A Qualitative Inquiry into the Prevalence of Tobacco and Alcohol Dependency among Individuals with Mental Health

Background

Mental health and substance abuse disorder (MHSA) patients, according to Morisano, Bacher, Audrain-McGovern, & George (2013) have very high rates of tobacco smoking. In fact, various studies, for instance, Lasser et al. (2010) have estimated that the odds of tobacco smoking amongst patients of MHSA are more than double when compared to the odds for the overall human population. However, the relationship that exists between nicotine and MHSA disorders, as its nature is complicated. Tobacco smoking might act as a coping mechanism for MHSA disorders patient, primarily as a medication, the signs of a psychiatric condition or the side effects of psychotropic drugs. Tobacco smoking helps in decreasing emotional distress linked with substance abuse disorders by shifting away from the attention from stressors.

Nevertheless, if the use of nicotine or tobacco smoking is a coping mechanism for MHSA disorder patients, then the apparent positive benefits seem to be illusory. Smokers with MHSA disorder report increased rates of addiction, depression, opioid use, interference with the activities in their lives. These individuals have a quite poor outcome with regards to their MHSA treatment progress, and are at a higher risk with regards to developing ideas of suicide, compared to their counterparts who do not smoke tobacco despite suffering from MHSA disorders (Cook et al., 2014; Morisano et al., 2013). Various theories have been advanced concerning the connection between cigarette use, mental health and substance abuse disorders and poorer MHSA disorders treatment progress and outcomes.

Introduction

While the prevalence of tobacco use and dependence in the world has decreased considerably, by close to 21%, a majority of smokers are finding quitting smoking to be very challenging. A significant sub-group of these intractable smokers are adults suffering from MHSA disorders; amongst this subset, the rates of smoking are argued to be between two to four times more than the rates in the overall population. For instance, a recent study in the US conducted by Lasser et al. (2010) showed that the pervasiveness of cigarette smoking amongst people who do not have mental health issues and those without were at 42% and 23.5% respectively. The study also found out that the highest rate of prevalence amongst cigarette smokers was amongst those with substance abuse disorders; it stood at approximately 66.7%.

Furthermore, in another study by Grant et al. (2014), the authors found that although tobacco-dependent smokers suffering from mental health issues constituted 9.1% of the overall smoking population, this group used more than 32% of all the cigarettes manufactured and sold (Morisano et al., 2013). In fact, some other studies have shown that those with MHSA disorders were at a higher risk of developing numerous diseases that are smoking-related, such as respiratory and cardiovascular diseases amongst many others as opposed to the overall population. Most striking, however, is the finding by these authors that illnesses and conditions related to tobacco smoking might be number one cause of deaths in tobacco users with MHSA disorders.

In the previously mentioned study by Lasser et al. (2010), the rate of quitting tobacco use and dependence amongst patients with a history of MHSA disorders was found to be at approximately 41%. The authors also found out that people with issues of alcohol abuse recorded a quite low rate with regards to quitting cigarette smoking; this stood at 17%. Nevertheless, those with bipolar disorder,  non-affective psychosis, posttraumatic stress disorder, as well as major depressive disorder also recorded lower rates of cessation which stood at 26%, 25%, 22.3%, and 25.2% respectively (Morisano et al., 2013). It is clear that there is an urgent need for better treatment for nicotine addiction among people with MHSA, especially regarding substance abuse disorders such as alcohol. It is possible that better mechanistic rationalization for these troubled relationships could help in the process of coming up with new and better treatment for this co-morbidity.

Various scholars have advanced some explanations as to why there is pervasiveness of tobacco use amongst people with MHSA disorders. For instance, there is the proposal that certain intrinsic factors might exist such as shared genes which might predispose people MHSA patients to start and entrench smoking behaviors (Cook et al., 2014; Morisano et al., 2013). There is also the proposal that people with MHSA might rely on and use tobacco smoking to medicate themselves against the symptoms of the psychiatric condition or the side effects of psychotropic drugs. Additionally, there might also be environmental and social factors of this co-morbidity such as availability and ease of access, stress, or poverty. It is not shocking that concomitant presentation of MHSA disorders is strongly linked with tobacco smoking. Furthermore, the administration of nicotine through tobacco smoking might modulate specific neurotransmitter systems that have been considered to be involved in the MHSA disorders' pathogenesis.

Statement of the Problem

While there has been considerable progress concerning reduction of cigarette smoking within the general global population, patient's with MHSA disorder use tobacco at alarmingly high rates, which various studies have shown to be almost two times that of people without MHSA disorders, and compromise close to over 50 % of smokers who are nicotine dependent. The rates of smoking are higher among people who have been diagnosed with numerous lifetime psychiatric disorders such as schizophrenia, as well as other chronic mental illnesses (Gfroerer et al., 2013; Lasser et al., 2010; Vanable, Carey, Carey, & Maisto, 2013). Mental health disorders are linked with higher levels of dependence on nicotine, tobacco-smoking severity regarding the number of cigarettes an individual smokes in the week, as well as the high intensity of tobacco smoking. MHSA disorders are also associated with very little success with regards to the cessation of tobacco smoking (McClave, McKnight-Eily, Davis, & Dube, 2010). Furthermore, tobacco smoking is believed, as various studies have asserted, to be accountable for the majority of the many deaths amongst people with severe MHSA disorders (Campion, Checinski, Nurse, & McNeill, 2008). According to Kessler, Chiu, Demler, Merikangas, & Walters (2015), it is also believed to be the reason behind the low life expectancy amongst people with chronic mental health disorders which is significantly less than the life expectancy of the overall population.

