Dr. Eric Heiligenstein can attest to how rewarding it is to help patients with mental health or addictive disorders to quit smoking. He does it all the time. Heiligenstein is the Director of Psychiatric Services at University Health Services (UHS) at the University of Wisconsin-Madison. UHS asks patients about their tobacco use as a vital sign in primary care and at all mental health intakes. By the time the patients see Heiligenstein, the electronic medical record shows tobacco status along with other comorbidities.

“My job is to work with the primary-care physician or tobacco-treatment specialist to develop a pharmacotherapy regimen for the patient that takes into consideration their psychiatric or substance-abuse disorder,” Heiligenstein said. “Resistance these days is more for substance-abuse treatment than for nicotine treatment. What most are surprised at is the linkage between their smoking and their mental-health or addictive disorder. Almost every patient will not have connected those two. They don’t realize the importance of quitting smoking to their overall wellness—not just physically, but emotionally.”

If a smoker doesn’t want to quit, Heiligenstein tells him he should consider it for the future because smoking is something that will get in the way of positive outcomes to mental health.

“You want to set up cognitive dissonance that smoking is not in their wellness plan. No patient has ever said to me, ‘I don’t care if I’m more depressed or have more episodes of mania.’ Everyone’s seeing you to get better.”

Heiligenstein speaks about this at conferences across the nation. “What I see when I go around the country, consult or do record reviews is smoking is not even considered important. Clinicians record smoking status and that’s it, and that’s a mistake.”

Heiligenstein said he once had a smoker who came in for a refill from his mental-health clinician, but that clinician was out, so the patient saw Heiligenstein instead. “His luck,” Heiligenstein joked. “I said, ‘Smoking is going to be a problem, isn’t it?’”

 “How do you mean?” the patient said.

“Did you know there’s a relationship between the amount you smoke and how many episodes of depression you get?” Heiligenstein said.

“No, I didn’t know that.”

“You’re trying not to be depressed, right?”

“Right.”

“The less you smoke the less you’ll be depressed.” It started a whole conversation the patient had previously never had. That’s an example of how a few minutes of a clinician’s time can set the course to smoke-free living for the patient.