In-Depth Report: Science of Tobacco
Experts Work to Help Smokers with Psychiatric Disorders

Dr. Eric Heiligenstein

Dr. Eric Heiligenstein knows many patients with psychiatric disorders aren’t getting the tailored help they need to quit smoking.  While about 20 percent of the general population smokes, half of those with depression still smoke, 80 percent of alcoholics light up and nearly 90 percent of people with schizophrenia or bipolar disorder are addicted.  Heiligenstein, clinical director of psychiatric services at University Health Services and a collaborator on UW-CTRI projects, applauds the effort to reduce the smoking rate by 60 percent since 1950 among the general U.S. population.

“But what’s left are very difficult-to-treat smokers with other problems,” Heiligenstein said.  These smokers consume 45 percent of the cigarettes sold in the U.S.  His research shows that the worse the psychiatric condition, the more the individual is likely to smoke.  What’s more, the Massachusetts Department of Mental Health found that incidences of sudden death from suicide or heart disease are seven times higher among smokers with psychiatric conditions. 

It’s also harder for these patients to quit, Heiligenstein said.  Neurobiological factors among psychiatric patients reinforce nicotine use to a higher degree.  Many patients also feel isolated from mainstream cessation programs. 

Eric said there is a need for more research on how to help this population to quit, but a few factors are clear.  Research by UW-CTRI's Stevens Smith and others show nicotine replacement therapy has little effect on helping psychiatric patients quit.  But quit rates for psychiatric patients treated with bupropion appear to be comparable to those among the general population for up to two years, especially when combined with behavioral therapy.

Another key, Heiligenstein said, is to treat tobacco dependence while treating comorbidities.  Research shows it works and doesn’t deter treatment of psychiatric conditions.  Heiligenstein said there is a lot of work to be done to ensure psychiatric care providers treat tobacco use as a vital sign and offer tailored counseling and medication to help patients quit.

How UW-CTRI Helps
UW-CTRI employees work every day to address this issue.  For example, UW-CTRI Regional Outreach Specialists Kristine Hayden and Susanne Morris are working with Ron Alexander, an addiction specialist, to provide technical assistance for Quit Tobacco Now, a community collaboration between UW-CTRI Outreach, healthcare providers and other organizations in Marathon County to treat tobacco dependence among psychiatric patients and the general population.  Meanwhile, Tricia Brein and Megan Piper are working with Dane County Mental Health on a ground-breaking study to help people with mental-health diagnoses to quit smoking.  In addition, the UW-CTRI Clinic and support group regularly treat tobacco use among psychiatric patients.  And UW-CTRI speakers such as Doug Jorenby and Smith do periodic presentations on how to help patients quit, often focusing on people with psychiatric disorders.

For Mental Health Practitioners
For more information on how to treat tobacco dependence by psychiatric patients, click here.

More Stories
To access the UW-CTRI news story archives, click here.