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July 31, 2024

Smoking Cessation as a Priority for Psychiatrists

Author Affiliations
  • 1Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  • 2Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  • 3Neurological Institute, Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, Ohio
  • 4Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
JAMA Psychiatry. 2024;81(10):951-952. doi:10.1001/jamapsychiatry.2024.2162

The last 50 years have seen important reductions in cigarette smoking in the United States. However, these reductions have been unevenly distributed, and rates of cigarette smoking remain elevated among individuals with psychiatric illness, including other substance use disorders (SUDs). Psychiatrists are uniquely positioned to address this disparity, having both the skills to treat tobacco use disorder and regular contact with patients more likely to smoke. In this Viewpoint, we advocate that evaluating for and offering treatment for tobacco use disorder should be a core part of psychiatric practice.

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2 Comments for this article
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Bring tobacco into general discussion of CV risk
James Berry, MD | Northern Light Mercy Hospital Portland Maine
Like it or not, psychiatrists who prescribe atypical antipsychotics are already involved addressing cardiovascular risk, due to the need to monitor and address weight gain and metabolic side effects associated with these mediations. Tobacco cessation will be more meaningful if it is addressed in the context of other aspects of cardiovascular risk reduction. If the subject is brought up in the discussion of medication-associated risk it opens the door to address tobacco cessation in the overall context of healthy behaviors rather than treating it as an isolated topic.
CONFLICT OF INTEREST: None Reported
Mental health care professionals seem addicted to NOT treating tobacco use disorder.
Robert C. van de Graaf, MD | MedTCC, The Netherlands
Dear Editor,

It is encouraging to see (again) colleagues speaking out about the persistent lack of tobacco use disorder interventions in mental health care [1]. This situation has remained unchanged for decades. It appears that psychiatrists and other mental health care professionals are habitually looking away and remaining silent when it comes to tobacco use disorder. Yellow fingers, smelling smoke, seeing a patient smoke, all indications of a tobacco use disorder, which is a potentially fatal, but treatable addictive disease. An essential treatment intervention is placing smoking and smoking cessation prominently on the healthcare agenda. Ignoring this issue has
the opposite effect—silence implies consent. Imagine if healthcare professionals were to remain silent when there were indications that someone had cancer, also a potentially fatal but often treatable condition. How would society and disciplinary bodies respond to these colleagues?

What is needed is a drastic culture change in healthcare, especially in mental health care. This culture change must go beyond merely training psychiatrists and psychiatry trainees; it requires a complete paradigm shift in how we think, feel, and act regarding tobacco addiction. We implemented this shift in a large mental health care institution in The Netherlands [2]. Although it is specialized in addiction care (and co-morbid other mental disorders), these kind of organizations generally do not differ from other mental health care organizations in terms of the tendency to remain silent and look away regarding smoking behaviour and tobacco use disorder. Today even smoking patients with severe tobacco withdrawal syndrome who need a residential smoking cessation treatment program to be able to quit smoking receive this treatment in the completely smoke-free mental health care environment [3-4]. Without the radical cultural change to stop our 'addiction' to NOT treating tobacco use disorder, such an approach would never have been possible.

Sincerely yours,
Robert C. van de Graaf, addiction medicine specialist

1. Kleinman RA, Barnett BS. Smoking cessation as a priority for psychiatrists. JAMA Psychiatry. Published online July 31, 2024. Doi:10.1001/jamapsychiatry.2024.2162.
2. Van de Graaf RC, Veldman K, Anthonio GG. Reaction to 'Integrating smoking cessation care in alcohol and other drug treatment settings using an organizational change intervention: a systematic review' by Skelton et al. (2018). Addiction. 2018 Dec;113(12):2318. doi: 10.1111/add.14409. Epub 2018 Sep 6.
3. Spoelstra SK, van de Graaf RC, Dijkstra A. Residential Treatment Exclusively for Tobacco Use Disorder: A Narrative Review. J Addict Med. 2024 Jan-Feb 01;18(1):33-41. doi: 10.1097/ADM.0000000000001234. Epub 2023 Oct 17.
4. Thybaut RJL, van de Graaf RC, Spoelstra SK (2024) Residential Treatment of a Woman with A Severe Tobacco Withdrawal Syndrome: A Case Report. J Med Case Rep Case Series 5(09): https://doi.org/10.38207/JMCRCS/2024/JUL05090285.
CONFLICT OF INTEREST: None Reported
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