Smoking and mental health - NCSCT

Smoking and mental disorders: special circumstances 7
7.3.3 Mental disorders and alcohol or drug misuse
Mental disorders are associated with high rates of alcohol and drug misuse.
Among 5–16 year olds in the UK, the most recent national child and adolescent
psychiatry morbidity survey 74 reveals that drinking alcohol twice a week or
more is 1.7 times more common among 5–16 year olds with emotional
disorders, 4 times more common in those with conduct disorder and 2.3 times
more common in those with hyperkinetic disorder. Cannabis use is 2.5 times more
common among those with emotional disorders, 3.5 times more common in
those with conduct disorder and 2.9 times more common in those with
hyperkinetic disorder. Use of other drugs, such as opiates or crack cocaine, is
4 times more frequent in those with emotional disorders, 2.5 times more
frequent in those with conduct disorder and 5 times more frequent among those
with hyperkinetic disorder.
Alcohol misuse and dependence are also increased in adults with common
mental disorders 75,76 and schizophrenia, with an estimated 43% prevalence of
alcohol misuse in one study of first episode psychosis. 77 Rates of drug misuse are
also higher in those with mental illness. Around half of those with a diagnosed
severe mental illness such as schizophrenia or chronic depression abuse
substances. 77–79 Among those in treatment for mental disorders in the UK, drug
and alcohol misuse are estimated to occur in 20–37% of those in community
mental health settings, 6–15% in addiction settings, and 38–50% in inpatient and
crisis team settings. 80
7.3.4 Impact of smoking in people with alcohol or drug misuse
Tobacco smoking is more hazardous to the health of people in treatment for
substance misuse than their primary presenting substance of abuse. Of 222
deaths in a cohort of 845 individuals with substance misuse followed for 11 years
in the USA, 51% were attributed to a tobacco-related cause of death, more than
to alcohol or other drug use. 81 Furthermore, respiratory and other symptoms
have been reported to be more common among smokers who abuse alcohol or
opiates compared with non-smokers, although not in cocaine users. 82
Tobacco smoking is also associated with a sevenfold higher likelihood of
cannabis smoking, 83,84 and usually precedes cannabis use, 85,86 which in turn
precedes use of cocaine and other drugs. 84 Among people with opiate addiction
there is a direct and dose-related association between tobacco smoking and
patients’ subjective symptoms of inadequacy (‘not holding’) of methadone
dose. 87 Smoking is associated with higher rates of illicit drug misuse in opiate
treatment programmes 88 whereas reduced heroin use is associated with reduced
tobacco use. 89
The combination of heavy use of alcohol and tobacco multiplies the risks of
upper respiratory and digestive tract cancers, including cancer of the mouth,
© Royal College of Physicians 2013 141