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Objectives. We compared prevalence, severity, and specific symptom profiles for nicotine withdrawal across categories of mental illness. We also examined the influence of nicotine withdrawal on efforts to quit smoking among those with mental illness.
Methods. We analyzed data from 2 sources: wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions, limiting the sample to current smokers (2001&-2002; n = 9913); and a 2-wave cohort telephone survey of a national sample of adult smokers (2004-2006; n = 751).
Results. Mental illness was associated with a substantially greater likelihood of nicotine withdrawal syndrome; approximately 44% of nicotine withdrawal syndrome diagnoses were attributable to mental illness. Symptom profiles were highly comparable between mental illness categories, although anxiety-related symptoms were better markers of withdrawal for those with an internalizing disorder. Smokers with mental illness were motivated to quit but were less likely to be successful in their quit attempts, and both dependence and withdrawal independently accounted for this lower likelihood of success.
Conclusions. Nicotine withdrawal may be a particularly important target for intervention among those with mental illness who smoke cigarettes. (Am J Public Health. 2014;104:e127-e133. doi:10.2105/AJPH.2013.301502)
Individuals with mental illness are more likely to smoke cigarettes, are more dependent on nicotine, and have greater difficulty quitting smoking1,2 than are those without mental ill- ness. The prevalence of mental illness in the United States is approximately 28%; yet, smokers with mental illness consume 40%- 50% of cigarettes.1,2 A self-medication hy- pothesis has largely driven the conceptualiza- tion of this issue3-8: smoking is initiated and maintained to reduce psychiatric symptoms, and these symptoms are exacerbated during abstinence. This notion, that smoking can be important for symptom self-management, has likely contributed to smoking disparities be- tween those with and those without mental illness.3 There are effective means of treating smoking for those with mental illness9; how- ever, nontreatment remains the norm.10 A growing body of researchers, clinicians, and policymakers has called for a paradigm shift in how we approach this issue.3,11-13 Smoking is becoming increasingly viewed as a preventable and treatable cause of diminished life quality among those with mental illness,3,12 rather than a necessary form of self-medication.
A 2008 National Institute of Mental Health report noted that the focus on a self-medication hypothesis has come...