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.
