Tobacco Cessation .....................................................................................................
Smoking rates are high among individuals with
mental health disorders, due to common
neurobiological and psychosocial risk factors,
the tendency to smoke as a means of self-
medication and a reduced ability to manage the
difficult process of cessation.^18
Practice guidelines for smoking cessation
underscore the importance of providing smoking
cessation services to patients with co-occurring
mental health disorders, utilizing motivational
and cognitive-behavioral approaches and
combining psychosocial therapies with
pharmaceutical interventions--practices that
mirror those that are recommended for the
general population.^19 However, in implementing
these approaches, care must be taken to ensure
that interventions are tailored to the clinical
needs of the patient and that such interventions
do not contraindicate other treatments the patient
might be receiving for his or her mental illness.^20
Bupropion has been approved by the FDA as
both a smoking cessation medication and an
antidepressant, making it uniquely suited to treat
individuals with co-occurring mood disorders
and addiction involving nicotine.^21 Preliminary
findings indicate that use of bupropion, in
conjunction with nicotine replacement therapy
(NRT), can be particularly helpful in treating
patients with co-occurring mental health
disorders.^22 However, research on smoking
cessation interventions in populations with co-
occurring mental health disorders is very
limited, in part because patients with such
disorders historically have been excluded from
many smoking cessation studies.^23
Monitoring a patient’s smoking and cessation
activities is extremely important for those with
mental illnesses since tobacco use can affect the
treatment of mental health disorders.^24 For
example, because smoking may influence the
metabolism of certain commonly prescribed
psychiatric medications,* dosages of these
medications may need to be adjusted when a
- Smokers typically need twice the dosage of these
medications than nonsmokers.
patient is cutting back or quitting their ingestion
of tobacco products.^25Treatment for Addiction Involving Alcohol and Other Drugs ..................................
Psychosocial interventions have proven effective
for patients with co-occurring mental health
disorders and addiction.^26 Patients with co-
occurring schizophrenia and addiction appear to
respond positively to psychosocial approaches
that include cognitive behavioral therapy (CBT),
motivational interviewing (MI) and family
therapy components.^27 Patients with co-
occurring addiction and mood disorders respond
well to behavioral skills training.† 28 Integrated
group therapy (IGT), a CBT-based intervention
for co-occurring addiction and bipolar disorders,
was found to be significantly more beneficial
than a standard group therapy program: in one
study, IGT patients used alcohol and other drugs
half as often as other patients did during the
intervention and three months after treatment.^29There also is evidence of the efficacy of
pharmaceutical interventions for patients with
co-occurring disorders.^30 Antidepressants,
including selective serotonin reuptake inhibitors
(SSRIs), are an effective pharmaceutical
treatment for many individuals with co-
occurring mood disorders and addiction
involving alcohol^31 and may be effective for
patients with co-occurring mental health
disorders and addiction involving opioids or
sedatives as well. Stimulating antidepressants,
such as desipramine or bupropion, may be more
useful for treating patients with co-occurring
depression and addiction involving cocaine.^32
Preliminary research also suggests that certain
anticonvulsant medications may be effective in
treating patients with co-occurring mood or
anxiety disorders and addiction involving
alcohol.^33† The behavioral skills training model utilized a
psycho-educational approach to teach patients self-
management skills and provide opportunities for
practice.