Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and is a leading cause of death and disability. This study examines training in tobacco treatment in psychiatry residency programs across the United States.
The authors recruited training directors to complete a survey of their program's curriculum related to tobacco treatment, attitudes related to treating tobacco in psychiatry, and perceptions of residents' skills for addressing nicotine dependence in psychiatric patients.
Respondents were representative of the national pool. Half of the programs provided training in tobacco treatments for a median duration of 1 hour. Content areas covered varied greatly. Programs with tobacco-related training expressed more favorable attitudes toward addressing tobacco in psychiatry and were more likely to report confidence in their residents' skills for treating nicotine dependence. Programs without tobacco training reported a lack of faculty expertise on tobacco treatments. Most training directors reported moderate to high interest in evaluating a model tobacco curriculum for psychiatry and stated they would dedicate an average of 4 hours of curriculum time.
The findings demonstrate the need for and interest in a model tobacco treatment curriculum for psychiatry residency training. Training psychiatrists offers the potential of delivering treatment to one of the largest remaining groups of smokers: patients with mental disorders.
"Reduced tobacco dependence services in behavioral health care settings may, at least in part, represent a training or knowledge deficit. In psychiatry residency training programs , tobacco treatment education is not a training requirement and only half of programs currently provide it (Prochaska et al. 2006). Both training and practicing psychiatrists appear unprepared to treat nicotine dependence, although they report considerable interest in this area (Prochaska et al. 2005; Williams et al. 2009b). "
[Show abstract][Hide abstract] ABSTRACT: Despite the high prevalence of tobacco use, disproportionate tobacco consumption, and excess morbidity and mortality, smokers with mental illness have reduced access to tobacco dependence treatment across the health care spectrum. We have developed a comprehensive model for Mental Health Tobacco Recovery in New Jersey (MHTR-NJ) that has the overarching goal of improving tobacco cessation for smokers with serious mental illness. Important steps involve engaging patients, professionals and the community to increase understanding that addressing tobacco use is important. In addition to increasing demand for tobacco treatment services, we must educate mental health professionals in evidence-based treatments so that patients can seek help in their usual behavioral health care setting. Peer services that offer hope and support to smokers are essential. Each of the policy or cessation initiatives described address the two core goals of this model: to increase demand for tobacco cessation services for mentally ill smokers and to help more smokers with mental illness to quit. Each has been pilot tested for feasibility and/or effectiveness and revised with feedback from stakeholders. In this way this implementation model has brought together academics, clinicians, administrators and mental health consumers to develop tobacco programming and policy that has been tested in a real world environment and serves as a model for other states.
Administration and Policy in Mental Health and Mental Health Services Research 11/2010; 38(5):368-83. DOI:10.1007/s10488-010-0324-x · 3.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In mental health and addiction treatment settings, failure to treat tobacco dependence has been rationalized by some as a clinical approach to harm reduction. That is, tobacco use is viewed as a less harmful alternative to alcohol or illicit drug use and/or other self-harm behaviors. This paper examines the impact of providers' failure to treat tobacco use on patients' alcohol and illicit drug use and associated high-risk behaviors. The weight of the evidence in the literature indicates: (1) tobacco use is a leading cause of death in patients with psychiatric illness or addictive disorders; (2) tobacco use is associated with worsened substance abuse treatment outcomes, whereas treatment of tobacco dependence supports long-term sobriety; (3) tobacco use is associated with increased (not decreased) depressive symptoms and suicidal risk behavior; (4) tobacco use adversely impacts psychiatric treatment; (5) tobacco use is a lethal and ineffective long-term coping strategy for managing stress, and (6) treatment of tobacco use does not harm mental health recovery. Failure to treat tobacco dependence in mental health and addiction treatment settings is not consistent with a harm reduction model. In contrast, emerging evidence indicates treatment of tobacco dependence may even improve addiction treatment and mental health outcomes. Providers in mental health and addiction treatment settings have an ethical duty to intervene on patients' tobacco use and provide available evidence-based treatments.
Drug and alcohol dependence 04/2010; 110(3):177-82. DOI:10.1016/j.drugalcdep.2010.03.002 · 3.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: The purpose of the present paper is to evaluate the effects of a smoking ban in a general hospital psychiatric unit. Methods: We study the effects of smoking ban in 40 consecutive psychiatric inpatients. The staff registered socio-demographic and tobacco-related variables. We also registered any kind of behavioral effects of smoking ban. Results: The patients were willing to stop smoking during their hospital stay (with or without nicotine replacement) with two mild behavioural incidences registered throughout the study. Conclusions: The benefits of non-smoking policy in a psychiatric unit can be significant. The introduction of smoking bans in psychiatric inpatients settings is possible and safe.
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