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InForum: Mentally ill more likely to smoke, die from tobacco-related illness

The mentally ill and those battling substance abuse are much more likely than others to smoke, and suffer higher illness and death rates as a result.
The American Lung Association in North Dakota is launching an effort to target smoking cessation programs at those who are mentally ill or dealing with addictions.
Tobacco control advocates also are working with mental health professionals to take a more aggressive approach to help those with behavioral health problems quit smoking.
“We have seen a decline in all populations except those with mental illness or substance abuse,” said Reba Mathern-Jacobson, director of tobacco control for the American Lung Association in North Dakota, referring to the drop in smoking among most groups.
As a result, those with mental illnesses and addictions can die decades earlier than the general population, and smoking is a major contributor to sickness and early death, according to statistics cited by the federal Substance Abuse and Mental Health Services Administration:
• About half of people with behavioral health disorders smoke, compared to 23 percent of the general population.
• People with mental illnesses and addictions smoke half of all cigarettes made, and are only half as likely as other smokers to quit.
• Smoking-related illnesses cause half of all deaths among people with behavioral health disorders.
“Folks are dying a lot sooner than they need to,” said Carlotta McCleary, executive director of Mental Health America in North Dakota, an advocacy group. The issue is starting to draw more attention, she said, and collaborations are forming to address the problem.
“People who are alcoholic die from tobacco-related diseases more than they do from alcohol-related diseases,” Mathern-Jacobson said.
Those with mental illness or substance abuse problems find it more difficult to quit smoking for a variety of reasons.
Nicotine’s mood-altering effects put people with mental illness at greater risk for cigarette use and nicotine addiction. Also, people with mental illness are more likely to face stressful lives, have lower incomes and lack access to health care, making quitting more difficult.
“People might be self-medicating, that kind of thing,” by using nicotine, McCleary said.
Another problem is what tobacco control advocates view as a lackadaisical attitude among some mental health professionals.
“It’s been seen as a lesser of evils,” Mathern-Jacobson said. “Now that population is bearing the brunt of it.”
Mental health professionals are significantly more likely to smoke than other health professionals, surveys show, which might suggest a culture that is more tolerant of tobacco, she said.
It’s worth noting that nicotine dependence is listed as a behavioral disorder in the diagnostic manual used by mental health clinicians, Mathern-Jacobson said. “Nicotine is a drug, let’s treat it like one.”
Melissa Markegard, a tobacco control coordinator with Fargo Cass Public Health, said she believes mental health clinicians are increasingly more likely to take nicotine addiction seriously.
“A lot of times, smoking is a trigger for other substances, especially alcohol,” she said. “It’s kind of like you can’t do one without the other.”
More integration of behavioral health and general health care would help to combat smoking among the mentally ill and those battling addictions, McCleary said.
“It’s not just OK to focus on behavioral health alone,” or on physical health in isolation, she said. There is a growing movement in health care to do more to combine the two, McCleary added, but said much more integration is needed.
The American Lung Association in North Dakota is bringing in an expert to help train behavioral health professionals including psychiatrists, counselors, nurses, social workers and other treatment providers who serve people with mental illness or substance abuse disorders.
The training sessions will be June 21-22 in Fargo and will feature Dr. Jill Williams, an addiction psychiatrist from Rutgers Robert Wood Johnson Medical School. Details still are pending. Anyone interested can contact Mathern-Jacobson atreba.mathern-jacobson@lung.org or by calling 701-354-9719.
http://www.inforum.com/news/3986011-mentally-ill-more-likely-smoke-die-tobacco-related-illness

