Nicotine Dependence: The Forgotten Substance-Related Disorder

ABSTRACT

Behavioral healthcare providers are increasingly using integrated approaches to identify and treat co-occurring severe and persistent mental illness (SPMI) and substance-related disorders, as well as discriminating among specific substances of abuse, e.g., alcohol, marijuana, cocaine, opiates, and methamphetamine, as well as poly-substance abuse or dependence. Although people with serious psychiatric disorders are significantly over-represented among those with tobacco dependence, nicotine dependence is rarely considered nor treated as a co-occurring substance disorder for this population in the context of behavioral healthcare. The authors outline elements of an intervention for people with SPMI and co-occurring nicotine dependence that adapts the evidence based practice Integrated Dual Disorders Treatment (IDDT) for use in community mental health settings.

KEYWORDS:

• Nicotine
• tobacco
• intervention
• mental illness
• substance use disorders
• co-occurring
• stage-wise intervention

This issue's “Best Practices” column focuses on an often neglected cooccurring disorder of dual diagnosis patients: nicotine dependence. Smoking kills more people each year than suicide and homicide combined, and is associated with a broad range of health consequences. Smoking has been associated with lowering circulation levels and effectiveness of psychotropicmedications. Persons with serious and persistentmental illnesses have much higher rates of nicotine dependence than the general population, and suffer consequently higher levels of medical co-morbidity, disability and premature death. Despite a growing optimistic literature on effectiveness of treatment approaches to nicotine dependence, including a range of psychosocial treatments and incontrovertible evidence of the effectiveness of Nicotine Replacement Therapies and other somatic treatments, our incorporation of these approaches into our standard treatment of mentally ill and dual diagnosis patients is lagging. The following article describes a pilot program incorporating stage-wise tobacco prevention and cessation programming within an Integrated Dual Diagnosis Treatment model, which will hopefully gain broader application to the populations we serve at large.