Individuals with mental illness are more likely to smoke. Source: http://upload.wikimedia.org/wikipedia/commons/3 /32/Zwei_zigaretten.jpg
On Tuesday, October 22nd, Dr. Mary Brunette gave a talk on Nicotine Dependence in Mental Illness: Motivation, Treatment and Technology at the Dartmouth-Hitchcock Medical Center. Her talk was one of Dartmouth-Hitchcock’s Norris Cotton Cancer Center’s Grand Round lectures. The title of her talk aptly summarized the three basic topics of the talk: why individuals with mental illness are more likely to use tobacco, how to engage them in cessation treatment to quit tobacco use, and the advantages of using technology in cessation treatment.
Individuals with mental illness are likely to use tobacco for a variety of psychological, biological, and social reasons. People with mental illness who smoke often experience a psychological effect called positive reinforcement: because smokers with mental illnesses feel enhanced cognition and better reward responsivity after and during smoking, they will continue smoking. Data show that nicotine improves cognition and reward responsivity, but only very moderately. Biological factors such as the way nicotine affects the schizophrenic brain may also explain why individuals with mental illness are more likely to smoke. Social and environmental factors also account for this likelihood. A good indication of the probability that someone smokes is if his/her family members or friends smoke; since a majority of people with mental illness—like schizophrenics—smoke, their behavior influences other individuals they may know who have the same mental illness. Much misinformation in society also exists about cessation treatments; some people wrongly believe that smoking helps to control one’s mental illness and cessation will cause the mental illness to develop further. As a result of misinformation, people are more likely to continue smoking.
A variety of techniques are used to engage individuals with mental illness in cessation treatment. These include behavioral and biological treatments, which should be used in conjunction with one another: individual and group counseling, therapy, and nicotine replacement products/non-nicotine medications such as Chandrix or bupropion are examples of behavioral and biological treatments, respectively.
Lastly, the use of cessation websites has been shown to be very effective in helping individuals with mental illness quit smoking. These sites expand quality treatment to a wider audience; a Minnesota study found that up to ten times more individuals would visit a website engaging individuals in cessation treatment as opposed to its respective in-person clinic. Websites are not only extremely low-cost and convenient for patients to use and access, but also consistent in getting cessation information out to patients, as opposed to professionals who may give a range of advice. Dr. Brunette and other professionals created a website of their own for individuals with mental illness going through cessation treatment. It provided complete, quality content and high usability, two aspects that popular cessation websites lacked but that were nonetheless important for cessation.
Dr. Brunette’s presentation gave the audience a good overview of tobacco use in the U.S. population, why people smoke, the prevalence of smoking among individuals with mental illness, how to help these individuals quit, and how cessation treatment websites can encourage and make more effective their efforts to quit. The cessation website Dr. Brunette and others designed had a measurable and positive effect on smokers with mental illnesses.