Smokers with mental disorders, drug and alcohol problems need doctors' help to quit
Smokers who also have alcohol, drug and mental disorders would benefit greatly from smoking-cessation counseling from their primary care physicians and would be five times more successful at kicking the habit, a study by researchers at UCLA's Jonsson Comprehensive Cancer Center has found.
Smokers with these co-morbid conditions make up about 40 percent of the smoking population, have a more difficult time quitting and represent a significant burden on the health care system. If their primary care physicians could help them to quit smoking, it would not only improve their health of patients but would reduce tobacco-related health care costs, said Dr. Michael Ong, an assistant professor of general internal medicine and health services research at the David Geffen School of Medicine at UCLA and a researcher with UCLA's Jonsson Comprehensive Cancer Center.
"We found it would be very effective for primary care physicians to provide help in quitting smoking to these patients," Ong said. "However, in the context of everything these physicians are trying to do in a day, smoking cessation may fall by the wayside. It's also been thought that with this patient population, doctors should only take on one thing at a time, for example treating an opiate addiction and opting to deal with the smoking cessation later. But at the end of the day, we showed that smoking cessation counseling is effective in this patient population and should definitely be pursued."
The study was published Aug. 23 in Nicotine and Tobacco Research, the peer-reviewed journal of the Society for Research on Nicotine and Tobacco.
Primary care physicians play an important role in smoking-cessation counseling. However, prior to this study, their effectiveness with this patient population was unclear, Ong said.
And while Ong's study found that smokers, both those with and those without alcohol, drug or mental disorders, were equally likely to receive smoking-cessation counseling (72.9 percent and 79.9 percent, respectively), those with these disorders also quit smoking at equal levels when they got a little help from their doctor.
The study found that the probability of patients with co-morbid disorders quitting without smoking-cessation counseling was 6 percent, while patients without co-morbid disorders had a 10.5 percent chance of successfully kicking the habit. But with smoking-cessation counseling, patients with co-morbid conditions had five-fold better chance of quitting, at 31.3 percent, while smokers without the other disorders had a three-fold better chance, at 34.9 percent.
"This study shows that primary care physicians can help smokers with alcohol, drug or mental disorders to successfully quit," the study states. "These smokers should be targeted for smoking-cessation counseling to reduce the health burden of tobacco."
Ong said there are much higher rates of smoking among schizophrenics and those with depression and anxiety disorders. Among drinkers, those with alcohol disorders include people who are alcohol dependent as well as weekend binge drinkers.
For the study, Ong and his team examined the relationship between past-year smoking-cessation counseling and successful quitting among 1,356 patients. The patients had reported smoking in the 1998–99 Community Tracking Study survey and later reported seeing a primary care physician in the last year in a follow-up Healthcare for Communities Survey in 2000–01.
"We sampled for patients with these disorders, and if they were smoking at one time, we followed up two years later to see if they had talked to their primary care physician about quitting and whether they did, in fact, quit smoking," Ong said. "We picked out smokers from the original survey in 1998 and analyzed data from the second survey in 2000. Nobody had ever examined smokers with these co-morbid conditions from this angle before."
Ong said he hopes the study results will be incorporated into new clinical practice guidelines when they come out so that primary care physicians treating smokers with co-morbid conditions realize that smoking-cessation counseling in this difficult patient population can be successful.
"Getting people to quit smoking is the No. 1 way to reduce deaths in the United States," Ong said. "We know these deaths are preventable and we should be incorporating every tool in our toolbox to keep people healthy. This study provides evidence that counseling all types of patients, even those challenging patients with co-morbid conditions, to quit smoking can work."
According to the Centers for Disease Control, more deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined. Cigarette smoking causes about one of every five deaths in the United States each year, accounting for 443,000 deaths annually.
The study was funded in part by the Robert Wood Johnson Foundation's Substance Abuse Policy Research Program, the UCLA–RAND National Institutes of Mental Health Partnered Research Center for Quality Care, and a seed grant from the Jonsson Cancer Center Foundation.
UCLA's Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson Center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2011, the center was named among the top 10 cancer centers nationwide by U.S. News & World Report, a ranking it has held for 10 of the last 12 years.