Smoking cessation - links to recovery |
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| Thursday, 16 June 2011 |
Sue Downie and William Lauder of NHS Ayrshire and Arran have experience of helping clients within the mental health service to quit smoking. However this has also led them to wonder whether stopping smoking may signify a step towards mental health recovery. Here they explore the issue and you can have your say on smoking and recovery in the online poll. Smoking for people with mental health conditions has a long and troubled history. Some people with mental illness feel that smoking helps alleviate their anxiety, or use it to ‘self medicate’ unwanted symptoms arising from their condition or the prescribed medication. Others have felt that smoking may be the only activity that they can control in an otherwise threatening or restrictive environment. Smoking was also entrenched in the culture of many mental health staff who used cigarettes as way to placate or to engage with patients – the so-called ‘jag or a fag’ approach to mental health treatment!There is however now significant evidence of the burden of ill health and early mortality for people with mental health conditions. As smoking rates are on average twice as high as those for the general public, this leads to much poorer physical health outcomes for people with mental illness (ASH Scotland, Tobacco use and people with mental health problems, April 2011). As such the death toll from illnesses associated with smoking (heart disease, cancers, diabetes and hypertension) far outweighs the 10% lifetime risk of suicide. In addition to this, the interaction of smoking with certain anti-psychotic medications causes smokers to be prescribed higher doses of these medications than would otherwise be ‘necessary’ or desirable for these individuals leading to increased likelihood of undesirable side-effects and potential disengagement with treatment. It is also now recognised that smoking can also be harmful to mental health. There is evidence from large population studies that smoking increases the risk of developing a mental health problem, as well as data that indicate a clear relationship between the amount of tobacco smoked and the number of depressive and anxiety symptoms experienced by all smokers. The good news however is that giving up smoking is associated with significant mental health gains, particularly in relation to these symptoms of anxiety and depression (McNally, Does smoking cessation affect mental health?, 2009). In 2008 all mental health units in England went smoke-free by law, and the Scottish Government has recently produced guidance to support the implementation of smoke free wards with mental health hospitals in Scotland. In recognition of these smoking related health inequalities experienced by people with mental health conditions, and in anticipation of this policy change within mental heath hospitals, Fresh Airshire (the smoking cessation services for NHS Ayrshire and Arran) has been working with colleagues in the mental health services to support clients who seek to quit. Our experience of helping clients within the mental health service to quit has however also led us to wonder whether quitting smoking may signify a step towards mental health recovery? For example, two of our clients (‘Stuart’ and Ailsa) have both described the enormous sense of achievement they experienced in having quit smoking. In Stuart’s case, having been supported to quit whilst in hospital he has described feeling much happier since stopping, and how it has ‘changed the way you feel about yourself’. Another outcome for Stuart has been the financial resources that he now has since giving up smoking, and the way in which he uses this to treat his nephews when he is out on a pass from hospital. Being able to give to others has been a very positive result for Stuart – as he says ‘It’s something I can do that I wouldn’t have been able to do if I was smoking because I wouldn’t have been able to afford it’. Ailsa, on the other hand was initially refused NRT by her GP who felt that it wasn’t a ‘good time’ for her to quit. Having now succeeded under her own volition (and with the support of a smoking cessation group), Ailsa rightly recognises her great achievement in being able to quit, and to manage emotional and other difficulties in her life without resorting to smoking. As she describes this, ‘before I would worry about everything…go into a panic and reach for a cigarette. Now I can now work things out, and figure out things that have worked in the past’ We recognise that these two examples are not conclusive evidence that giving up smoking ‘caused’ recovery for these individuals. However the sense of achievement, pride, empowerment, ability to give to others, and reduction in anxiety described by Ailsa and ‘Stuart’ suggest that smoking cessation may be a factor in supporting recovery. And perhaps even more importantly, help us to ditch the ‘fag or a jag’ approach once and for all. Sue Downie (Health Promotion Officer) and William Lauder (Clinical Nurse Manager), NHS Ayrshire & Arran What do you think? Submit your comments below and take part in the poll. Comments (2)
... written by Jo, June 16, 2011
I'm quite eager to quit and having tried just about every NRT known to woman I'm now on the e-cig and optimistic even though it's just day one. The great thing about the e-cig is that with education I'M in control. Not some pharmacist or worker...
I find normally on NRT after about 20 hours to 2 days I get psychotic and depressed and I can't handle the MH side of things.. But recently just from making my roll ups thinner I've cut down by 1/3 and now I'm optimistic. I've quit in the past but I was quite well at that point....I went back due to lack of chocolate on the ward when sectioned. I'm in a chronic slow recovery phase right now so have already discussed the e-cig with the ward and they said I just keep my juice (nicotine liquid which I dilute) in the pharmacy and then like refill the carts (mouthpieces) every am...DV It'll be a while before I'm there again. They trust me not to OD on nicotine but you can't exactly keep nicotine liquid in your locker like you can vit pills for risk of deliberate/accidental OD by other patients. So yeah people can email me if they want my e-cig links....I buy most the stuff online and am now on my 3rd e-cig using a mod box (nifty piece of plastic basically) with 801 carts and 14500 batteries that I find last between 2 and 4 hours.... It's also important to have lots of support from folk who've 'been there' whether in real life or online.. Write comment
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I stopped 3 weeks ago with the help of a smoking cessation clinic & the will to stop has been much aided by my ongoing recovery & a big reduction in my self destructive behaviour. In other words, I have hope for my future & my life is more worth living. There is enjoyment in my days instead of them having to be endured.