Successful Change in Tobacco Use in Schizophrenia

Abstract

The high rates of tobacco use among individuals with schizophrenia are well documented, but there has been less attention paid to identifying what are the special needs for this population. In fact, there have even been suggestions from early work that standard interventions and approaches might be adequate. In contrast, based on more than a decade of experience supporting change smoking behavior among people with schizophrenia, three key factors were identified as unique considerations that are associated with success. The first factor involves readiness to change; smokers with schizophrenia are rarely given opportunities to even try to quit unlike their counterparts in the general population and therefore have not benefited from the self-efficacy aspects of attempt experiences. The second factor is medication and symptom monitoring; there are special needs for nurses and medical staff to monitor symptoms (including schizophrenia symptoms and mood symptoms), medication dosage and side-effects, during the period when individuals with schizophrenia are changing (reducing) their tobacco use, particularly when nicotine replacement therapy is being implemented. Finally, the third factor is peer and caregiver support; the use of peer assistants in group-based programs and the teaching of nurses and other professional casegivers as well as family members about their role as supports can make an important difference in tipping the balance toward successful change and toward maintenance of change over time.

Keywords

schizophrenia tobacco nicotine dependence smoking cessation

Get full access to this article

View all access options for this article.

References

Addington, J. ( 1998). Group treatment for smoking cessation among persons with schizophrenia. Psychiatric Services, 49, 925-928.

Aubin, H.-J. ( 2009). Management of emergent psychiatric symptoms during smoking cessation. Current Medical Research and Opinion, 25, 519-525.

Barnes, M. , Lawford, B.R. , Burton, S.C. , Heslop, K.R. , Noble, E.P. , Hausdorf, K. , et al. (2006). Smoking and schizophrenia: Is symptom profile related to smoking and which antipsychotic medication is of benefit in reducing cigarette use? Australian and New Zealand Journal of Psychiatry , 40, 575-580.

Covey, L.S. , Glassman, A.H. , & Stetner, F. ( 1997). Major depression following smoking cessation. American Journal of Psychiatry, 154, 263-265.

Dalack, G.W. , Healy, D.J. , & Meador-Woodruff, J.H. (1998). Nicotine dependence in schizophrenia: Clinical phenomena and laboratory findings. American Journal of Psychiatry, 155, 1490-1501.

Diaz, F.J. , Rendon, D.M. , Velasquez, D.M. , Susce, M.T. , & de Leon, J. ( 2006). Smoking and smoking cessation among persons with severe mental illness. Psychiatric Services, 57, 462.

el-Guebaly N. , Cathcart J. , Currie S. , Brown D. , Gloster S. ( 2002). Smoking cessation approaches for persons with mental illness or addictive disorders. Psychiatric Services, 53, 1166-1170.

Els, C. ( 2007). Canada: Pharmacy tobacco sales to mentally ill people . Tobacco Control, 16, 75.

Ferron, J.C. , Alterman, A.I. , McHugo, G.J. , Brunette, M.F. , & Drake, R.E. ( 2009). A review of research on smoking cessation interventions for adults with schizophrenia spectrum disorders. Mental Health and Substance Use: Dual Diagnosis, 2, 64-79.

10.

George, T.P. , Ziedonis, D.M. , Feingold, A. , Pepper, W.T. , Satterburg, C.A. , Winkel, J. , et al. (2000). Nicotine transdermal patch and atypical antipsychotic medications for smoking cessation in schizophrenia. American Journal of Psychiatry, 157, 1835-1842.

11.

Goff, D.C. , Henderson, D.C. , & Amico, E. ( 1992). Cigarette smoking in schizophrenia: Relationship to psychopathology and medication side-effects. American Journal of Psychiatry , 149, 1189-1194.

12.

Goldberg, J.O. , & Cook, P.E. ( 1996). Cognitive rehabilitation for negative symptoms. In P. W. Corrigan & S. C. Yudofsky (Eds.), Cognitive rehabilitation of neuropsychiatric disorders (pp. 383-401). Washington, DC: American Psychiatric Press.

