Psychiatric patients given smoking-cessation treatment less likely to be rehospitalized

Patients who participated in a smoking-cessation program during hospitalization for mental illness were able to quit smoking and were less likely to be hospitalized again for their psychiatric conditions, according to a new study led by a Stanford University School of Medicine scientist.

The findings counter a longstanding assumption, held by many mental-health experts, that smoking serves as a useful tool in treating some psychiatric patients.

Smoking among such patients has been embedded in the culture for decades, with cigarettes used as part of a reward system. Indeed, clinicians sometimes smoke alongside patients as a way of creating a rapport with them, said Judith Prochaska, PhD, MPH, associate professor of medicine at the Stanford Prevention Research Center and lead author of the study.

The result is that psychiatric patients are among the country's most prolific smokers and among those most likely to die of smoking-related ailments, Prochaska said. Nearly half of the cigarettes sold in the United States are to people with psychiatric or addictive disorders, according to data from the U.S. Centers for Disease Control and Prevention. The average life expectancy for people with severe mental illness is 25 years less than that of the general population, and their leading cause of death is chronic illness, mostly tobacco-related.

Prochaska said it has long been thought that if these patients quit smoking, it would be detrimental to their recovery — that they would lose a critical crutch for coping with stress. However, she pointed out that the daily cycle of nicotine withdrawal a smoker experiences creates a great deal of stress, and that mental-health providers are well-equipped to assist patients with developing healthier forms of coping.

The new study showed that a simple intervention that included periodic contact with a counselor, written and computerized materials, and the use of nicotine patches could support, rather than harm, the patients' mental health, she said.

"This is a very low-cost, brief intervention that helped patients quit smoking and offers evidence that it may have helped their mental health recovery," said Prochaska, who focuses on developing interventions to treat tobacco dependence in people with mental illness or addictive disorders.

She said the study, done in collaboration with researchers at UC-San Francisco, is the first to examine the impact of a stop-smoking intervention in adult psychiatric patients. It will be published online Aug. 15 in the American Journal of Public Health.

Michael Fiore, MD, MPH, director of the University of Wisconsin Center for Tobacco Research and Intervention and a leader in national policy for tobacco treatment who was not involved in the study, said the paper "provides powerful evidence that evidence-based tobacco dependence treatments can substantially increase quit rates among psychiatric inpatients. We know that psychiatric patients smoke at very high rates and are at tremendous risk from their smoking. Thus, the findings hold promise to make an important, real-world contribution to the health of these patients."