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Working with smokers with mental
health problems
John Hughes and Linda Caine
Abstracts
John Hughes:
About 15% of smokers seeking treatment have either a current
alcohol/drug or depression problem. Although nicotine
does have antidepressant, anxiolytic, anti-hunger, and
cognitive enhancement effects, what proportion, if any,
of smoking is due to self-medication is unknown. Nicotine
withdrawal symptoms can mimic psychiatric symptoms (e.g.
irritability from alcohol withdrawal or insomnia from
depression) and thus confuse diagnosis. Smoking cessation
can increase the levels of many psychiatric medications
and this is not influenced by NRT. Smoking cessation also
appears to increase risk for relapse of alcoholism or
depression in 10 to 15% of smokers. No specific treatments
for smokers with mental health problems have been validated
in several studies. Cessation is best done when mental
health problems are in remission. Surprisingly, data suggests
those with past (not current) alcoholism/depression do
not have more difficulty quitting. Thus, all those in
remission should have brief motivational therapy and advice
to quit. Treatment should probably be more intensive and
involve close monitoring to detect early signs of relapse
of mental health problems (or treat these prophylactically).
Finding former smoker to provide support and structuring
free time may be especially important.
Linda Caine:
Smoking and mental health - are these two issues irretrievably
linked? Should we treat smokers with MH problems any differently
from the rest of society? What are some of the myths?
The NHS as exemplar: turning NHS environments into smokefree
health 'gardens' is a legitimate aim. What has happened
at the Norfolk & Waveney Mental Healthcare Partnership
Trust since 2003, what were the issues and what have been
the benefits?
Biography
John R Hughes, MD is Professor of Psychiatry, Psychology
and Family Practice at the University of Vermont. Dr Hughes
is board certified in Psychiatry and Addiction Psychiatry.
His major focus has been clinical research on tobacco
use. Dr Hughes was the recipient of the first Ove Ferno
Award for research on nicotine dependence and the Alton
Ochsner Award Relating Smoking and Health. He is a co-founder
and past president of the Society for Research on Nicotine
and Tobacco. Dr Hughes is Chair of the Vermont Tobacco
Evaluation and Review Board which oversees VT's multi-million
dollar tobacco control programmes.
John Hughes
Professor, Department of Psychiatry, University of Vermont
john.hughes@uvm.edu
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