Innovative approaches to support smoking cessation for individuals with mental illness and co-occurring substance use disorders

Expert Rev Respir Med. 2017 Oct;11(10):841-850. doi: 10.1080/17476348.2017.1361823. Epub 2017 Aug 9.

Abstract

Tobacco remains the leading preventable cause of death in the US, accounting for over 520,000 deaths annually. While the smoking prevalence has declined over the past 50 years, those with mental illness and addictive disorders continue to smoke at high levels and with significant tobacco-related health problems. Areas covered: This review highlights the epidemiology, contributing factors, and evidence-base for intervening upon tobacco use in those with mental illness and addictive disorders. Historically underprioritized, a growing body of literature supports treating tobacco within mental health and addiction treatment settings. Critically, treating tobacco use appears to support, and not harm, mental health recovery and sobriety. This review also summarizes novel, emerging approaches to mitigate the harms of cigarette smoking. Expert commentary: People with mental illness and addictive disorders have a high prevalence of tobacco use with serious health harms. Treating tobacco use is essential. Evidence-based strategies include individual treatments that are stage-matched to readiness to quit and combine cessation medications with behavioral therapies, supported by smoke-free policies in treatment settings and residential environments. Emerging approaches, with a focus on harm reduction, are electronic nicotine delivery systems and tobacco regulatory efforts to reduce the nicotine content in cigarettes, thereby reducing their addiction potential.

Keywords: CYP1A2; Tobacco; dual diagnosis; e-cigarette; mental illness; nicotine; nicotine replacement therapy; quit-line; smoking; substance use disorders.

Publication types

  • Review

MeSH terms

  • Cognitive Behavioral Therapy
  • Cytochrome P-450 CYP1A2 / metabolism
  • Electronic Nicotine Delivery Systems
  • Genome-Wide Association Study
  • Hotlines
  • Humans
  • Mental Disorders / psychology*
  • Nicotinic Agonists / therapeutic use*
  • Psychotropic Drugs / pharmacology
  • Smoking / physiopathology
  • Smoking Cessation / methods*
  • Substance Withdrawal Syndrome / psychology
  • Substance-Related Disorders / psychology*
  • Suicidal Ideation
  • Tobacco Smoke Pollution / adverse effects
  • Tobacco Use Cessation Devices*

Substances

  • Nicotinic Agonists
  • Psychotropic Drugs
  • Tobacco Smoke Pollution
  • CYP1A2 protein, human
  • Cytochrome P-450 CYP1A2