Quitting smoking difficult for all, especially the mentally ill

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The results of a small study on Pfizer’s smoking cessation drug Chantix (varenicline) underscore the difficulties smokers face when attempting to kick the habit for good. Published in the Archives of Internal Medicine, Peter Hajek of the UK Center for Tobacco Control Studies studied 101 middle-aged smokers. Half were randomized to start Chantix four weeks prior to quitting, while a control group took the drug just one week before stopping smoking. In the latter group, participants received sugar pills for the first three weeks and then switched to Chantix. Only about a third of smokers in the four-week Chantix group were still completely smoke-free three months later.

Unlike the study participants, people in the real world are not closely monitored with regular medical check-ups and clinical evaluations when they attempt to quit smoking, adds ACSH’s Dr. Gilbert Ross. “Most have to undertake this task alone, which helps to explain why only between 4 and 7 percent of those who try to stop smoking actually succeed.”

Distraught by these unimpressive results, ACSH’s Dr. Elizabeth Whelan points out that, “Even under the best possible medical circumstances, patients only accomplish a 35 percent quit rate in three months. This is simply unacceptable and emphasizes the need for other interventions like smokeless tobacco and clean nicotine delivery systems.”

To demonstrate how complex the addiction to smoking and nicotine is, Melinda Beck wrote a poignant article in The Wall Street Journal’s Health Journal on the association between smoking and mental health. She noted that, according to a study published in the Journal of the American Medical Association in 2000, nearly half of all cigarettes sold in the U.S. were smoked by people with a mental illness. Those with schizophrenia, bipolar disorder and other disorders are twice as likely to smoke compared to the general population, and they smoke about 50 percent more cigarettes per day.

Dr. Whelan reminds us that, “Depression is a significant risk factor for smoking and vice versa. In many substance abuse programs, such as Alcoholics Anonymous, patients are encouraged to quit drinking, but sadly, they are often not encouraged to quit smoking, too. Hopefully, new clinics will help people stop abusing all noxious substances.”

Substance abuse is often closely linked with depression, says Dr. Ross. “In the past decade, the smoking rate has decreased, and people with mental illnesses are less likely to quit than the general population. Therefore, I’d bet that an even greater fraction of cigarettes are smoked by patients with serious mental health problems today,” he speculates. "An enlightened approach to substance abuse treatment must encompass all substances, including cigarettes.”