Tobacco Use Among Individuals With Schizophrenia: What Role Has the Tobacco Industry Played?

Department of Psychiatry, University of California, San Francisco, CA 94143-0984, USA.
Schizophrenia Bulletin (Impact Factor: 8.45). 06/2008; 34(3):555-67. DOI: 10.1093/schbul/sbm117
Source: PubMed


Rates of tobacco use among individuals diagnosed with schizophrenia have been estimated as high as 80%. A variety of hypotheses
have been proposed to explain the high rate of tobacco use among this vulnerable group. This study examined the tobacco industry's
efforts to establish and promulgate beliefs about schizophrenic individuals’ need to smoke and the hazards of quitting. The
current study analyzed previously secret tobacco industry documents. The initial search was conducted during January–July
2005 in the Legacy Tobacco Documents Library. The search yielded 280 records dating from 1955 to 2004. Documents indicate
the tobacco industry monitored or directly funded research supporting the idea that individuals with schizophrenia were less
susceptible to the harms of tobacco and that they needed tobacco as self-medication. The tobacco industry promoted smoking
in psychiatric settings by providing cigarettes and supporting efforts to block hospital smoking bans. The tobacco industry
engaged in a variety of direct and indirect efforts that likely contributed to the slowed decline in smoking prevalence in
schizophrenia via slowing nicotine dependence treatment development for this population and slowing the rate of policy implementation
vis-à-vis smoking bans on psychiatric units.

Download full-text


Available from: Judith J Prochaska, Jan 02, 2014
  • Source
    • "strategies for coping with boredom [261] and the lack of a smoke-free hospital environment [253]. Last but not least, in the USA, internal documents of the tobacco industry were released showing that the industry made a multitude of direct and indirect efforts to slow down the reduction of smoking prevalence among people with schizophrenia [15] [236]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Tobacco dependence is the most common substance use disorder in adults with mental illness. The prevalence rates for tobacco dependence are two to four times higher in these patients than in the general population. Smoking has a strong, negative influence on the life expectancy and quality of life of mental health patients, and remains the leading preventable cause of death in this group. Despite these statistics, in some countries smokers with mental illness are disadvantaged in receiving intervention and support for their tobacco dependence, which is often overlooked or even tolerated. This statement from the European Psychiatric Association (EPA) systematically reviews the current evidence on tobacco dependence and withdrawal in patients with mental illness and their treatment. It provides seven recommendations for the core components of diagnostics and treatment in this patient group. These recommendations concern: (1) the recording process, (2) the timing of the intervention, (3) counselling specificities, (4) proposed treatments, (5) frequency of contact after stopping, (6) follow-up visits and (7) relapse prevention. They aim to help clinicians improve the care, health and well-being of patients suffering from mental illness.
    Full-text · Article · Jan 2014 · European Psychiatry
  • Source
    • "Whereas neurobiological and other factors have been implicated in the comorbidity between tobacco and other drug use (e.g., Guydish et al., 2011; Hall & Prochaska, 2009; Pontieri, Tanda, Orzi, & Di Chiara, 1996), a lore that cigarette use is therapeutic and supports drug abstinence may contribute to this overlap. Tobacco industry efforts to market cigarettes as medicinal (e.g., Gardner & Brandt, 2006; Prochaska, Hall, & Bero, 2008) as well as the pervasive influence of Alcoholics Anonymous, which has historically viewed smoking cessation as an impediment to sobriety (Bobo & Husten, 2000), are likely culprits in this cultural zeitgeist. Accordingly, less than 20% of drug abuse treatment centers offer smoking cessation counseling (Knudsen, Studts, Boyd, & Roman, 2010), with approximately 40% discontinuing this service over time (Knudsen, Muilenburg, & Eby, 2013). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Drug-involved smokers may be less motivated to quit smoking because they expect smoking cessation to occasion adverse outcomes (e.g., exacerbation of drug use). Non-treatment-seeking adult smokers from the community (N=507) reported drug involvement, expectancies for smoking abstinence via the Smoking Abstinence Questionnaire (SAQ), and motivation to quit smoking (desire to quit and abstinence goal). Mediation analyses evaluated the indirect effects of binge drinking, marijuana, cocaine, other stimulant, opiate, and barbiturate/other sedative involvement on motivation to quit smoking through the SAQ Adverse Outcomes scale. Adverse outcomes expectancies accounted for a reduced desire to quit smoking and a lower likelihood of endorsing a goal of complete smoking abstinence among those involved with binge drinking, marijuana, cocaine, other stimulants, opiates, and barbiturates/other sedatives. Drug-involved smokers' greater expectancies for adverse outcomes upon quitting smoking may deter smoking quit attempts. Interventions are encouraged to counteract the notion that smoking cessation jeopardizes sobriety.
    Full-text · Article · Oct 2013 · Journal of substance abuse treatment
  • Source
    • "Smoking rates exceeding 75% in schizophrenia populations are associated with decades cut from individual life spans, lower psychiatric treatment compliance and financial impoverishment as government assistance for the mentally ill is channeled into tobacco industry profits (Steinberg, Williams & Ziedonis 2004; Parks et al. 2006; Prochaska, Hall & Bero 2008). Psychiatric research on nicotine use in mental illness has traditionally been guided by the hypothesis that this "
    [Show abstract] [Hide abstract]
    ABSTRACT: Nicotine dependence is the leading cause of death in the United States. However, research on high rates of nicotine use in mental illness has primarily explained this co-morbidity as reflecting nicotine's therapeutic benefits, especially for cognitive symptoms, equating smoking with 'self-medication'. We used a leading neurodevelopmental model of mental illness in rats to prospectively test the alternative possibility that nicotine dependence pervades mental illness because nicotine is simply more addictive in mentally ill brains that involve developmental hippocampal dysfunction. Neonatal ventral hippocampal lesions (NVHL) have previously been demonstrated to produce post-adolescent-onset, pharmacological, neurobiological and cognitive-deficit features of schizophrenia. Here, we show that NVHLs increase adult nicotine self-administration, potentiating acquisition-intake, total nicotine consumed and drug seeking. Behavioral sensitization to nicotine in adolescence prior to self-administration is not accentuated by NVHLs in contrast to increased nicotine self-administration and behavioral sensitization documented in adult NVHL rats, suggesting periadolescent neurodevelopmental onset of nicotine addiction vulnerability in the NVHL model. Delivering a nicotine regimen approximating the exposure used in the sensitization and self-administration experiments (i.e. as a treatment) to adult rats did not specifically reverse NVHL-induced cortical-hippocampal-dependent cognitive deficits and actually worsened cognitive efficiency after nicotine treatment stopped, generating deficits that resemble those due to NVHLs. These findings represent the first prospective evidence demonstrating a causal link between disease processes in schizophrenia and nicotine addiction. Developmental cortical-temporal limbic dysfunction in mental illness may thus amplify nicotine's reinforcing effects and addiction risk and severity, even while producing cognitive deficits that are not specifically or substantially reversible with nicotine.
    Full-text · Article · Aug 2013 · Addiction Biology
Show more