May is Mental Health Awareness Month. Psychiatrist and Medical Director of Keystone Behavioral Health, Dr. Irakli Mania, shares some information about tobacco addiction and how it is connected to mental health.
Introduction
Tobacco use disorder is the most common substance use disorder among people with psychiatric conditions, and we as psychiatrists see a lot of this. About 44% of the tobacco sold in the United States is used by mental health patients, and more than half of mental health patients smoke. It is well-known that smoking results in multiple health problems, shorter lifespans, and reduced quality of life; its use even increases suicide risk. Smoking is the number one preventable cause of death in the United States.
Why is it hard for people who use tobacco to quit?
Despite previous thoughts to the contrary (mainly supported and pushed by tobacco manufacturing companies) it has been long established that nicotine is highly addictive. In fact, it is one of the most addictive substances. It triggers the same addictive circuit in the brain that other drugs of abuse do and eventually it is out of the person’s immediate control to decrease use or stop using. This can lead to many unsuccessful attempts at quitting.
What makes nicotine so addictive?
In addition to physical causes there are psychological factors involved. There is a common belief that smoking is used for self-medication, and that it offers some rescue from overwhelming stress and psychiatric symptoms. While there is some research into medications that work through the body’s nicotinic receptors in order to treat illnesses like schizophrenia, an increasing amount of medical literature and studies defeats the false belief that smoking offers mental health benefits. Growing evidence shows significant improvement in mental health and quality of life as a result of quitting tobacco, especially in individuals with psychiatric or substance use disorders.
Often, patients with mental disorders and their medical providers delay talks and decisions about smoking cessation until after their mental health is stabilized and other substance use disorders are addressed. But research shows that psychiatric patients can safely quit smoking even while quitting other substances and stabilizing their psychiatric conditions.
How does stress affect the desire to smoke?
Smoking usually increases in times of stress. It is important to avoid stress as much as possible when trying to quit. If someone has a recurring stress in their life, they should work to develop coping strategies other than smoking.
What steps can someone take to stop?
The first step in any change is the decision to make that change. This comes in stages. Initially people think they do not have a problem, then comes realization that there is a problem, then there is contemplation whether this needs to change. This is followed by preparation for the change, then actual change, and unfortunately, in many cases, this can loop back with relapse to the contemplation stage. In the next article, I will discuss techniques that can be used to improve one’s chances of quitting successfully.
This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.
