Smoking and mental health - NCSCT

Summary and conclusions 10
10.4 Smoking cessation in mental disorders
People who smoke and have mental disorders are no less likely to want to quit
smoking than those without, but are more likely to be heavily addicted to
smoking, more likely to anticipate difficulty quitting smoking and less likely to
succeed. However, as in the general population, smokers with mental disorders
are more likely to quit if provided with behavioural support and
pharmacotherapy. In view of the high levels of dependence it is particularly
important to provide nicotine replacement therapy (NRT) in high doses by
combining slow- and faster-acting products, and provide more intensive
behavioural support. Use of the non-nicotine cessation therapies, bupropion and
varenicline, in people with mental disorders has been inhibited by concerns over
exacerbation of depression or other adverse effects on mental health, but both
therapies appear to be effective in this group and can be used, subject to
supervision and monitoring to ensure that therapy is stopped in the event of
adverse effects.
Quitting smoking does not markedly exacerbate mental disorders, and is likely
to improve mental health symptoms over the longer term. Quitting smoking also
reduces the rate of metabolism of many psychoactive drugs, doses of which
therefore need promptly to be reduced, and increased in the event of relapse to
smoking. Symptoms of nicotine withdrawal are easily confused with those of
underlying mental disorders, and should be treated with NRT or other cessation
therapy.
Smokers who are not ready or willing to attempt to quit smoking should be
encouraged as strongly as possible to use NRT or other sources of nicotine to cut
down on smoking, and should be provided with nicotine for smoking
substitution during visits or inpatient stays in smoke-free mental health facilities.
Asking and recording smoking status, and delivery of cessation and/or harm
reduction interventions to all patients who smoke, should be routine
components of all primary and secondary care, including mental health services.
Recent evidence suggests that ascertainment of smoking and delivery of advice to
quit in primary care, where most people with mental disorders are managed,
have improved in recent years in the UK, although the quality of these
interventions is not known. In inpatient facilities, behavioural support and
pharmacotherapy should be provided in-house.
10.5 Tobacco policy and mental health
Population-level policies to prevent smoking have contributed to significant
declines in smoking prevalence across the general population over recent
decades, but not among people with mental disorders. It is not clear whether this
reflects a true lack of sensitivity to population policies in this group, or whether
their effects are undermined (particularly in those with more severe disorder) by
© Royal College of Physicians 2013 191