For more than half a century it has been assumed by the psychiatric community that allowing people in psych hospitals and treatment centers to smoke was a good idea. This was based on several untested assumptions — common sense, if you will — never a good idea when it comes to mental health issues, including addiction.
One assumption was that patients were calmed by smoking, and that encouraging or forcing them to stop would put them under too much stress and exacerbate their mental health issues or, in the case of addicts, interfere with their recovery. This doctrine was even taken to the extreme of psychiatrists being encouraged to smoke with their patients, in order to foster a feeling of fellowship and solidarity.
It turns out (none-too-surprisingly) that the majority of people confined to psychiatric hospitals die, not from the effects of their psychiatric disorders, but from smoking-related causes such as emphysema, heart problems, and lung cancer. Alcoholics and other addicts are also high on the list for these disorders. Rather more surprising is the fact that people with mental health and addiction disorders are responsible for consumption of nearly half the cigarettes sold in the United States.
However, it turns out that the assumption that patients couldn’t tolerate the effects of quitting is totally bogus. In fact, it turns out — based on recent studies of patients in Scandinavia who were introduced to smoking-cessation programs — that patients respond successfully if properly motivated, if nicotine replacement therapy (“the patch”) is available to make the transition easier, and if supportive counseling is available. It was also found that, if anything, quitting cigarettes improved their mental state and that many were enthusiastic about the idea of quitting.
The improvement is thought to involve participants’ enhanced feelings of self-esteem and control over their own lives. In psych patients it was undoubtedly due, as well, to the elimination of repeated withdrawal. Patients in psych hospitals and wards are not permitted to smoke all the time. There are usually supervised smoke breaks about every 4 hours. The result is that the smokers are stressed several times a day by nicotine withdrawal, which sets in within an hour after the last smoke. Those cravings cause them to smoke even more during the breaks, building up the nicotine, carbon monoxide and other chemicals in their blood to levels higher than those of most chronic smokers. Then they go through the cycle all over again. (This is also true, incidentally, in many employment settings.)
In addition to the withdrawal, nicotine causes much faster elimination of several commonly-used psych meds. In fact, it is likely that the “improvement” often reported in psychiatric patients when they are allowed to smoke is in fact due to the reduction of depressants like Haldol, often used to calm patients as a matter of convenience.
In yet another…ah…surprise, it turns out that the tobacco industry has been pushing cigarettes on the psychiatric treatment community for more than half a century, even hosting seminars to educate practitioners about their “benefits.” Thus, we can look for some powerful push back against these new findings. After all, psychiatric patients and addicts are literally their most valuable customers.
Nonetheless, maybe it is time for alcohol and addiction treatment to consider these results. After all, smoking is the number one worldwide cause of preventable death. And really, isn’t it just a bit ingenuous to claim to foster sobriety while allowing patients to avoid treatment for the most dangerous addiction of all?
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