Smoking and mental health - NCSCT

More documents

Recommendations

Info

Smoking and mental health throat, larynx and oesophagus. 72,90 Smoking also appears to impede the process of cognitive recovery after alcohol abstinence. 72 Smokers require higher doses of a number of benzodiazepines and opiates due to induction of liver enzymes by tobacco smoke (see Chapter 5). 7.3.5 Smoking cessation and alcohol or drug misuse Contrary to popular perception, people in treatment for alcohol and drug misuse who smoke are often concerned about their smoking and interested in quitting. 73,91,92 Due to their two- to threefold higher rates of smoking and its impact on recovery, smokers with alcohol and drug misuse disproportionately benefit from appropriate smoking cessation service provision. 72,90 However, addressing smoking in the context of treatment for alcohol and drug misuse remains rare. A review of 342 drug misuse treatment units in the USA found that 69% offered no treatment for smoking cessation intervention 93 and, although equivalent recent data are not available for the UK, the historic negligence of smoking in the context of drug and alcohol misuse treatment is well recognised. 94,95 Commonly cited reasons for a failure to intervene in smoking include clinicians arguing the case of ‘first things first’, staff reservations over treating smoking and beliefs that cessation could jeopardise recovery efforts. 94 However, the available evidence provides little if any support for these concerns, and if anything suggests that the opposite may be true. 72,90 Smoking cessation support can be integrated into treatment for alcohol and drug misuse without jeopardising recovery goals, and indeed can improve treatment outcomes, as discontinuance of one drug (nicotine) can support abstinence from other drugs due to shared neurobiological mechanisms. 90 The evidence for effectiveness of smoking cessation interventions in those who misuse alcohol and other drugs is substantial. A meta-analysis of 19 randomised controlled trials of smoking cessation interventions for people in treatment for drug and alcohol misuse and in recovery showed that concurrent treatment of smoking resulted in a 25% increased likelihood of long-term abstinence from alcohol and illicit drugs. 96 This meta-analysis also showed that cessation interventions, including those that offered behavioural support but not NRT, were effective in patients with drug and alcohol misuse, doubling the likelihood of cessation during treatment for drug and alcohol misuse, and that interventions using NRT were more effective. Although these effects were not sustained in the longer term in the meta-analysis, 96 these findings and those of a separate review 90 provide clear evidence that cessation intervention achieves at least short-term benefit, and may enhance the success of other drug and alcohol misuse interventions. Results of a recent study employing intense tailored interventions, 97 with abstinence rates of 43% at completion, or one that integrated tobacco dependence treatment into substance abuse treatment 142 © Royal College of Physicians 2013
Smoking and mental disorders: special circumstances 7 pathways 98 indicate that further research exploring the effectiveness of bespoke interventions in this population is warranted in this group. 72,96 7.3.6 Summary points > Smoking is highly prevalent among people who misuse alcohol and other drugs. > Smokers who misuse alcohol and/or other drugs are often concerned about their smoking, and willing to address it. > Interventions to address smoking concurrently with alcohol and/or drug misuse are effective and can also support alcohol and drug abstinence. However, only a minority of those with alcohol and/or drug misuse receive smoking cessation interventions. > Efforts to address this shortcoming through the development and assessment of more effective tailored treatment programmes, and through systematic integration into care pathways, are urgently required 7.4 Homeless people 7.4.1 The size of the UK homeless population The number of homeless people, comprising those of no fixed abode who sleep rough or in hostels or night shelters, is difficult to measure. The Department of Health estimated that there were about 100,000 homeless people in England in 2007–8, 99 but this figure excluded the ‘hidden homeless’ such as those who do not use hostel services. The resulting underestimate is likely to be substantial, because a recent survey of 437 single homeless people found that 62% were ‘hidden homeless’ on the night that they were interviewed, and that the majority had never stayed in hostels. 100 The true figure may therefore be closer to the 380,000 estimated by the charity Crisis for 2003. 101 7.4.2 Homelessness and mental disorders Mental disorders, including substance abuse, are significantly more prevalent in homeless people than in the general population. 99 Homeless people in England in 2000 were more than ten times more likely to have psychosis, four times more likely to have a current common mental disorder and over five times more likely to be dependent on alcohol or other drugs. 102 A more recent review suggests that mental illness and alcohol or drug misuse occur together in around 10–20% of the homeless population, 103 whereas research from a London-based charity for homeless people found that around a third (32%) of service users were alcohol © Royal College of Physicians 2013 143
Page 1 and 2:
PDF not for circulation Smoking and
Page 3 and 4:
Contents Members of the Tobacco Adv
Page 5 and 6:
Contents 4.4.3 Attention deficit hy
Page 7 and 8:
Contents 6.4.3 Staff knowledge 122
Page 9 and 10:
Contents 10.5 Tobacco policy and me
Page 11 and 12:
Contributors Anthony Aclet - Specia
Page 13 and 14:
Contributors Jill Williams - Associ
Page 15 and 16:
1 Mental disorders 1.1 What is a me
Page 17 and 18:
Mental disorders 1 1.3 Common menta
Page 19 and 20:
Mental disorders 1 1.4.4 Somatisati
Page 21 and 22:
Mental disorders 1 In addition to s
Page 23 and 24:
Mental disorders 1 not diagnosed un
Page 25 and 26:
Mental disorders 1 Similar to many
Page 27 and 28:
Mental disorders 1 12 Chang CK, Hay
Page 29 and 30:
Mental disorders 1 52 Young S, Toon
Page 31 and 32:
Smoking among people with mental di
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Neurobiological and behavioural mec
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Epidemiology of the association bet
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Smoking cessation interventions for
Page 101 and 102:
Page 103 and 104:
Page 105 and 106: Smoking cessation interventions for
Page 125 and 126: 6 Population strategies to prevent
Page 127 and 128: Population strategies to prevent sm
Page 145 and 146: Smoking and mental disorders: speci
Page 155: Smoking and mental disorders: speci
Page 179 and 180: The economic cost of smoking in peo
Page 197 and 198: Ethical and legal aspects 9 pose co
Page 199 and 200: Ethical and legal aspects 9 less an
Page 201 and 202: Ethical and legal aspects 9 patient
Page 203 and 204: 10 Summary and conclusions 10.1 Smo
Page 205 and 206: Summary and conclusions 10 10.4 Smo
Page 207 and 208:
Summary and conclusions 10 although
Page 209 and 210:
11 Key conclusions and recommendati
Page 211 and 212:
Key conclusions and recommendations
Page 213 and 214:
Page 215:
show all

Smoking and mental health - NCSCT

Create successful ePaper yourself

Delete template?

Save as template?