By Marvin Ross
Over the years, I’ve written about the fact that a majority of those with serious mental illness smoke. In one of my earlier articles I talked about the research that shows that for those with schizophrenia, nicotine can be beneficial. In that article, I pointed out that “Recent research at Yale has found that nicotinic α7 receptors in the brain, when properly stimulated, are essential for proper excitation of the working-memory circuits in the cortex. Inhalation of nicotine is an attempt to stimulate those nicotinic α7 receptors. Smoking is not therapy and drugs to stimulate that receptor are being investigated. Until then, many of those with schizophrenia will continue to smoke.”
In a later article, I castigated the political correctness of so many health institutions for banning smoking by those with mental illness. Yes, smoking is harmful but for those with mental illness, they do find comfort and it is cruel to prevent them from smoking in specialized rooms. Those who can go out on a short pass can go out to smoke but not those in isolation. Being prevented from smoking only adds to their stress.
The Centre for Mental Illness and Addictions in Toronto went so far as to ban tobacco from their property entirely.
I was just reading a new attempt to help those with serious mental illness kick their habit. It is laudable as there are health benefits to quitting but at the expense of mental health. Locally, one of the schizophrenia programs in Hamilton has long run a quit smoking program for its members and that has proven to be very difficult. I’ve been told that the participants can’t wait for a break so they can rush outside for a smoke and that some people have taken the course numerous times with no luck in quitting.
This new trial of a novel strategy is called SCIMITAR+ [Smoking Cessation Intervention for Severe Mental Illness] and was described by the American Psychiatric Association. The study involved 526 adults with SMI (which included schizophrenia, schizoaffective disorder, and bipolar disorder) who smoked at least five cigarettes a day. To quote from the report “The participants were randomly assigned to receive usual care (access to smoking cessation medications and a telephone helpline) or a tailored cessation intervention for 12 months. The tailored intervention included cessation medications and behavioral therapy adapted to meet the needs of people with SMI; these adaptations included providing assessments and nicotine replacement before setting a quit date, providing home visits, and providing additional face-to-face support following smoking relapse.”
The results are fascinating. After 6 months, 14% of the intervention patients had quit compared to 6% for the treatment as usual group. Clearly, this intervention helped more than the usual methods but 14% is not a very optimistic number. After all, 86% were still smoking. By the end of 12 months, the quit rate was 15% versus 10%. thus the majority of people were unable to quit.
I really have to wonder if any of this is of any value. Smoking is bad for health and of that there is no dispute but is it worth the effort to bug people with SMI to quit. As a society, we can still ensure their health with regular checks into lung capacity, blood pressure and blood sugar. A UK study found that just having a serious mental illness reduces life expectancy more than being a heavy smoker. One reason for that is that those with serious mental illness do not get as good medical assessments as those without a mental illness.
The importance of proper medical care was nicely illustrated by a US study. Researchers looked at cardiovascular deaths in states with expanded Obama Care (ACA) and found that there were 1800 fewer deaths per year in states that expanded Medicaid under the ACA.
The benefit of proper regular health assessments with appropriate interventions will go a long way to ensuring that those with serious mental illness benefit from modern medicine and it will extend their lives. That is where the emphasis should be. Forget wasting time and effort on smoking cessation.