I was shocked when I read this statistic in Melinda’s Beck top-notch column, “Health Journal,” in the Wall Street Journal:
Nearly half of all the cigarettes sold in the U.S. are smoked by people with a serious mental illness, according to a study in the Journal of the American Medical Association in 2000. People with schizophrenia, bipolar disorder and other mental illnesses are twice as likely to smoke as the general population, and they tend to smoke about 50% more cigarettes per day.
Beck discusses a pilot program at the International Center for the Disabled (ICD) that began in January that is challenging today’s culture regarding smoking among the mentally ill: that persons with serious mood disorders don’t want to quit, and they shouldn’t if the withdrawal will create even more depression and other symptoms that are best left alone. Smoking is often used as a reward for good behavior in psychiatric hospitals and is not discouraged because it satiates the patients.
But the nicotine fix comes with great risk. Beck explains:
Smoking can take a heavy toll on patients already struggling with mental-health issues. People receiving Social Security disability spend one-quarter to one-third of their income on cigarettes each month. And people with serious mental illnesses die, on average, 25 years earlier than the rest of the population, largely due to high rates of smoking-related illnesses like cancer, heart disease and stroke.
Concern over the physical health of such patients—and high medical costs—has prompted some states to begin addressing the issue. About 60% of state mental hospitals now prohibit smoking. But only one-third of them offer treatment to help patients quit. And few people living on their own with mental-health problems have access to smoking-cessation programs.
The pilot program is using nicotine-replacement therapy and one-on-one counseling with therapists trained in this area, and is already having positive results. For many patients, giving up smoking has increased their confidence and motivated them to pay better attention to their health. They have found that smoking didn’t really help with stress; in fact, it may have contributed to it.
Beck explains that the ICD program is funded by a grant from SAMHSA, the Substance Abuse and Mental Health Services Administration, to test model programs integrating medical and mental-health care. She reports, “Of ICD’s 500 patients, many of whom are homeless, jobless and struggling with legal and family problems as well as their psychoses, 35 are now working to quit smoking or have stopped.”