Dr. Jill Williams recently helped a lifelong smoker in his fifties quit smoking. What makes his case noteworthy is that the man had been treated for smoking-related vascular disease for decades, but according to his medical records was never given assistance to quit smoking. “He was constantly seeing doctors, but I looked at some of the medical notes, and they say things like, ‘He’d like to quit smoking,’ but it wasn’t really clear that anybody was showing him how,” says Williams, Director of the Division of Addiction Psychiatry at Rutgers University – Robert Wood Johnson Medical School.
After the patient was referred to Williams for depression, she helped him start a quit-smoking program combining nicotine-replacement medication and behavioral therapy. “He’s been smokefree for 18 months now,” says Williams. “I think it was very successful because we talked about his desire to quit and integrated a Quit Plan into his treatment for depression.”
People with mental health or substance abuse disorders are more than twice as likely to smoke cigarettes as people without such disorders, but they are underserved when it comes to smoking cessation treatment. In 2016, fewer than half of the mental health and substance abuse treatment facilities in the United States reported offering quit smoking counseling or medications, according to a CDC report.
In a recent interview with Williams, we learned more about her mission to educate the mental health community on the importance of offering evidence-based smoking cessation assistance to those who need it. Read on for more from our interview with Dr. Williams. Note: this conversation has been edited.
Quitter’s Circle: What are some of the reasons that people with mental health disorders are more likely to smoke cigarettes?
Dr. Williams: It's a complex group of reasons. I would say it's “bio-psycho-social.” There are biological reasons, there are psychological reasons, and there are social reasons. Certainly, there's biological evidence that people with mental health and addiction disorders may be more vulnerable to developing nicotine addiction than other populations, but that's not the only reason. A psychological reason might be if people are using their cigarettes to cope, then we need to help them have better, healthier coping strategies. I think the fact that it gets largely ignored in behavioral health treatment settings is a social reason that’s not being addressed.
Quitter’s Circle: What’s the impact of smoking on this population?
Dr. Williams: It's overwhelmingly the number one [preventable] cause of death in this population. The mental health population has reduced life expectancy because of smoking. It has many other consequences that are more immediate, like it takes away your money, makes it harder to get a job, harder to get a date, harder to find a place to live, many negative aspects.
Quitter’s Circle: Is it harder for someone with a mental health condition to quit smoking?
Dr. Williams: There's evidence that this population is more addicted to nicotine, that they have a more severe level of addiction, which always makes it harder to quit. And, if you're using it as your coping strategy, that makes it harder to quit, because you have to do something different. You have to really learn new coping skills. And [in a facility setting] if everyone in your group residence smokes, and your staff smokes, that makes it harder to quit. But in general, the same strategies to quit smoking apply to this population. Everyone should still get tobacco treatment medications (nicotine or non-nicotine) and quit-smoking counseling. The difficulty is that this population just has a harder time, but the same kinds of approaches work.
Quitter’s Circle: Can quitting smoking interfere with a person’s treatment for a mental health condition?
Dr. Williams: Most of the evidence is in the other direction, that when people quit smoking, their depression and anxiety get better. And when people quit smoking, there's evidence that their recovery from drugs and alcohol is also better. This has been studied extensively in the last 20 years, and most of the studies show that people get better when they quit.
Quitter’s Circle: Do people with mental health conditions generally want to quit smoking?
Dr. Williams: Absolutely, and most studies have shown that their motivational levels are fairly similar to the general population. In my experience, many people are interested in trying to live a healthier and longer life.
Quitter’s Circle: How can mental healthcare providers help patients fit a smoking cessation plan into their overall mental health treatment?
Dr. Williams: This has been a focus of my work for the past two decades, trying to educate providers who work in these systems to integrate it into the work they do, not just to refer people out, but to actually take ownership of the problem, to put it in the treatment plan. Often, people have multiple conditions that we're juggling and managing at the same time, and quitting smoking shouldn't be excluded. It should be part of the overall approach, as long as you're addressing it in some way.
Learn more about quitting smoking with the help of a healthcare provider.