Download Key Messages - NZ College of Mental Health Nurses

The ABC approach for smoking cessation
Key Messages for Mental Health Services
Key messages





The key steps to helping people who smoke are:
 ASK all people about their smoking status and document this
 Provide BRIEF advice to stop smoking to all people who smoke, regardless of desire or
motivation to quit
 Make and offer of, and refer, to or provide evidence based CESSATION treatment
People with mental illness who smoke also want to stop
Many suffer from physical illness related to their smoking
Mental health service users, who smoke, typically need more intensive support to stop
than those without mental illness
Use nicotine replacement therapy (NRT) to manage nicotine withdrawal in smokers who
may not want to stop but are unable to smoke whilst in smokefree environments.
Additional information
Tobacco use among people with mental illness is higher than in the general population. 1 For
example, the odds of being a smoker if diagnosed with schizophrenia is approximately six
times greater than for those people without schizophrenia.2
Those with mental illness also tend to be more dependent smokers 2-5 and have a higher
cigarette consumption.2 6 This has implications for treatment (e.g. they may need higher
doses of NRT and require longer use).
NRT use should also be considered for those who currently don’t wish to stop smoking, but
who are residing in smokefree environments. Recent data shows that use of NRT can reduce
agitated behaviour in people with mental health illness.7
Smoking tobacco causes induction of the liver enzyme cytochrome P450 (CYP1A1,
CYP1A2).8 This is mainly the effect of the polycyclic aromatic hydrocarbons present in
tobacco smoke, not an effect of nicotine. CYP1A2 is responsible for the breakdown of a
number of medications, and in a smoker medications metabolised by this enzyme will be
metabolised faster. On cessation of smoking these enzymes return to a normal level of
activity, but may mean that a number of medications are metabolised more slowly and so
may need a dosage adjustment.8 Relevant medications are shown included in the New
Zealand Smoking Cessation Guidelines.
1. Lawn S, Pols R. Smoking bans in psychiatric inpatient settings? A review of the research. Aust N Z J Psychiatry 2005;39(10):866-85.
2. de Leon J, Diaz FJ. A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking
behaviors. Schizophrenia Research 2005;76(2-3):135-57.
3. McNeill A. Smoking and Mental Health. London: ASH, 2002.
4. Breslau N, Kilbey M, Andreski P. Nicotine dependence, major depression, and anxiety in young adults. Arch Gen Psychiatry
1991;48(12):1069-74.
5. Haug NA, Hall SM, Prochaska JJ, Rosen AB, Tsoh JY, Humfleet G, et al. Acceptance of nicotine dependence treatment among currently
depressed smokers. Nicotine & Tobacco Research 2005;7(2):217-24.
6. Watt J, Friedli L, Bates C. Smoking and Mental Health. London: SmokeFree London, Mentality, ASH, 2001.
7. Allen MH, Debanne M, Lazignac C, Adam E, Dickinson LM, Damsa C. Effect of Nicotine Replacement Therapy on Agitation in Smokers
With Schizophrenia: A Double-Blind, Randomized, Placebo-Controlled Study. Am J Psychiatry 2011.
8. Zevin S, Benowitz NL. Drug Interactions with Tobacco Smoking. Clin Pharmacokinetics 1999;36:425-438.