Smoking Cessation in Patients with Mental Illness

Electronic Cigarettes

Electronic cigarettes are becoming increasingly popular, although their use remains controversial.¹⁴ Preliminary evidence suggests that e-cigarettes are likely safer than regular cigarettes and helpful to some smokers as a means of reducing or quitting smoking.¹³ A prospective 12-month pilot study of e-cigarettes in 14 patients with schizophrenia found sustained 50% reduction in the number of cigarettes smoked daily, and sustained smoking abstinence at week 52 was observed in 14.3% of participants. The researchers concluded, “The use of e-cigarettes substantially decreased cigarette consumption without causing significant side effects in chronic schizophrenia patients who smoke, not intending to quit.”¹⁵ Further research is necessary to determine the safety and utility of this treatment.

RELATED: Are E-Cigarettes Masquerading as a Safer Alternative?

Psychosocial Interventions

Behavioral strategies “complement pharmacotherapy by enhancing the smoker’s motivation to quit and teaching quitting skills such as managing relapse triggers.”¹⁶ The University of California- San Francisco’s resource guide on smoking cessation in the mentally ill recommends psychosocial modalities, including psychoeducation, counseling, and CBT, in conjunction with pharmacotherapy.¹⁷

Conclusion

Individuals with both mild and severe mental illness are frequently interested in and capable of smoking cessation.¹⁸ Evidence-based pharmacotherapy and nonpharmacologic interventions provide the best chance for this population to achieve both short- and long-term abstinence.

Resources for Clinicians

• Smoking cessation for persons with mental illnesses: A toolkit for mental health providers. (2009)
• Tobacco Cessation Leadership Project. Facts about Smoking and Mental Health Disorders.
• Smoking Cessation Leadership Center. Behavioral Health Resources. 

References

1. Centers for Disease Control and Prevention (CDC). Smoking and tobacco use. (2014) Available at: http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/. Accessed: February 7, 2014. 
2. Lasser K, Boyd JW, Woolhandler S, et al. Smoking and mental illness: A population-based prevalence study. JAMA. 2000;284(20):2606-2610.
3. Kalman D, Morissette SB, George TP. Co-morbidity of smoking in patients with psychiatric and substance use disorders. Am J Addict. 2005;14(2):106-23. 
4. Centers for Disease Control and Prevention (CDC). New CDC Vital Signs: Smoking among those with Mental Illness. (2014) Available at: http://www.cdc.gov/media/dpk/2013/dpk-vs-adult-smoking-mental-illness.html. Accessed: February 7, 2014.
5. Hartz SM, Pato CN, Medeiros H, et al. Comorbidity of severe psychotic disorders with measures of substance use. JAMA Psychiatry. 2014 Jan 1. [Epub ahead of print].
6. Ucar EY, Araz O, Yilmaz N. Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic. Multidisciplinary Respiratory Medicine. 2014;9:9.
7. Cahill K, Stevens S, Perera R, Lancaster T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev. 2013;5:CD009329.
8. Cahill K, Stevens S, Lancaster T. Pharmacological treatments for smoking cessation. JAMA. 2014;311(2):193-194.
9. Gibbons RD, Mann JJ. Varenicline, smoking cessation, and neuropsychiatric adverse events. Am J Psychiatry. 2013;170(12):1460-1467.
10. Thomas KH, Martin RM, Davies NM, et al. Smoking cessation treatment and risk of depression, suicide, and self harm in the Clinical Practice Research Datalink: prospective cohort study. BMJ. 2013;347:f5704.
11. Anthenelli RM, Morris C, Ramey TS, et al. Effects of varenicline on smoking cessation in adults with stably treated current or past major depression: a randomized trial. Ann Intern Med. 2013;159(6):390-400.
12. Allen MH, Debanné M, Lazignac C, et al. Effect of nicotine replacement therapy on agitation in smokers with schizophrenia: a double-blind, randomized, placebo-controlled study. Am J Psychiatry. 2011;168(4):395-399.
13. Tsoi DT, Porwal M, Webster AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database Syst Rev. 2013;2:CD007253.
14. Meier E, Tackett AP, Wagener TL. Effectiveness of electronic aids for smoking cessation. Curr Cardiovasc Risk Rep. 2013;7(6).
15. Caponnetto P, Auditore R, Russo C, et al. Impact of an electronic cigarette on smoking reduction and cessation in schizophrenic smokers: a prospective 12-month pilot study. Int J Environ Res Public Health. 2013;10(2):446-461.
16. Modesto-Lowe V, Chmielewska A. Coping with urges to smoke: what is a clinician to do? Conn Med. 2013;77(5):289-294.
17. University of California- San Francisco. Smoking Cessation Leadership Center. Behavioral Health Resources. (2010) Available at: http://smokingcessationleadership.ucsf.edu/MH_Resources.htm. Accessed: February 9, 2014.
18. Morris C, Waxmonsky J, May M, et al. Smoking cessation for persons with mental illnesses: A toolkit for mental health providers. (2009) Available at: http://www.integration.samhsa.gov/images/res/Mental%20Health%20Tobacco%20Cessation%20Toolkit%20January%202009.pdf. Accessed: February 9, 2014