Smoking cessation treatments work and are safe for people with severe mental illness

In a study published today in the journal Addiction, researchers have determined that treatment for smoking dependence is as effective among people with severe mental illnesses as it is for the general population. Importantly, they also found that offering such treatments does not appear to cause deterioration in mental health.

This is good news: people with severe mental illnesses (SMI) such as schizophrenia have some of the worst physical health of any section of the population. They are two to three times more likely to smoke, and smoking-related illnesses contribute significantly to their high sickness and death rates. Mortality rates for those with SMI are three times that of the rest of the population.

Although treatment for smoking dependence would improve the physical health of people with SMI, the medical community has traditionally ignored health promotion and worried that such treatments would worsen people's mental states.

The authors brought together the most rigorous evidence on smoking cessation treatment among people with SMI. They were able to determine the effectiveness of smoking cessation treatment and chart any predictable adverse effects. In general, people with SMI responded well to pharmaceutical and behavioural treatments, which doubled their chance of quitting.

Because most of the studies focused on people with well controlled psychiatric conditions, it was not possible to state how well people with acute mental illness (such as those who have experienced recent hospitalisation) would respond to smoking cessation treatment.

Professor Simon Gilbody from the University of York & Hull York Medical School, who co-authored the review, commented that "schizophrenia is a devastating condition which causes people to die 25 years earlier than the rest of the population. This is a huge health inequality, and it is largely due to smoking-related illness rather than schizophrenia itself."

Dr Lindsay Banham, who led the review, added "what this review suggests is that quit-smoking treatments like nicotine replacement therapy may work just as well for people with disorders like schizophrenia. Smoking by those with SMI has largely been ignored and people with schizophrenia are not consistently offered treatment or services. We found evidence that smoking cessation treatments are effective and safe. We hope our research leads to better services for this neglected population."

Professor Gilbody concluded, "Despite huge expansion in smoking cessation services in recent years, people with severe mental illness have been left behind. The challenges for health services are to ensure people with schizophrenia are offered these treatments, and that services reflect the needs of this population.''

More information: Banham L. and Gilbody S. Smoking cessation in severe mental illness: What works? Addiction 2010; 105: doi:10.1111/j.1360-0443.2010.02946.x

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