(guitar strums)
- My name is Mary Brunette.
I'm an addiction psychiatrist,
and an Associate Professor of Psychiatry
at the Geisel School of Medicine at Dartmouth.
I'd like to talk with you today
about five myths we commonly hear
about quitting smoking
among people with mental illness and addiction.
The first myth is that people
with mental illness or addiction
must smoke to manage their symptoms,
or to avoid using substances.
This is simply not true.
People with mental illness do not need to smoke
to manage their mental illness.
People with substance abuse disorders
do not need to smoke to avoid using substances.
In fact, people with mental illness and addiction
usually smoke in response to urges to smoke.
They also smoke to reduce nicotine withdrawal symptoms.
What is nicotine withdrawal?
Nicotine is the addictive ingredient in tobacco.
Regular smokers will experience withdrawal
when they abruptly cut down
or stop using nicotine in their tobacco.
Withdrawal symptoms include craving.
Withdrawal also includes upset,
or depressed mood, irritability,
frustration, anger, anxiety, insomnia,
difficulty concentrating, and restlessness.
These symptoms overlap with feelings people have
with their mental illness and with their addictions.
Because symptoms of nicotine withdrawal
and symptoms of mental illness or addiction overlap,
people get confused, and they think they're smoking
to manage their mental illness
or their substance abuse disorder, but actually,
they are smoking to address their nicotine withdrawal.
I'd like to talk about the second common myth:
that people with mental health or substance abuse disorders
don't want to quit.
In fact, most smokers with these disorders,
they know that smoking is bad for them,
and they try to quit,
but they have more difficulty quitting,
so they feel discouraged and ambivalent.
Tobacco cessation treatments improve their outcomes,
and many studies show that people
with mental illness and addiction
respond quite well to education
and motivational counseling for smoking.
With motivational counseling, about half of people
will move forward with a quit attempt.
Another myth is that people with mental illness
and addiction, simply cannot quit.
This just isn't true either.
I've worked with many people
who have mental illness and addictions,
who've been able to quit smoking.
Many studies have shown
that when smokers use cessation treatment,
including counseling, nicotine replacement therapy,
and medications such as Brupropion or Varenicline,
these smokers are able to quit.
However, when people try cold turkey,
or without treatment, they often fail.
Additionally, it's important for people
to get their mental illness and addiction stable
before they try to quit smoking.
This means that folks have only moderate symptoms,
and they've gotten some abstinence
from their substances of abuse.
The next myth I want to discuss
is the concern that nicotine replacement therapy
can be harmful.
In fact, when you use nicotine replacement therapy
as indicated in the package, it is perfectly safe.
It reduces uncomfortable withdrawal symptoms
while people change their smoking habit.
You can watch my video on nicotine replacement therapy
to hear about the details of how to use it effectively.
That said, the smoke from tobacco
contains thousands of toxic chemicals,
some of which cause many diseases,
including cardiovascular diseases, stroke,
lung diseases, and diabetes.
But again, it's the toxins in the smoke,
not the nicotine, that's the problem.
The last myth I want to talk about
is the idea that only primary care providers
are equipped to treat tobacco use disorder.
This just isn't true.
Many kinds of providers can do a great job
of helping people quit smoking.
Mental health and addiction providers
are particularly well-equipped for this.
We have the most access to smokers,
we have training in motivational
and behavioral change strategies,
also, tobacco use disorder is a DSM-5 diagnosis,
and that's what mental health and addiction providers treat.
With a little education about how to do it,
mental health and addiction providers
can do a great job helping smokers quit.
Can people with mental illness and addiction quit smoking?
Yes, they can.
Cessation treatment improves people's ability to quit.
People with mental illness and addiction
will have the most success when they use counseling,
support, and nicotine replacement therapy,
or other medicines to quit.
An integrated approach of treatment
for the mental illness, the addiction,
and the tobacco use disorder, leads to success.
So here are the facts.
People with mental illness and addiction
smoke in response to urges and nicotine withdrawal.
When they use cessation treatment,
like nicotine replacement therapy, to treat withdrawal,
they do really well while they are quitting.
People with mental illness and addiction
do want to quit, but they're ambivalent and discouraged.
Motivational counseling can help people get motivated,
and use effective cessation treatment.
Nicotine replacement therapy is safe,
it prevents nicotine withdrawal symptoms,
and it improves people's ability to give up cigarettes,
and quit smoking altogether.
Mental health and addiction treatment providers
are well-equipped to help people quit smoking.
Check out my other videos
on how to provide cessation treatment.
Thanks for joining me today.