Smoking and mental health - NCSCT

Smoking and mental disorders: special circumstances 7
7.2.8 Misuse of NRT
Cigarettes are often used by prisoners as a currency 26,67 and the same can
apply to medicinal nicotine. 49,66,67 Prisoners have been reported to have
accessed smoking cessation programmes to obtain NRT to sell to other
prisoners, while continuing to smoke 66 or to steal or extort NRT from other
prisoners. Some prisons have introduced exchange schemes, dispensing
nicotine patches only in exchange for used patches, in response to this
problem. 49 Some prisons insist on using transparent nicotine patches to
prevent concealment of illicit substances. Most prisons prohibit all forms of
chewing gum, including NRT; some prisons also prohibit foil wrapping or
plastic containers.
7.2.9 Impact of mental disorders in the prison setting
The occurrence of mental disorders adds further challenges to the many
institutional, logistic and cultural factors perpetuating smoking in prison settings
outlined above. Prisoners with mental health problems may be victimised in
prison society, and may experience difficulty engaging in cessation group work as
a direct result of mental disorder, or because their vulnerability requires them to
be moved at different times to the general prison population to avoid
confrontation, and hence restricts access to cessation services. Concerns over the
effect of quitting on ability to cope with the stresses of prison life may be a
substantial deterrent to cessation, as are the problems of misattribution of
nicotine withdrawal symptoms to mental disorder outlined in earlier chapters in
relation to the general population of people with mental disorders. Monitoring
antipsychotic medication blood levels as cigarette consumption declines may be
more difficult in the prison setting, and historical concerns over potential adverse
effects of varenicline and bupropion on mood have tended to inhibit the use of
these treatments in prison settings. Collectively these various influences combine
to perpetuate smoking among prisoners with mental disorders, and major
changes are needed to reverse this effect.
7.2.10 Summary points
> Smoking and mental disorders are extremely prevalent in the prison
population.
> Smoking is also prevalent among prison staff.
> Smoking is heavily engrained in the culture of some prisons, and tobacco is
also sometimes used as a surrogate currency.
> Prisoners with mental health problems are likely to experience particular
difficulty engaging with cessation services, and in quitting.
© Royal College of Physicians 2013 139