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A new tool kit just came out for treating smokers and mental illness or substance use disorder, The Help to Quit Toolkit. It was produced by BeBetter Networks and funded by Novartis.
It can be downloaded from the following website: www.help-to-quit.com
Treating tobacco dependence in mental health and addiction settings are available for free download See below.
Treatment of tobacco dependence in mental health and addictive disorders
Can J Psychiatry. 2009; 54(6):368-78.
Hitsman B, Moss TG, Montoya ID, George TP.
Abstract
People with mental health and addictive (MHA) disorders smoke at high rates and require tobacco treatment as a part of their comprehensive psychiatric care. Psychiatric care providers often do not address tobacco use among people with mental illness, possibly owing to the belief that their patients will not be able to quit successfully or that even short-term abstinence will adversely influence psychiatric status. Progress in the development of treatments has been slow in part because smokers with current MHA disorders have been excluded from most smoking cessation trials. There are several smoking cessation treatment options, including psychological and pharmacological interventions that should be offered to people with an MHA disorder who smoke. Building motivation and readiness to quit smoking is a major challenge, and therefore motivational interventions are essential. We review the treatment options for people with tobacco dependence and MHA disorders, offer recommendations on tobacco assessment and tailored treatment strategies, and provide suggestions for future research. Treatment efficacy could be enhanced through promoting smoking reduction as an initial treatment goal, extending duration of treatment, and delivering it within an integrated care model that also aims to reduce the availability of tobacco in MHA treatment settings and in the community.
Highlights
• Tobacco treatment combining cognitive-behavioral therapies and motivational enhancement interventions tailored to the needs of smokers with MHA disorders, as well as pharmacotherapy integrated into ongoing psychiatric care, provides the best abstinence outcomes.
• Tobacco treatments do not appear to have an adverse effect on psychiatric symptoms. On the contrary, patients may demonstrate significantly improved clinical status following treatment regardless of abstinence status.
• Smoking reduction (reduction as the initial treatment goal), a chronic disease approach, and integrated care strategies have the potential to improve the efficacy of existing smoking treatment tailored to MHA smokers.
Mechanisms underlying the co morbidity of tobacco use in mental health and addictive disorders
Can J Psychiatry. 2009;54(6):356–367.
Morisano D, Bacher I, Audrain-McGovern J, George TP
Abstract
We discuss potential explanations for the high prevalence of tobacco use and tobacco dependence (TD) in people with mental health and addictive (MHA) disorders. The biopsychosocial basis for this co morbidity is presented, integrating evidence from epidemiologic and clinical studies. We also review evidence that suggests a shared vulnerability related to biological, genetic, and environmental factors may be the most parsimonious mechanism to explain the association between TD and MHA disorders. Finally, we review the examples of various MHA disorders that are associated with TD, and suggest avenues for new investigation that could aid in the development of rationale and more effective treatments for tobacco and MHA disorder co morbidities.
Highlights
• The prevalence of tobacco use in people with MHA disorders is 2 to 4 times higher than in the general population.
• Reasons to explain the high rates of this co morbidity include the self-medication hypothesis, the shared vulnerability hypothesis, and the social determinants hypothesis. Most of the evidence supports the latter 2 hypotheses.
• Converging genetic, epidemiologic, neuroimaging, neurocognitive, and clinical data suggest that intrinsic features of MHA may predispose to the initiation and maintenance of smoking behaviors in these populations, with the best data available for schizophrenia, mood disorders, and alcoholism.
• A better understanding of the biopsychosocial determinants of tobacco use and MHA co morbidity may lead to the development of more rational, safe, and effective pharmacological and behavioral treatments for this co morbidity.
Addressing Tobacco Dependence in Psychiatric Practice: Promises and Pitfalls
Can J Psychiatry. 2009;54(6):353–355.
George TP, Ziedonis DM
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