This article reviews cigarette smoking in patients with psychiatric disorders (PD) and substance use disorders (SUD). Rates of smoking are approximately 23% in the U.S. population but approximately two-to four-fold higher in patients with PD and SUD. Many remaining smokers have had repeated smoking cessation failures, possibly due to the presence of co-morbid PD and SUDs. There is modest, evidence-based support for effective treatment interventions for nicotine addiction in PD and SUD. Further research is needed to increase our understanding of nicotine addiction in PD and SUD and develop more effective treatment interventions.Although smoking prevalence in the United States has decreased from 43.8% in 1965 to 23.3% in 2000, 1 there are many cigarette smokers who have been unable to quit. An important subset of refractory smokers are those with psychiatric disorders (PD) and substance use disorders (SUD), among whom smoking rates exceed those in the general population by two-to fourfold. 2 In a population-based study of smoking prevalence in the U.S., Lasser and colleagues found that smoking prevalence among persons with and without a psychiatric disorder were 41% and 22.5%, respectively. 2 The highest prevalence (67.9%) was found among persons with drug abuse. Consistent with these results, Degenhardt and Hall 3 reported similar findings in their study of smoking prevalence in Australia. The prevalence of smoking in various PD and SUD 4 is presented in Fig. 1. Other studies have found that individuals with PD and SUD are at higher risk for many tobacco-related diseases, including cardiovascular illness, respiratory disease, and cancer, than individuals in the general population. 5-8 Among "ever smokers," persons with PD or SUD are less likely to be former smokers than other smokers. Lasser et al. 2 found that the quit rate among ever smokers with no history of PD or SUD was 42.5%. Significantly lower quit rates were associated with several other PD and SUD, including alcohol use disorder (16.9%), bipolar disorder (25.9%), major depression (26.0%), and post-traumatic stress disorder (23.2%). Clearly, improved treatments for nicotine addiction are needed for these populations.Several explanations have been proposed for the high prevalence of smoking in individuals with PD and SUD. First, there may be intrinsic factors (eg, shared genes, abnormalities in brain

Smoking is highly prevalent across most anxiety disorders. Tobacco use increases risk for the later development of certain anxiety disorders, and smokers with anxiety disorders have more severe withdrawal symptoms during smoking cessation than smokers without anxiety disorders. The authors critically examined the relationships among anxiety, anxiety disorders, tobacco use, and nicotine dependence and reviewed the existing empirical literature. Future research is needed to better understand the interrelationships among these variables, including predictors, moderators, and mechanisms of action. Increased knowledge in these areas should inform prevention efforts as well as the development and improvement of smoking cessation programs for those with anxiety and other psychiatric disorders.

Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are highly prevalent among Veterans of the conflicts in Iraq and Afghanistan. These conditions are associated with common and unique neuropsychological and neuroanatomical changes. This review synthesizes neuropsychological and neuroimaging studies for both of these disorders and studies examining their co-occurrence. Recommendations for future research, including utilizing combined neuropsychological and advanced neuroimaging techniques to study these disorders alone and in concert, are presented. It is clear from the dearth of literature that more attention in the literature should be given to examining temporal relationships between PTSD and mTBI, risk and resilience factors associated with both disorders and their co-occurrence, and mTBI-specific factors such as time since injury and severity of injury, utilizing comprehensive, yet targeted cognitive tasks.