Sep 9, 2009 12:26 pm US/Central
Doctors Fear Asking Mentally Ill To Quit Smoking
They Fear Their Patients' Disorders Will Get Worse, Study Says
CHICAGO (Sun-Times Media Wire) ―
People with mental illnesses such as depression and anxiety are the heaviest smokers and their doctors are afraid to ask them to quit. They assume that if their patients try to quit, their mental disorders will get worse.
That is a myth, according to Brian Hitsman, tobacco addiction specialist and assistant professor of preventive medicine at Northwestern University's Feinberg School of Medicine.
Hitsman detailed in The Canadian Journal of Psychiatry the first comprehensive, evidence-based plan for psychiatrists, psychologists and other mental health providers to help patients quit smoking, according to a release from NU.
Between 40 to 80 percent of people with mental illness are daily smokers, compared to less than 20 percent of people who don't have such problems, according to research. The mentally ill also smoke more cigarettes per day -- often up to two packs -- and have a disproportionately high rate of tobacco-related disease and mortality, with a correspondingly heavy financial burden to the health-care system.
The mentally ill receive tobacco treatment on only 12 percent of visits to a psychiatrist and 38 percent of visits to a primary care physician, Hitsman said.
Doctors erroneously believe mental disorders will worsen if they take away tobacco, but "not a single study shows that symptoms get worse," Hitsman said.
He examined 13 randomized clinical trials that measured psychiatric symptoms during smoking cessation treatment. Seven studies showed psychiatric symptoms actually improved and six showed no changes, the release said.
Another problem is mental health professionals believe tobacco is not a real addiction compared to other drugs.
"The perception is patients need tobacco because it's their only source of pleasure and helps them feel better," Hitsman said. "There is very little evidence, though, that smoking cigarettes serves to self-medicate emotional symptoms."
Hitsman's tobacco-cessation plan combines cognitive behavioral therapy, pharmacotherapy and motivational counseling. He also has identified several treatment medications that may further facilitate quitting.
People with mental disorders do have a harder time quitting, Hitsman acknowledged, but said newer studies show it is possible to enhance the chance of success. Even if patients simply reduce their smoking, they are much more likely to quit successfully later.
Tobacco dependence also needs to be treated as a chronic disease, Hitsman believes.
(Source: Sun-Times Media Wire © Chicago Sun-Times 2009. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed.)
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