Common Myths about Smoking Cessation in Behavioral Health

Common Myths
Smoking Cessation in Behavioral Health

Myth #1: Tobacco is a good self-medication tool for individuals with behavioral health issues

NICOTINE has some benefits:

  • Improves short-term performance on attention and memory tasks.
  • Improves cognitive impairments associated with Alzheimer’s disease, schizophrenia, and attention-deficit/hyperactivity disorder.
  • Found to reduce negative affect through dependence/withdrawal. Many people smoke to relieve stress, but its likely they are just relieving nicotine withdrawal.

HOWEVER, there are big downsides and risks:

  • Rapid decrease in nicotine response with repeated exposure (tolerance)
  • Self-dosing of nicotine through tobacco use is associated with significant health risk.

Myth #2: People with behavioral health issues are not ready or interested in quitting smoking

  • Over 80% who smoke have made 1+ quit attempt in their lifetime.
  • Approximately 48% have made at least one quit attempt in past  year.
  • Smokers with co-occurring disorders make approximately 5-10 attempts before sustaining a quit attempt.

Myth #3: People with behavioral health issues are not able to quit smoking while addressing co-morbid problems

Individuals with mood disorders as well as those with substance use issues are able to quit or cut down when provided with the means and support to do so.

In a Randomized Controlled Trial of depressed smokers, when treated with a combination of 

  • motivational counseling,
  • nicotine patches, and
  • behavioral therapy

depressed smokers were much more likely than their counterparts who did not receive the interventions to be smoke-free at 12- and 18-month assessments

Among opioid-dependent women, a 6-week smoking cessation intervention was associated with decrease in daily cigarettes, at 3-month follow-up, by:

  • 49% among pregnant women
  • 32% among non-pregnant women

Myth #4: Smoking cessation efforts interfere with recovery.

  • Among depressed patients who quit smoking:
    • No increase in suicidality
    • No increase in psych hospitalization
    • Comparable improvement in number of days with emotional problems
    • No difference in drug use and less alcohol use among those who quit smoking
    • A meta-analysis of 26 studies showed quitting smoking was associated with:
    • Decreases in depression, anxiety and perceived stress
    • Increases in positive affect and purpose in life.
  • Among patients with schizophrenia who quit smoking:
    • No effect on cognitive function or clinical symptoms of schizophrenia
    • Bupropion (Zyban©): decreased negative symptoms of schizophrenia
    • Varenicline (Chantix©): no worsening of clinical symptoms
  • Incorporating smoking cessation into substance use treatment programming does not lead to increased risk of relapse and seems to promote abstinence from other illicit substances
    • Associated with a 25% increased likelihood of long-term abstinence from alcohol and illicit drugs.

Myth #5: Smoking cessation is a low priority when treating individuals with other behavioral health problems.

Much of the rationale section highlighting the health disparities and increased mortality as well as the second myth about interest are in direct conflict with this not being an important priority.  Clients are asking for it and it is a very risky health behavior that can be incorporated into current behavioral health services.