Smokers who also have a mental disorder or other substance abuse problem significantly benefit from smoking-cessation counseling from their primary care physicians and end up being five times more likely to quit smoking, according to research from the UCLA Jonsson Comprehensive Cancer Center.
Up to 40 percent of smokers suffer from these co-occurring conditions, and these individuals experience more difficulty trying to quit. If primary care physicians could offer counseling, it not only would improve their patients’ health but would also cut back on tobacco-related health care costs, said Dr. Michael Ong, an assistant professor of general internal medicine and health services research at the David Geffen School of Medicine at UCLA and a researcher with the Jonsson center.
Primary care doctors play an important part in smoking-cessation counseling. Prior to this study, however, their effectiveness with this patient population was unclear, Ong said.
“We found it would be very effective for primary care physicians to provide help in quitting smoking to these patients,” Ong said. “However, in the context of everything these physicians are trying to do in a day, smoking cessation may fall by the wayside.”
“It’s also been thought that with this patient population, doctors should only take on one thing at a time, for example treating an opiate addiction and opting to deal with the smoking cessation later. But at the end of the day, we showed that smoking cessation counseling is effective in this patient population and should definitely be pursued.”
Researchers found that the probability of patients with co-occurring disorders quitting on their own (without smoking-cessation counseling) was 6 percent, while smokers without these extra disorders had a 10.5 percent chance.
Smokers—both with and without alcohol, drug or mental disorders—were equally likely to receive smoking-cessation counseling (72.9 percent and 79.9 percent, respectively); however, those with these disorders quit smoking at equal levels when they received help from their doctor.
When counseling is given, smokers with co-morbid conditions had a fivefold better chance of quitting (31.3 percent), while smokers without the other disorders had a threefold better chance (34.9 percent).
“This study shows that primary care physicians can help smokers with alcohol, drug or mental disorders to successfully quit,” the study states. “These smokers should be targeted for smoking-cessation counseling to reduce the health burden of tobacco.”
Ong noted that there are far higher rates of smoking among schizophrenics and those with depression and anxiety disorders.
For the study, researchers examined the connection between past-year smoking-cessation counseling and successful quitting among 1,356 patients. The participants had reported smoking in the 1998-99 Community Tracking Study survey and later reported seeing a primary care physician in the last year in a follow-up Healthcare for Communities Survey in 2000-01.
“We sampled for patients with these disorders, and if they were smoking at one time, we followed up two years later to see if they had talked to their primary care physician about quitting and whether they did, in fact, quit smoking,” Ong said.
“We picked out smokers from the original survey in 1998 and analyzed data from the second survey in 2000. Nobody had ever examined smokers with these comorbid conditions from this angle before.”
Ong said he would like the study results to be added to new clinical practice guidelines so that physicians treating smokers with co-occurring conditions would understand that smoking-cessation counseling in this particular patient population is more successful.
“Getting people to quit smoking is the No. 1 way to reduce deaths in the United States,” Ong said. “We know these deaths are preventable and we should be incorporating every tool in our toolbox to keep people healthy. This study provides evidence that counseling all types of patients, even those challenging patients with comorbid conditions, to quit smoking can work.”
The study is published in Nicotine and Tobacco Research.
Source: University of California