Innovative approaches to support smoking cessation for individuals with mental illness and co-occurring substance use disorders

ABSTRACT

Introduction: Tobacco remains the leading preventable cause of death in the US, accounting for over 520,000 deaths annually. While the smoking prevalence has declined over the past 50 years, those with mental illness and addictive disorders continue to smoke at high levels and with significant tobacco-related health problems.

Areas covered: This review highlights the epidemiology, contributing factors, and evidence-base for intervening upon tobacco use in those with mental illness and addictive disorders. Historically underprioritized, a growing body of literature supports treating tobacco within mental health and addiction treatment settings. Critically, treating tobacco use appears to support, and not harm, mental health recovery and sobriety. This review also summarizes novel, emerging approaches to mitigate the harms of cigarette smoking.

Expert commentary: People with mental illness and addictive disorders have a high prevalence of tobacco use with serious health harms. Treating tobacco use is essential. Evidence-based strategies include individual treatments that are stage-matched to readiness to quit and combine cessation medications with behavioral therapies, supported by smoke-free policies in treatment settings and residential environments. Emerging approaches, with a focus on harm reduction, are electronic nicotine delivery systems and tobacco regulatory efforts to reduce the nicotine content in cigarettes, thereby reducing their addiction potential.

KEYWORDS:

• Tobacco
• smoking
• nicotine
• mental illness
• substance use disorders
• e-cigarette
• dual diagnosis
• nicotine replacement therapy
• CYP1A2
• quit-line

Declaration of interest

JJ Prochaska has consulted for Pfizer, which makes smoking cessation medications; Carrot Sense, which makes a tobacco cessation device; and has been an expert witness for in litigation against the tobacco industry. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This manuscript has been funded by the National Cancer Institute (R01CA204356), the National Heart, Lung, and Blood Institute (R01HL117736), and the State of California Tobacco-Related Disease Research Program (24RT-0035 and 25IR-0032).