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Cited by 735Smoking Behavior and CessationSubstance Abuse Treatment and OutcomesMental Health Treatment and Access

Tobacco use and cessation in psychiatric disorders: National Institute of Mental Health report

Ziedonis, D., Hitsman, B., Beckham, J. C., Zvolensky, M., Adler, L. E., Audrain-McGovern, J., Breslau, N., Brown, R. A. +4 more·2008·Nicotine & Tobacco Research
DOI 10.1080/14622200802443569
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Abstract

The National Institute of Mental Health (NIMH) convened a meeting in September 2005 to review tobacco use and dependence and smoking cessation among those with mental disorders, especially individuals with anxiety disorders, depression, or schizophrenia. Smoking rates are exceptionally high among these individuals and contribute to the high rates of medical morbidity and mortality in these individuals. Numerous biological, psychological, and social factors may explain these high smoking rates, including the lack of smoking cessation treatment in mental health settings. Historically, "self-medication" and "individual rights" have been concerns used to rationalize allowing ongoing tobacco use and limited smoking cessation efforts in many mental health treatment settings. Although research has shown that tobacco use can reduce or ameliorate certain psychiatric symptoms, overreliance on the self-medication hypothesis to explain the high rates of tobacco use in psychiatric populations may result in inadequate attention to other potential explanations for this addictive behavior among those with mental disorders. A more complete understanding of nicotine and tobacco use in psychiatric patients also can lead to new psychiatric treatments and a better understanding of mental illness. Greater collaboration between mental health researchers and nicotine and tobacco researchers is needed to better understand and develop new treatments for cooccurring nicotine dependence and mental illness. Despite an accumulating literature for some specific psychiatric disorders and tobacco use and cessation, many unstudied research questions remain and are a focus and an emphasis of this review.

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  • Anxiety and depression are major impediments to smoking cessation.

    “Research suggests that anxiety and depression are major impediments to smoking cessation,16,17 which is particularly relevant to SLWH given the population’s elevated rates.18”

    From Evaluation of an integrated treatment to address smoking cessation and anxiety/depressive symptoms among people living with HIV: Study protocol for a randomized controlled trial (2021) · cites this paper as [16]

    The sections on anxiety-disorder treatment and depression outcomes report that anxiety symptoms can negatively affect cessation and that depressive symptoms and recurrent depression are associated with relapse or poorer outcomes (page numbers unavailable). But the report calls for more research on cessation in people with anxiety disorders and says a lifetime history of depression is not a significant risk factor for poor outcomes in most studies. Calling anxiety and depression, without qualification, “major impediments” overstates its findings. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Research on the treatment needs and outcomes of quit attempts among smokers with bipolar disorder is limited.

    “Despite these known disparities in tobacco smoking and its health consequences for people with BD, there is limited research on the treatment needs and outcomes of quit attempts for this group of smokers.”

    From Smokers with bipolar disorder, other affective disorders, and no mental health conditions: Comparison of baseline characteristics and success at quitting in a large 12-month behavioral intervention randomized trial. (2018) · cites this paper as Ziedonis et al., 2008

    The Suggestions for future research section (page unavailable) says smoking-cessation studies in people with mental disorders have generally used small samples and calls for research on adapting treatments to different psychiatric populations. That supports a general research gap, but our copy does not specifically assess treatment needs or quit-attempt outcomes among smokers with bipolar disorder. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Depressive and anxiety syndromes are more prevalent among smokers than nonsmokers, and smokers with these conditions are more likely to be nicotine dependent.

    “For instance, depressive and anxiety syndromes are more prevalent among smokers than nonsmokers [6,7], and smokers with these conditions are more likely to be nicotine dependent [4,8].”

    From Acceptance and Commitment Therapy Wellness Program for Latine Adults Who Smoke and Have Psychological Distress: Protocol for a Feasibility Study (2023) · cites this paper as [6]

    The sections on anxiety-disorder prevalence and factors contributing to smoking and depression (pages not provided) report higher nicotine-dependence prevalence among people with anxiety disorders and greater progression to dependence among young adults with a history of depression. They do not establish the claim’s specific comparison among smokers with and without these conditions. The earlier clause about syndrome prevalence is cited to other sources, not this one. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Limited integration of factors that interfere with smoking cessation, such as anxiety and depressive symptoms, within treatments for people living with HIV who smoke may contribute to quit difficulty and mixed findings.

