February 14, 2014 | Batya Swift Yasgur MA, LMSW
Adults with mental illness have a smoking rate that is 70% higher than adults without mental illness and die approximately 25 years earlier than the general population, due largely to their high rates of substance use—including cigarette smoking. Quit rates among smokers with mental illness are significantly lower than those among the general population.
Individuals with both mild and severe mental illness are frequently interested in and capable of smoking cessation. Evidence-based pharmacotherapy and nonpharmacologic interventions provide the best chance for this population to achieve both short-and long-term abstinence.
Seven FDA-approved pharmacologic interventions are available to aid in smoking cessation—five nicotine replacement therapies (NRT), bupropion, and varenicline. A recent meta-analysis found higher rates of smoking cessation associated with NRT (17.6% )and bupropion (19.1%) compared with placebo (10.6%). Varenicline (27.6 percent) and combination NRT (31.5%) were most effective for achieving smoking cessation. None of the therapies was associated with an increased rate of serious adverse events.
Electronic cigarettes are becoming increasingly popular, although their use remains controversial. Preliminary evidence suggests that e-cigarettes are likely safer than regular cigarettes and helpful to some smokers as a means of reducing or quitting smoking.
Behavioral strategies "complement pharmacotherapy by enhancing the smoker's motivation to quit and teaching quitting skills such as managing relapse triggers."
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