Project ECHO Importance of Treating Tobacco Use In People With Behavioral Health Disorders Jan Blalock, Ph.D.

Project ECHO Importance of Treating Tobacco Use In People With Behavioral Health Disorders Jan Blalock, Ph.D.

High Levels Of Tobacco Use Almost twice as likely to smoke as people without disorders (36.1% vs 21.4%) 31.7% of all smokers have behavioral health disorders Smoked 31% of all cigarettes smoked (2009 2011) Smoke more cigarettes per day 40% smoke more than 25 30 cigarettes per day vs 15% in general population Less likely to quit (34.7% vs 53.4%) Lawrence et al., BMC Public Health, 2009; 9:285; CDC, MMWR; 62; Feb 5, 2013;

Reprinted from Lawrence et al., BMC Public Health, 2009; 9:285

Tobacco Related To Early Death Men with behavioral health disorders die 16 years younger compared to people with no disorder Women die 12 years younger 80% of deaths due to smoking related health conditions Heart disease Lung disease Cancer Smoking predicts suicidal behavior independent of behavioral health disorders Lawrence et al., Canadian J Psychiatry. 2010;55:752 760; Lawrence et al., BMJ. 2013;346:f2539; Ruther et al., European Psych; 2014; 29: 65 82

Percent Of Death Caused By Tobacco In Seriously Mentally ILL Death from tobacco related conditions Schizophrenia 2.45 more tobacco related deaths than general population 53% of total deaths Bipolar Disorder 1.57 more tobacco related deaths 48% of total deaths Depressive Disorder 1.95 more tobacco related deaths 50% of total deaths Callaghan et al., J Psychiatric Review, 2014; 48:102 110

Financial Effects Patients with schizophrenia spend 27.4% of monthly income on cigarettes Ruther et al., European Psych; 29: 65 82; 2014

Change In Smoking Rate In Psychiatric VS. General Population Smoking is declining in mentally well individuals, but unchanged in people with behavioral health disorders Reprinted from SAMHSA, The CBHSQ Report, July 18, 2013

Change In Smoking Rate In Psychiatric VS. General Population (continued) Smoking is declining in mentally well individuals, but unchanged in people with behavioral health disorders Reprinted from New York Statement Department of Health, Tobacco Control Program StatShot, 5(2), Feb. 2012.

Policies To Encourage Quitting Not Effective Increasing price, education on health effects, restricting use in public places Have not been tailored to people with behavioral health disorders May be less relevant or less effective May have contributed to large differences we see in smoking rate and death Lawrence et al., BMC Public Health, 2009, 9:285

Other Factors That Contribute To Problem Targeted marketing by Tobacco Industry Focus on stress relief, emotion control, performance enhancement Reduced access to cessation services Williams et al., Am J Public Health, 103(9), 1549 1555; Sept 2013

Recommendations For Addressing Tobacco Problem Integrate smoking cessation treatments into behavioral health care Use standard smoking cessation interventions (i.e., group, individual counseling and medication), which are effective Callaghan et al., J Psychiatric Review, 2014; 48:102 110; Le Cook et la., JAMA, 2014; 311;172 182; Williams, JAMA Psychiatry, 2013; 70: 1261 1262

Smokers With Behavioral Health Disorders Are Motivated To Quit 1000 smokers with schizophrenia, schizoaffective, PTSD and OCD 84% had tried to quit before 88% said they wanted to quit Reasons for wanting to quit Concerns about developing long term health problems Wanting to feel better Wanting to feel better about self Concerns about cost of cigarettes Children being worried about their smoking Ashton et al., Australian and New Zealand J of Psych, 2013; 47(7): 631 636

Smokers With Behavioral Health Disorders Need Assistance To Quit 11 year study of people with severe mental illness 89% were smokers at baseline 75% tried to quit at least once over the 11 year period None who tried quitting received nicotine replacement or bupropion Only 17% were abstinent at year 11 Ferron et al., Psychiatric Services, 2011; 62(4): 353 359

Improvement In Mental Health After Smoking Cessation In studies that measured mental health before and after quitting General population and people with medical and psychiatric conditions Quitting associated with decrease in: Anxiety Mixed anxiety and depression Depression Stress Psychological quality of life Positive affect No differences between clinical and general population Taylor et al., BMJ, 2014; 348

Improvement In Mental Health After Smoking Cessation (continued) Quitting in people with and without behavioral health disorders at year 3 following treatment Improved negative and positive affect Reduced risk of developing or maintaining a substance use disorder No increase in risk of major depressive disorder Piper et al., Drug Alcohol Dep, 2013; 128:148 154; Blalock et al., Psychol Addict Behav, 2008; 22(1):122 128; Mathew et al., Nicotine Tob Res, 2013;15(11):1807 1815

Improvement In Mental Health After Smoking Cessation (continued) In our studies with chronic MDD smokers, people who had quit at 6 months have Increased positive affect Decreased depressive symptoms Greater remission from MDD Piper et al., Drug Alcohol Dep, 2013; 128:148 154; Blalock et al., Psychol Addict Behav, 2008; 22(1):122 128; Mathew et al., Nicotine Tob Res, 2013;15(11):1807 1815