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Smokers With Psychiatric Illnesses Need More Cessation Counseling

Physicians infrequently counsel smokers with psychiatric illnesses to quit, suggest the results of a study.

"Primary care physicians and psychiatrists are missing opportunities to decrease the toll of tobacco-related disease among patients with psychiatric illnesses," said lead author Anne N. Thorndike, MD, MPH, of the Tobacco Research and Treatment Center at Massachusetts General Hospital and the Department of Medicine at Harvard Medical School, in Boston, Mass.

Thorndike and colleagues analyzed data on more than 170,000 patient visits from a national survey conducted by the National Center for Health Statistics. Physicians asked three quarters of the patients with psychiatric conditions whether they smoked, but less than one quarter of those who answered ‘yes' received smoking-related counseling, according to the researchers.

The study results are published in the current issue of the journal Nicotine and Tobacco Research.

The researchers noted that smokers without psychiatric conditions are no more likely to receive counseling -- previous studies found a comparable 25 percent receive physician cessation counseling. Before this study, less had been known about how frequently physicians address smoking in patients with psychiatric conditions. These individuals are more likely to smoke and are less likely to be motivated to quit, according to the study.

Although quitting may be more challenging for some smokers with psychiatric conditions, physicians should not assume they are not capable of quitting. "The enormous health risk of tobacco use makes it imperative that physicians address cigarette smoking when caring for patients with all diagnoses," Thorndike said.

Current American Psychiatric Association guidelines recommend that physicians counsel smokers with psychiatric illnesses to quit and provide treatments such as nicotine replacement therapy to patients motivated enough to set a quit date, according to the study.

Thorndike and colleagues also found that -- at least when it came to smokers suffering from anxiety -- primary care physicians were more likely to provide smoking counseling than were psychiatrists. "The differences between specialties partially reflect the fact that large-scale efforts to promote smoking cessation targeted primary care physicians long before they targeted psychiatrists," Thorndike noted.

This study was funded by a National Heart, Lung and Blood Institute Mentored Clinical Scientist Development Award.

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Nicotine & Tobacco Research is the official peer-reviewed quarterly journal of the Society for Research on Nicotine and Tobacco. For information about the journal, contact Gary E. Swan, PhD, at (650) 859-5322.