Various studies have recently suggested that tobacco users with MHSA disorders are very motivated to stop and might do so without worsening psychiatric symptoms so long as they are offered necessary support (Prochaska et al., 2011; Siru, Hulse, & Tait, 2012). In fact, there is ready availability of evidence-based cigarette smoking cessation programs and interventions that incorporate MHSA treatment (Fiore & Jaén, 2012; McGovern et al., 2012), which are well suited to be included as part of psychotherapy (Muñoz et al., 2012). However, according to Schroeder & Morris (2013), it is not often that behavioral health professionals include pharmacological and behavioral interventions in their therapy to induce the reduction of smoking. In fact, there is no evidence regarding research or studies that investigate the trends of smoking amongst people with mental health and substance abuse disorders. Further, there is inferior understanding concerning what role the mental health system plays in reducing cigarette dependence and prevalence, which is apparently quite high, amongst this critical subset of the population. Also, there is no clear insight and understanding of the tobacco use and dependence trends amongst MHSA disorder patients and those without, particularly about how those trends vary in terms of the type of diagnosis and in terms of the treatment preferred for the mental health and substance abuse disorder.

Purpose of the Study

The rationale for this research is to demonstrate the significant prevalence of tobacco use as a coping mechanism mainly amongst those patients with MHSA disorders.  The objective to characterize further the relationship between tobacco smoking and MHSA and determine why the recent decreases in tobacco smoking amongst the general population have not been replicated amongst individuals with MHSA disorders, such as anxiety and episodic mood disorder amongst many others. According to Aubin, Rollema, Svensson, & Winterer (2012), the mechanisms that sustain determinedly higher tobacco smoking rates amongst people with MHSA disorders are complicated and continue to be under-investigated. Individuals with MHSA disorders might give a lot of credit regarding reward and benefits to tobacco smoking as opposed to those without MHSA disorders (Spring, Pingitore, & McChargue, 2010). Furthermore, they might go through much more challenging life situations including higher negative impact or simply a lack of substitute rewards (Aubin et al., 2012; Warner & Mendez, 2013). Thus, it is clear that novel intercession to address strategies that are specific to this subset - people with MHSA disorders - should be of paramount concern regarding cigarette control policy.

There are quite high prevalence rates of tobacco smoking amongst MHSA disorder patients. This study intends to shed light on and explain why this is the case, especially concerning comparisons between those with possible anxiety or psychological stress. Mental health issues are not only independent risk factors for tobacco use but are also linked with various risk factors related to smoking such as lower academic level, higher poverty, as well as lower rates of employment. Due to these relationships, the provision in terms of care to a person who has been diagnosed with MHSA disorder must be looked at as a way of inducing treatment for preventing or ceasing tobacco smoking.  In fact, for a majority of people undergoing mental health therapy, interactions with mental health specialists are the only opportunity and access that they have with regards to preventive medical counseling.  Fiore & Jaén (2012) and  McGovern et al. (2012) have asserted that effective cigarette quitting therapies and interventions, which include treatments for MHSA disorders as well as therapies for nicotine substitution, are very available and can comfortably fit together with psychosocial therapies, as well as prescription of psychotropic medications.

To achieve the purpose that this study has set out to accomplish, light must be shed particularly on the relationship that exists between tobacco smoking and MHSA disorders. This paper, thus, explores three fundamental research questions:

(1) Why is it that the decrease in rates of tobacco smoking reported amongst the general population has not been realized amongst people with MHSA disorders?

(2) What does the trend of tobacco smoking amongst MHSA disorders compared to the general population suggest with regards to taking up of incorporated therapies and existing obstacles to cessation therapies in MHSA care settings?

(3) Is there a considerable fraction of people with MHSA disorders who deliberately use tobacco smoking as a coping mechanism?

(4) Is there a statistically noteworthy relationship between mental illness therapies and the rates of tobacco use cessation.  Investigating these research questions will assist in not only demonstrating the extent of the dependence on tobacco smoking amongst MHSA disorder patients as a mechanism for coping, but also to explain the trends and the relationship that exists between tobacco smoking MHSA disorders.

Conclusion

This study discussed the probable explications for the high pervasiveness rates of cigarette use and dependence for coping in people with MHSA disorders. This study hopes to present the bio-psychosocial grounding for this co-morbidity, including evidence from clinical and epidemiological research. The study will show that decrease in the rate of cigarette use amongst individuals with MHSA disorders over the past five years has fundamentally been less than the decline reported amongst smokers within the general population, despite there being a significant drop in the rates smoking cessation amongst patients with MHSA disorders.