Can Quitting Smoking Increase Longevity for the Mentally Ill? An Innovative Approach

Mary F. Brunette, M.D., Assoc. Prof., Psychiatry, Dartmouth Medical School
Mary F. Brunette, M.D.

From The Quarterly, Winter 2012

People with mental illness tend to smoke more than the general population. One reason that has been suggested is the self-medication effect. Research has demonstrated that if you put nicotine patches on the arms of normal non-smokers, they will show improved attention and memory and respond more to rewarding stimuli, behaviors that are impaired in people with severe mental illnesses such as schizophrenia. However, smoking is one of the factors contributing to the high rate of early death among people with mental illness: on average 25 years earlier than the general population.

Research on smoking cessation treatments in the general population has shown that nicotine replacement increases the ability to quit by a factor of one and a half, and that high-dose nicotine replacement doubles the odds. Medicine combined with behavioral therapy improves the prospects even further. A growing body of literature suggests that these methods also work among people with mental illness, but there are limited funds to support smoking cessation programs. Dr. Brunette and her colleagues are working to implement programs that help to motivate and assist smoking cessation in this population in a cost-effective way.

Decision-support systems are systems that provide concrete, comprehensible information and motivational material, often provided electronically, making it possible to provide a lot of information rapidly and cheaply and tailored for a particular population. Dr. Brunette and her team have developed a simple program designed specifically for people with severe mental illness who have cognitive deficits and may have difficulty navigating typical websites. Her site provides information and simple exercises that allow users to insert their own ideas and information and get feedback. Properly set up, the program requires no ongoing clinician time, which should make it attractive for public mental health systems with limited funds.
Initial testing of the program with people with mental illness who have little past experience with computers has had positive results. Within two months of initiating the program, 70 percent of the participants had met with a treatment provider or initiated efforts to quit smoking. The Brunette team is now expanding the program and designing sites specifically for African-American and Latino participants.