Tobacco Use in Adults With Mental Illness: An Overview of One State-Wide Tobacco Cessation Program

Even though one of the public health's top achievements of the 20th century involves tobacco cessation, a disproportionate burden of tobacco-related comorbidity still affects those with mental illness (Centers for Disease Control and Prevention, 2017; Cook et al., 2014). There is evidence suggesting that psychiatric disorders are associated with an increased prevalence in cigarette smoking (Tsoi, Porwa, & Webster, 2013). One explanation for this is the potentiating effect of nicotine on dopamine receptors (Mao, Gallagher, & McGehee, 2011). Other explanations include poverty, educational advancement and industry bias in tobacco marketing (MMWR Vital Signs: Current Cigarette, 2016; CDC Morbidity and Mortality, 2013). We know that adults with mental illness smoke at rates twice that of the general population, and are nicotine-dependent at rates up to three times higher than the general population (Cook et al., 2014; Grant, Hasin, Chou, Stinson, & Dawson, 2004). Adults with mental illness comprise about 19% of the population, but smoke approximately one-third of all the cigarettes smoked (MMWR Vital Signs: Current Cigarette, 2016). In the United States, the national tobacco use prevalence is estimated at 19%; however, prevalence among those with bipolar disorder is 51%–70% and 36%–80% among those with major depressive disorder (Grant et al., 2004; King, Dube, & Tynan, 2012; Lasser et al., 2000). Despite these high rates, recent studies suggest that smokers with mental illness are highly motivated to quit (Cook et al., 2014). However, it remains rare for mental and behavioural health professionals to offer tobacco cessation pharmacotherapy and counselling to clients with psychiatric disorders.