Wednesday, December 9, 2009

People with mental illness are getting muscled to kick the cigarette habit-- why not leave some of them alone?

This is a bit contrary. Let's start with observations. Cigarette smoking is on the decline except for people with mental illness who now smoke about half the cigarettes sold in the US (who's counting?) These people must therefore find personal satisfaction with cigarettes despite the state's attempt to paint them as evil and price them beyond what poor people can afford. Smoking causes early death from health problems that include emphysema, heart disease, high blood pressure and cancer. But overweight causes these too, and smoking keeps your weight down. It's the medicines' side effects and peoples' lifestyles that cause overweight so why do doctors prescribe medicines that have such pernicious effects? Well, they are more concerned with regulating symptoms of your disease; that's why you get Risperdal or Zyprexa which blow you up like a ball in a matter of weeks.

Why are so many smokers lounging around outside the club? Doctors writing in the OMH News,August 2009, say family, friends and clients have viewed cigarettes as a way to ease the stress associated with mental illness. Nicotine is seen as helping to relieve symptoms and lessen the side effects of medicines. So, whether true or false, nobody's riding herd on these patients and the doctors want professionals to push people to quit more aggressively. They now counsel treatment to reduce tobacco dependence in combination with nicotine replacement therapy or medication that reduces craving.

That's all well and good but what feels good to someone who experiences the unpleasantness of stress as part of daily life, won't be exchanged for nicotine gum, some pills or pushups at the health spa without really pressing incentives. There's another point. Withdrawal brings its own pains, something these people are going to avoid like the plague. One explanation is that withdrawal symptoms can be confused with worsening of the emotional symptoms of their illness—people get irritable, depressed, anxious, or intense--and they fear this happening.

The state Office of Mental Health is adding muscle to its campaign for tobacco cessation. It wants outpatient clinic programs in state facilities to regularly check on their clients' smoking status and urge smokers to enter a smoking cessation project. Personalized recovery services (PROS), coming to Schenectady's Ellis mental health clinic soon, will pay Ellis to feature tobacco abstinence treatment. Providers are to receive training online to work on this. It will become more prominently part of combined mental health and addiction treatment.

A more guarded approach from NAMI

NAMI national has a guarded policy for smoking and wellness, trying to accommodate voices of smokers who are patients with the role of the guardians over their lives. NAMI wants education and support so people can make healthy choices in their lives. It says “smoking has been inappropriately accepted and even encouraged in therapeutic settings for treatment and recovery. Access to smoking is sometimes used coercively and can be a source of disruption in treatment facilities. Smoking and other tobacco use also increase stigma. NAMI encourages smoke free and tobacco free environments in treatment and other health care facilities, group centers and common areas in housing, including prohibiting smoking and other tobacco use by health care providers, caregivers and others working in and visiting such facilities, centers and housing. NAMI opposes any practice that uses access to smoking and tobacco as a form of coercion or reward.”

At the same time, the policy continues, “NAMI recognizes that the best time to provide and support smoking and other tobacco use cessation is not when consumers are in crisis because such treatment may exacerbate psychiatric symptoms and other conditions. Nicotine addiction is powerful and withdrawal is difficult for the general population, so it is particularly difficult for individuals experiencing a psychiatric crisis.”

A personal view is that the state and various hospitals and health authorities have mobilized huge resources to go after smokers at this late hour. We've known for almost half a century about cancer producing effects of cigarette smoking from huge federal studies done back then. State hospitals have forbidden smoking by patients and staff on campus for at least 10 years. It's against state law to smoke in restaurants, hospitals, almost every public facility and most places of employment. Millions of dollars are being spent to wring the habit out of the last remnant of smokers. The ones who persist can't or won't give it up. Many of them are mentally ill. Why not let them continue? Is this really an epidemic? The relatively small number involved does not seem to justify the massive resources aligned against them. Like children with a natural tendency to be hyperactive, do we need to classify them as disordered and stick them on Prozac?

For the smokers who puff their cigarettes outside in the cold these days, finding solace in the company of others like themselves, giving up the habit may be too much. With an eye on all the dollars the state throws at the problem, a better answer might be to Let them be! (Roy Neville)


  1. Bottom line. The mental health industry likes to stick their nose in where they have no right to be. I want my freedom back, the right to make my own choices.

    When are they gonna show a backbone to the pharmacutical companies to stop producing psych meds that cause diabetes, hypothyroidism and heart disease from severe weight gain.

    I am a former smoker only guit 3 months so far but it was my own choice. I know from experience being an alcoholic that you cannot force and addict to quit. The program doesn't work that way. The will to quit any addiction has to come from within.

    It is not fair to those who are in a mental health facility for an extended stay to be forced to quit smoking. They are there against their will, probably in crisis and you kick them when they are down. Shame on the professionals who think they are Gods and know better for everyone. Oh by the way those in State prisons and county Jails lose that right to smoke and they committed a crime. What crime did someone with a mental illess committ.

    Oh by the way lets take this to a fairness. Next time you see a mental health or hospital professional at a drug lunch take away that white bread roll too many starches. Oh and that ham is to high in salts and that pad of butter or margerine is high in colestral. And that diet caffinated soda and the coffee is high in caffine another chemical not good for us.

    See how you like someone pickin on your choices in life!

    I am not condoning smoking. I am now suffering the effects of years of smoking and the last 25 years it was my choice even after education in it's effects I decided I wanted and liked smoking. I also make the personal choice to quit. Price didn't help any though. I really did quit due to health reaons but I see my freinds in the low income bracket due to having a mental illess suffering because of this unfair stand the Mental Health professionals and other health professionals have taken.

    There will be a day you are told what you can eat oops the government already has and is doing that with the transfat issue. So much for freedom.

  2. Let the folks smoke. If they get some enjoyment from smoking, so be it. I agree.