Cigarette Smoking in Youths With Mental Health and Substance Use Problems: Prevalence, Patterns, and Potential for Intervention

Abstract

Mental health symptoms and substance use disorders are clear risk factors for cigarette smoking and nicotine dependence among young people, yet research on cigarette smoking among youths with concurrent mental health and substance use disorders ("dual diagnosis") is considerably lacking. We examined smoking history and perspectives regarding smoking, cessation, and mental health and substance use in 97 adolescents and emerging adults (ages 14 to 24) referred to a program for youths with concurrent mental health and substance use disorders in Canada. Results show high rates of cigarette smoking, and modest interest in quitting but little interest in attending formalized programs to assist with cessation. Many participants reported smoking more when mental health was worse; most reported that they frequently smoke cigarettes and use drugs or alcohol concurrently. Current smokers perceived more benefits from cigarette smoking in regulating emotions and ameliorating their mental health symptoms than former smokers. In contrast, perceived detrimental effects of smoking were unrelated to current smoking status. Results suggest a need for integrated treatment that incorporates emotion regulation as part of cessation approaches. Integrating smoking cessation approaches into existing mental health and substance use treatments may be more palatable to adolescents and emerging adults than stand-alone smoking cessation programs.

Tobacco Treatment Outcomes for Hospital Patients With and Without Mental Health Diagnoses

“…However, tobacco use is not evenly distributed across the population. Those with diagnosed mental health or substance use disorders are nearly three times as likely to smoke compared to those without [41%; ( 2 , 3 )]. Rates of smoking among those diagnosed with schizophrenia have been shown to be ~62% ( 4 , 5 ).…”

Tobacco smoking and mental disorders in Australian adolescents

“…Identifying tobacco smoking and providing minimal brief intervention is an important element of clinical practice for health professionals in all settings that help adolescents with mental health problems (The Royal Australian College of General Practitioners, 2011; Towns et al, 2017). Important opportunities exist to identify tobacco smoking and to intervene when young people present at youth mental health services (Brown et al, 2020; Hermens et al, 2013) which may be more acceptable services to young people than stand-alone smoking cessation programmes (Catchpole et al, 2017). Other interventions such as those to reduce parental smoking are proving to be effective in reducing adolescent smoking (The Royal Australian College of General Practitioners, 2011).…”

Attitudes about smoking cessation treatment, intention to quit, and cessation treatment utilization among young adult smokers with severe mental illnesses

“…Additionally, although many studies have described middle-aged smokers with SMI (e.g. (Aschbrenner et al, 2017;Lucksted, McGuire, Postrado, Kreyenbuhl, & Dixon, 2004;Wehring et al, 2012)), few studies have described the beliefs, attitudes, social context and perceptions of social norms related to smoking among young adults with mental illness (Grana et al, 2012;Morris et al, 2011), and research on beliefs about smoking cessation and use of cessation treatment among young smokers with SMI is also sparse (Catchpole et al, 2017;Leatherdale & McDonald, 2007;Morris et al, 2011). A fuller understanding of the characteristics, beliefs, attitudes, social norms and perceived behavioral control about cessation treatment, to is needed to inform health communications and intervention development for groups that have not yet responded robustly to tobacco control efforts, such as young adults with SMI.…”