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Mentally ill more likely to smoke, die from tobacco-related illness

FARGO – The mentally ill and those battling substance abuse are much more likely than others to smoke, and suffer higher illness and death rates as a result.

The American Lung Association in North Dakota is launching an effort to target smoking cessation programs at those who are mentally ill or dealing with addictions.

Tobacco control advocates also are working with mental health professionals to take a more aggressive approach to help those with behavioral health problems quit smoking.

"We have seen a decline in all populations except those with mental illness or substance abuse," said Reba Mathern-Jacobson, director of tobacco control for the American Lung Association in North Dakota, referring to the drop in smoking among most groups.

As a result, those with mental illnesses and addictions can die decades earlier than the general population, and smoking is a major contributor to sickness and early death, according to statistics cited by the federal Substance Abuse and Mental Health Services Administration:

• About half of people with behavioral health disorders smoke, compared to 23 percent of the general population.

• People with mental illnesses and addictions smoke half of all cigarettes made, and are only half as likely as other smokers to quit.

• Smoking-related illnesses cause half of all deaths among people with behavioral health disorders.

"Folks are dying a lot sooner than they need to," said Carlotta McCleary, executive director of Mental Health America in North Dakota, an advocacy group. The issue is starting to draw more attention, she said, and collaborations are forming to address the problem.

"People who are alcoholic die from tobacco-related diseases more than they do from alcohol-related diseases," Mathern-Jacobson said.

Those with mental illness or substance abuse problems find it more difficult to quit smoking for a variety of reasons.

Nicotine's mood-altering effects put people with mental illness at greater risk for cigarette use and nicotine addiction. Also, people with mental illness are more likely to face stressful lives, have lower incomes and lack access to health care, making quitting more difficult.

"People might be self-medicating, that kind of thing," by using nicotine, McCleary said.

Another problem is what tobacco control advocates view as a lackadaisical attitude among some mental health professionals.

"It's been seen as a lesser of evils," Mathern-Jacobson said. "Now that population is bearing the brunt of it."

Mental health professionals are significantly more likely to smoke than other health professionals, surveys show, which might suggest a culture that is more tolerant of tobacco, she said.

It's worth noting that nicotine dependence is listed as a behavioral disorder in the diagnostic manual used by mental health clinicians, Mathern-Jacobson said. "Nicotine is a drug, let's treat it like one."

Melissa Markegard, a tobacco control coordinator with Fargo Cass Public Health, said she believes mental health clinicians are increasingly more likely to take nicotine addiction seriously.

"A lot of times, smoking is a trigger for other substances, especially alcohol," she said. "It's kind of like you can't do one without the other."

More integration of behavioral health and general health care would help to combat smoking among the mentally ill and those battling addictions, McCleary said.

"It's not just OK to focus on behavioral health alone," or on physical health in isolation, she said. There is a growing movement in health care to do more to combine the two, McCleary added, but said much more integration is needed.

The American Lung Association in North Dakota is bringing in an expert to help train behavioral health professionals including psychiatrists, counselors, nurses, social workers and other treatment providers who serve people with mental illness or substance abuse disorders.

The training sessions will be June 21-22 in Fargo and will feature Dr. Jill Williams, an addiction psychiatrist from Rutgers Robert Wood Johnson Medical School. Details still are pending. Anyone interested can contact Mathern-Jacobson atreba.mathern-jacobson@lung.org or by calling 701-354-9719.

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