Mental illness linked to cigarette addiction
Posted: July 15, 2008
Dr. R. Andrew Chambers is an assistant professor of psychiatry at the Indiana University School of Medicine.
Question: Do mental illnesses and cigarette addiction go hand in hand?
Answer: That's correct. One recent study documents that up to 50 percent of cigarettes are smoked by people with some form of mental illness. This includes schizophrenia, bipolar disorder, major depression, anxiety disorders, post-traumatic stress disorder, borderline personality disorder.
In the general population, the smoking rate is between 20 and 25 percent, depending on where you live. In schizophrenia, the smoking rate is 75 to 90 percent. Alcoholism is about 80 percent. Bipolar disorder is 60 to 70 percent, and major depression is 40 to 50 percent.
Q: Why is there a link between smoking and nicotine addiction?
A: The traditional theory is that people are self-medicating and they're receiving some kind of benefit from the nicotine. There is evidence out there that nicotine in certain circumstances does have cognitive-enhancing effects or might be a modulator of mood or anxiety.
Another theory is that people with mental illness are more susceptible to the disease of addiction. There's quite good evidence for that because you also see addictions with many other drugs, such as cannabis, cocaine and alcohol. It may be that nicotine is just a not-so-unique example of a broader picture.
There's a third cutting-edge perspective that nicotine can change the brain, especially in adolescents. In 90 percent of smokers, smoking begins between 15 and 25, when the brain is undergoing a lot of changes. Nicotine exposure in that period can change the brain chemistry in a way that may make you more susceptible to mental illness.
Q: So are different smoking cessation methods recommended for the mentally ill?
A: That is being looked at. Self-medication is the most popular theory, but ironically the least validated. If you label it self-medication, the label does not acknowledge that they're addicted, and when clinicians go along with that, they're sort of rationalizing the drug use.
The cultures of mental health care and addiction-ology are segregated. That creates huge problems. Most of our patients who need mental health care have an addiction of some kind. Yet we have an amazing inability to effectively treat those addictions.
Chantix, the newest drug for smoking addiction, appears to be very effective. When that drug was developed, the trials excluded people with mental illness. It got approved and the drug shows efficacy, but now we're finding out this drug has all kinds of implications for people with mental illness.
What I'm arguing for is for psychiatrists to be trained in addiction. But that's a long way off.