Almost 50% of All Cigarettes Smoked by Mentally Ill
Big Tobacco Appears to be Aware of the Link
by ROSIE MESTEL, Los Angeles Times [11/22/00]
Excerpts: MENTALLY ILL TWICE AS LIKELY TO BE SMOKERS, STUDY FINDS; TOBACCO: SPECIAL PROGRAMS MAY BE NEEDED TO ENCOURAGE PATIENTS TO QUIT, GIVEN THEIR ISOLATION AND TENDENCY TO USE NICOTINE TO FIGHT DEPRESSION, EXPERTS SAY.
Nearly half of all cigarettes purchased in the United States are smoked by people who suffer from mental illnesses, according to Harvard Medical School research.
Mentally ill people are roughly twice as likely to smoke cigarettes as those without mental illnesses, according to the research, published in today's Journal of the American Medical Assn. Not only does the habit put them at greater risk for serious ailments such as heart disease and lung cancer, but in some cases it can interfere with the effectiveness of medications to treat their disorders.
Smoking is often used as a form of self-medication because nicotine can have a powerful impact on mood, according to previous research. And because people with mental illnesses tend to be more cut off from mainstream society and less able to motivate themselves to quit, it may take specially targeted educational efforts to reduce the smoking rates in this group, experts say.
"What works on ordinary, mentally healthy adults may not work as well when we're dealing with adults with mental problems," said John Banzhaf, executive director of Action on Smoking and Health, a Washington-based nonprofit advocacy group and a professor of public interest law at George Washington University.
The researchers found that a person who had suffered from a mental illness during the month before the interview or at some time in the past was more likely to smoke or have smoked in the past. In fact, those who reported a mental illness during the prior month were nearly three times as likely to be current smokers as those who didn't have a mental illness.
From the survey, the scientists estimated that 44.3% of the cigarettes smoked in the United States are smoked by the mentally ill.
In considering the high smoking rates that are common among people who use other drugs and alcohol, Dr. Ernest Noble, professor of psychiatry at UCLA, said there appears to be a genetic tendency in some addicts that makes them more likely to abuse an array of different drugs.
The link between other mental illnesses and cigarette smoking is also well-known, Noble said. Patients smoke to enhance mood: thus, not illogically, antidepressants have been found to help people quit smoking. And in the case of schizophrenia, the medications that patients must take alter chemicals in their brains, causing a despondency that smoking alleviates.
Some studies suggest, however, that certain mental illnesses may be triggered or exacerbated by smoking, again perhaps because of its mood-altering potential. For instance, in an article in the Journal of the American Medical Assn. published earlier this month, scientists reported that adolescents and young people who smoked heavily were more likely to develop anxiety disorders later in life.
People who suffer from mental illnesses are also more likely to be poor -- and smoking is strongly linked to poverty, Banzhaf said. And quitting cigarettes requires long-term planning, impulse control and the ability to personalize risk -- all that much harder to do when one's thinking is impaired by mental illness.
The authors of the latest paper also suggest that the tobacco industry may have been aware of the psychological vulnerability of part of their market. The scientists quote a 1981 document by R.J. Reynolds Tobacco Co., which noted that some smokers smoked for "mood enhancement" and "positive stimulation" or because smoking "helps perk you up," "calm down," and "cope with stress." R.J. Reynolds Co. did not return several calls seeking comment.
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