Serious about Smoking Cessation?

Sue Bergeson Health Guide
  • About 75% of individuals with serious mental illness are tobacco dependent, compared to approximately 22% of the general population.1,2 In fact, about 44% of all the cigarettes consumed in the U.S. are by individuals with a mental illness and/or substance use disorder.3 Those with psychiatric disorders tend to smoke more cigarettes per day and obtain more nicotine from the same number of cigarettes than the general population.1,3 The prevalence of smoking among people with mental illness is one of the highest of any group in the nation.


    DBSA has been developing several new peer-delivered Wellness Programs that address overall health—physical and mental—so I've been thinking about smoking cessation a lot lately. It's one more thing that pulls us down. One more thing that robs our pocketbooks. One more addiction that makes our bodies weak, makes it hard for us to enjoy a job, a home ...a full life. When I look at the smoking cessation material out there, it becomes very clear very fast that, as well-meaning as the creators of that material are, they don't understand us—people living with depression and bipolar disorder—at all. You cannot expect a message like "Stop smoking and get healthy" to motivate me if, most days, I want to die.

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    If the smoking cessation community is serious about finding ways to support those of us with mental illness in quitting, I believe that new programs must be created that take into account the following points:

    • Motivators for quitting are different for those of us in the consumer community, so we need good facilitation skills to figure out what is important to each of us. For most of us, smoking will be a means to another end, not an end in and of itself. In recovery, remember, our focus is on what we're creating, not what we're giving up or ending.
    • Because our community thinks about barriers and triggers differently, we need to consider them from both a mental health and a smoking cessation perspective.
    • Peer support is crucial for smoking cessation. I know our professional help cares, but they just don't understand from the lived experience. I cannot imagine a cessation program being successful in our community without a strong peer support element.
    • Symptoms of nicotine withdrawal can be very similar to depressive symptoms. Don't tell us that withdrawal symptoms are "mild" but then describe them in ways that reflect how we feel when we're spiraling into a deep depression. Withdrawal needs to be discussed in realistic terms, to prepare us so that we don't panic when we experience those familiar symptoms.


    Right now most of the work being done on smoking cessation in the consumer community focuses on teaching providers how to talk to us about quitting. It's time that changes. To beat the terrible drain that smoking has on our community, we need new tools and services created and delivered by peers. We deserve nothing less.


    What are your thoughts on smoking, mental health and peer support? Do you have any suggestions that the new DBSA Wellness Programs could incorporate to help those with mood disorders who want to quit smoking?


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    1American Psychiatric Association Practice Guidelines for the Treatment of Patients with Substance Use Disorders, Second Edition. In American Psychiatric Association

    Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2006. (Arlington, VA: American Psychiatric Association, 2006), pp. 291-563.


    2B.F. Grant, PhD; D.S. Hasin, PhD; P. Chou, PhD, et al., "Nicotine dependence and psychiatric disorders in the United States," Archives of General Psychiatry 61 (2004):1107-1115.


    3K. Lasser, J.W. Boyd, S. Woolhander, et al., "Smoking and mental illness: A population-based prevalence study," JAMA 284 (2000):2606-2610.

Published On: February 13, 2008