore it, citing key barriers providers report:
♦“My patients don’t want to quit.”
♦“They have more pressing matters.”
♦ “They rarely ask for help quitting.”
Heiligenstein’s visit to Fort Wayne was funded by a grant from Pfizer to the Indiana State Medical Association, with additional support from Lutheran Health Network, Parkview Health and Tobacco Free Allen County (TFAC).
Smoking worsens psychiatric illnesses, he said, but lack of education on that – along with lack of funding for cessation programs and interventions – magnifies the problem. The average medical student gets one to two hours of smoking cessation-related education over four years. And psychiatrists get only one.
Genetic vulnerability to tobacco
“Tobacco is not an equal opportunity killer,” Heiligenstein said, noting a general and erroneous assumption exists that smoking is a coping mechanism for dealing with other addictions, such as alcohol or cocaine.
“For the larger number of psychiatric patients, there is a shared genetic vulnerability,” he said, explaining that the genetic or biological factors that predispose someone to major depression, for example, also predispose the person to nicotine addiction.
Smoking is not just something that people with depression, schizophrenia or anxiety disorders do because they are around other smokers or because they are nervous or agitated, although those factors can contribute to increased nicotine use.
The number of diagnosed psychiatric disorders a person has correlates significantly with nicotine usage, Heiligenstein said.
More to the equation
Indisputable evidence shows that smoking leads to cardiovascular and lung diseases and certain cancers. But there is more to the equation.
The mental-health patient who smokes loses an average of 24 years of life due to tobacco, compared with 14 years of life lost from smoking within the general population, according to the National Association of State Mental Health Program Directors.
“There is almost no evidence in multiple studies that, if people quit smoking, they are more likely to return to alcohol or cocaine,” Heiligenstein said. Most people with an alcohol addiction “don’t die of alcohol-related disease but from tobacco-related usage.”
Some work is being done to curb smoking by people with mental illness.
In Wisconsin, mental-health providers must have training in smoking cessation and are required to address the issue among patients. But it took legislation to make that happen.
Counselors, psychologists and psychiatrists have long addressed alcohol and drugs as “high-risk markers for increased mental-health problems, yet tobacco use is a greater predictor of mental-health problems,” said Heiligenstein.
At Park Center, Fort Wayne’s largest community mental-health center, concerted efforts have been made in the past year to address smoking among clients and employees through support of Tobacco Free Allen County, said Paul Wilson, CEO. Clients are asked about their smoking status, and the center refers people to local cessation programs.
Part of the problem, however, is the center cannot bill for smoking cessation counseling. But staff provide assistance anyway, Wilson said.
Heiligenstein praised Park Center’s efforts, noting, “Only one out of three mental-health centers asks people if they are smokers.”
Because psychotherapeutic drugs can alter the effects of smoking-cessation drugs, close medical management is crucial.
The important thing, Heiligenstein said, is that “we’re talking about changing the tobacco culture for people with addictions and mental-health disorders.”
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