13.

Goldberg, J.O. , Moll, S. , & Washington, A. (1996). Exploring the challenge of tobacco use and schizoprhenia. Psychiatric Rehabilitation Skills, 1, 51-63.

14.

Goldberg, J.O. , & Van Exan, J. ( 2008). Longitudinal rates of smoking in a schizophrenia sample . Tobacco Control, 17, 271-275.

15.

Haller, E. , McNiel, D.E. , & Binder, R. ( 1996). Impact of a smoking ban on a locked psychiatric unit . Journal of Clinical Psychiatry, 57, 329-332.

16.

Hughes, J.R. ( 1992). Tobacco withdrawal in self-quitters. Journal of Consultant Clinical Psychology, 60, 689-697.

17.

Hughes, J.R. ( 1993). Possible effects of smoke-free inpatient units on psychiatric diagnosis and treatment. Journal of Clinical Psychiatry, 54, 109-114.

18.

Hughes J.R. , Carpenter M.J. ( 2005). The feasibility of smoking reduction: an update. Addiction, 100, 1074-1089.

19.

Hughes, J.R. , & Frances, R.J. ( 1995). How to help psychiatric patients stop smoking. Psychiatric Services, 46, 435-436.

20.

Lyon, E.R. ( 1999). A review of the effects of nicotine on schizophrenia and antipsychotic medications. Psychiatric Services, 50, 1346-1350.

21.

McChargue, D.E. , Gulliver, S.B. , & Hitsman, B. ( 2002). Would smokers with schizophrenia benefit from a more flexible approach to smoking treatment? Addiction, 97, 785-793.

22.

McCloughen, A. ( 2003). The association between schizophrenia and cigarette smoking: A review of the literature and implications for mental health nursing practice . International Journal of Mental Health Nursing, 12, 119-129.

23.

McEvoy, J.P. , Freudenreich, O. , & Wilson, W.H. ( 1999). Smoking and therapeutic response to clozapine in patients with schizophrenia. Biological Psychiatry, 46, 125-129.

24.

Moll, S. , Goldberg, J.O. , Washington, A. , & Pawlick, J. ( 1996). Smoking and people with mental health problems: A how-to guide for support people. Unpublished pamphlet.

25.

Prochaska, J.J. , DiClemente, C.C. , & Norcross, J.C. (1992). In search of how people change. The American Psychologist, 47, 1102-1114.

26.

Prochaska, J.J. , Fromont, S.C. , Leek, D. , Hudmon, K. , & Cat-also, J.K. (2009). Designing for dissemination: Development of an evidence-based tobacco treatment curriculum for psychiatry training programs. Journal of the American Nurses Association , 15, 24-31.

27.

Prochaska, J.J. , Hall, S.M. , & Bero, L.A. ( 2008). Tobacco use among individuals with schizophrenia: What role has the tobacco industry played. Schizophrenia Bulletin , 34, 555-567.

28.

Solomon, P. ( 2004). Peer support/peer provided services: Underlying processes, benefits and critical ingredients. Psychiatric Rehabilitation Journal, 27, 392-401.

29.

Solway, E. ( 2009). Windows of opportunity for culture change around tobacco use in mental health settings. Journal of the American Nurses Association, 15, 41-49.

30.

Whelton, C. , Pawlick, J. , & Cook, P.E. ( 1999). Growing with people with a psychiatric disability in a psychosocial rehabilitation program. Psychiatric Rehabilitation , 22, 290-293.

31.

Williams, J.M. , & Foulds, J. ( 2007). Successful tobacco dependence treatment in schizophrenia . American Journal of Psychiatry, 164, 222-227.

32.

Ziedonis, D.M. , & Trudeau, K. ( 1997). Motivation to quit using substances among individuals with schizophrenia: Implications of a motivation-based treatment model. Schizophrenia Bulletin, 23, 229-238.