Forbes: Alcohol, Drug Addicts Far More Likely to Smoke Tobacco

CJ Arlotta , Contributor – Forbes| Pharma & Healthcare

Turn on the television at any point of the day to find anti-smoking commercials sprinkled throughout a sports game or nightly sitcom. As many organizations and levels of government focus efforts on eliminating tobacco use from the general population, one sub-population in particular continues to be ignored: individuals addicted to alcohol and drugs in treatment recovery programs.
Published in Addiction – a peer-reviewed journal that covers research related to alcohol, illicit drugs, tobacco and other addictions – a new report concluded that the overall rate of smoking among addicts in treatment for drug and alcohol use was 84%, compared with a rate of 31% for individuals of the general public.
Lead study author Joseph R. Guydish, a professor of Medicine and Health Policy at the University of California, San Francisco (UCSF), said in an interview that tobacco use isn’t just an issue for addiction recovery programs; it’s also a problem for both county and state public health offices supporting rehabilitation facilities.
“At the federal level this means the Substance Abuse and Mental Health Services Administration, the Center for Substance Abuse Treatment, the National Institute on Drug Abuse and the National Cancer Institute,” he said. “Internationally this means the WHO, its Framework Convention on Tobacco Control and its MPOWER principles. These are the agencies that can exert leadership in the area of smoking and addiction treatment, and provide programs with resources needed to better address smoking.”
Researchers reviewed 54 studies, which were published from 1987 to 2013, involving a total of 37,364 participants in 20 countries on six continents. All the reports analyzed were written in English.
“Anyone interested in tobacco control, whether nationally or internationally, should take note,” he said. “We cannot reduce adult smoking much further (at least in the United States) without addressing smoking in sub-populations where smoking rates are high.”
When asked about how often addicts switch over from their drug of choice to nicotine during the recovery process, Guydish admitted that he’s unaware of any relevant data available on the topic. He did note, however, that he believes the “answer would be not very often.”
“Nicotine operates in the same reward pathways of the brain as other addictive drugs, however its effect is relatively weaker than the effect of those other drugs,” he said. “We know that nicotine potentiates the effects of other drugs, but it seems unlikely that a person would stop drug use (for example) and then begin smoking as a replacement. But it is possible.”
He added: “The scenario we hear of more often is one where a person quits smoking, sometimes because they have been in a smoke-free jail or prison, but relapses to smoking in the context of drug treatment where they are surrounded by smokers.”
“Tobacco control researchers have done a great job of implementing tobacco control policies and evaluating their effects in the general population, in healthcare settings and on college campuses,” Guydish said. “Further research should follow this lead and develop, implement, and evaluate a range of policy interventions in addiction treatment programs, such as smoke-free grounds, no evidence of smoking among staff during working hours, and funding to increase availability of smoking cessation interventions.”
http://www.forbes.com/sites/cjarlotta/2015/09/22/alcohol-drug-addicts-far-more-likely-to-smoke-tobacco/

Report: Smoking bans, cigarette taxes linked to lower suicide rates

SALT LAKE CITY — Utah mental health and public health officials say a new report that links stronger anti-smoking initiatives to lower suicide rates suggests an added benefit of states’ prevention and cessation efforts.

The report, published in the journal Nicotine & Tobacco Research, found that public health interventions, such as raising cigarette taxes and imposing indoor smoking bans, could reduce risk of suicide by as much as 15 percent.

Janae Duncan, coordinator of the Utah Health Department’s Tobacco Prevention and Control Program, said Utah’s Indoor Clean Air Act “is really strong.”

While the state’s rate of adult smoking of 10.6 percent is the lowest in the nation, Utah’s tobacco taxes are relatively low at $1.70 per pack of cigarettes, Duncan said. Utah’s rate is higher than the national average but well below the rates of some East Coast states such as New York, which imposes a tax of $4.35 per pack.

“The study said each dollar increase in cigarette taxes was associated with a 10 percent decrease in (the relative risk of) suicide,” she said. “Even though we have a low tobacco use rate, it may be a good reason to look at raising our excise tax for tobacco.”

Other Utah officials say the report lends credence to mental health and substance abuse treatment practices that encourage wellness across the spectrum.

The state’s 2013 Recovery Plus initiative, for instance, required all publicly funded substance abuse and mental health treatment facilities to be tobacco free by March 2013.

“When we first started talking about doing this, there was a lot of talk such as, ‘You can’t expect someone with substance abuse or mental illness to also give that up. It’s too much on a person.’ They found that’s not the case. It actually helps with their recovery,” said Teresa Brechlin, coordinator in the Utah Department of Health’sViolence and Injury Prevention Program.

Kim Myers, suicide prevention coordinator with the Utah Division of Substance Abuse and Mental Health, said Utah officials have long observed that clients in publicly funded substance abuse and mental health facilities smoke at substantially higher rates than the general population.

The authors of the report noted that clinical and general studies have likewise documented elevated rates of smoking among people with anxiety disorders, alcohol and drug dependence, and schizophrenia, among other diagnoses.

“However, it is also possible that smoking is not merely a marker for psychiatric disorders, but rather directly increases the risk for such disorders, which in turn increases the risk for suicide,” the study’s authors wrote.

Myers said the study raises the question whether nicotine itself raises suicide risk.

“How do we use that information on a population level, but also on an individual level, to reduce someone’s risk, especially when it comes to people who have some of those other risks such as serious mental illness or substance use disorders?” she asked.

The study also determined that smokers’ risk for suicide is two to four times greater than nonsmokers.

Duncan said more research is needed to understand how the link applies to Utah. Utah’s suicide rate has been consistently higher than the national rate for the past decade, according to state health department statistics, while smoking rates are very low.

“The study doesn’t give those clear answers. I think what it does do, it helps us see we should be looking at whole health, and it’s important to look at it across the board, not just issue by issue, but how all these things are tying together,” Duncan said.

http://www.ksl.com/?nid=157&sid=30887197