    “Limited integration of factors known to interfere with smoking cessation, such as anxiety and depressive symptoms,16,17 within treatments for SLWH may contribute to quit difficulty and mixed findings.”

    From Evaluation of an integrated treatment to address smoking cessation and anxiety/depressive symptoms among people living with HIV: Study protocol for a randomized controlled trial (2021) · cites this paper as [16]

  • Depression and anxiety place smokers at increased risk for cessation failure, though some studies suggest the evidence is inconclusive.

    “Considerable research has assessed the impact of depression and anxiety on cessation outcomes, with a number of studies reporting that depression and anxiety place smokers at increased risk for cessation failure [9-14], with other studies suggesting that the evidence is inconclusive [6,15-18].”

    From Acceptance and Commitment Therapy Wellness Program for Latine Adults Who Smoke and Have Psychological Distress: Protocol for a Feasibility Study (2023) · cites this paper as [6]

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Authors
Ziedonis, D., Hitsman, B., Beckham, J. C., Zvolensky, M., Adler, L. E., Audrain-McGovern, J., Breslau, N., Brown, R. A., George, T. P., Williams, J., Calhoun, P. S., & Riley, W. T.
Affiliations
  • UMass Memorial Health Care (US)
  • Northwestern University (US)
  • Duke University (US)
  • University of Vermont (US)
  • University of Colorado Health (US)
  • University of Pennsylvania (US)
  • Michigan State University (US)
  • Brown University (US)
  • University of Toronto (CA)
  • Rutgers, The State University of New Jersey (US)
  • National Institutes of Health (US)
ORCID
Venue
Nicotine & Tobacco Research
Publisher
Oxford University Press (OUP)
Published
2008-12-01
Volume
10
Issue
12
Pages
1691-1715
ISSN
  • 1462-2203 (ISSN-L)
  • 1469-994X
DOI
10.1080/14622200802443569
OpenAlex
W2126866313
Semantic Scholar
1098de69bc87efcdfb0ceacacd784724606d74d2
Cited by
735
References
246
Citations by year
2026: 15 · 2025: 20 · 2024: 18 · 2023: 42 · 2022: 27 · 2021: 30 · 2020: 48 · 2019: 28 · 2018: 50 · 2017: 32 · 2016: 62 · 2015: 65 · 2014: 59 · 2013: 50 · 2012: 62
FWCI
28.07
Type
journal article
Language
en
Open access
closed
Locations
  • Nicotine & Tobacco Research (publishedVersion)
  • PubMed (publishedVersion)
  • The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • Pfizer
  • Office of Research and Development
  • State of New Jersey Department of Health
  • National Alliance for Research on Schizophrenia and Depression
  • Missouri Department of Health and Senior Services
  • University of Toronto
  • National Institutes of Health (5k24da016388-10, 5r01da018734-03)
  • National Institute on Alcohol Abuse and Alcoholism (R01AA015950, AA015950)
  • National Institute of Mental Health (R01MH076672, MH 076629-01, MH076629, MH050787-11, R01MH050787, MH076672-01A1, R01MH076629)
  • National Institute on Drug Abuse (DA020705, R03DA016307, DA015537, DA 16307-01, DA019704, DA016738, R01DA020705, R21DA019704, R01DA016738, DA16611, R01DA017947, DA016388, R01DA013672, DA023190, DA018734--01A1, K08DA017145, DA017145, R01DA015537, R01DA023190, R01DA014039, DA13672, DA14039, DA017947, K02DA016611)
  • National Cancer Institute (R01CA096836, CA081595, R01CA081595, CA096836, R01CA109250, CA109250)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
tobacco use, smoking cessation, nicotine dependence, mental illness, anxiety disorders, depression, schizophrenia, self-medication hypothesis
MeSH terms
Anxiety Disorders, Mental Disorders, Depression, Humans, National Institute of Mental Health (U.S.), Primary Prevention, Risk Factors, Schizophrenia, Smoking, Social Environment, Tobacco Use Disorder, United States, Comorbidity, Prevalence, Smoking Cessation, Self Efficacy, Mentally Ill Persons, Persons with Psychiatric Disorders

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