There Has Been a Decrease in Tobacco Smoking Rates in Individuals with Severe Depression & Substance Use Disorder

According to a recent analysis of population-based survey data from JAMA, published on April 26th, 2022, drastic cuts in cigarette smoking were reported among U.S. people with severe depression, substance use disorder, or both from 2006 to 2019. Specialists from the National Institute on Drug Abuse (NIDA), which is part of the National Institutes of Health, and the Substance Abuse and Mental Health Services Administration (SAMHSA) collaborated on the study. 

The results suggest that tobacco use prevention and cessation strategies that have resulted in considerable reductions in tobacco use in the general population can target and assist those at greater risk of cigarette smoking. Simultaneously, the data underscores ongoing inequities, revealing that individuals with psychiatric problems have higher smoking rates than those who don’t.

“This study shows us that, at a population-level, reductions in tobacco use are achievable for people with psychiatric conditions, and smoking cessation should be prioritized along with treatments for substance use, depression, and other mental health disorders for people who experience them,” said Nora Volkow, M.D., director of NIDA and co-author of the study. “Therapies to help people stop smoking are safe, effective, and may even enhance the long-term success of concurrent treatments for more severe mental health symptoms in individuals with psychiatric disorders by lowering stress, anxiety, depression, and by improving overall mood and quality of life.”

Image Source: University of Maryland, Baltimore County

In the United States, cigarette smoking is the major avoidable cause of disease, disability, and death. Researchers credit this in addition to recent spikes in treatment options, medical insurance for these treatments, cigarette costs, smoke-free and tobacco-free regulations, mass media and educational efforts, or other substantial proof strategies to assist individuals to avoid or quit smoking.

Giving up smoking and using tobacco lowers your chances of cancer, heart disease, stroke, and lung disease. Smoking cessation has been shown to reduce anxiety, depression, and stress in individuals with mental disorders, as well as reduce the risk of developing a new substance use disorder and enhance the quality of life.

Smoking rates in adults with substance use disorders, significant depression, and other psychiatric diseases have held steady in previous studies. Researchers analyzed data from more than 558,000 people (about half the population of Maine) aged 18 and older who took part in the National Surveys on Drug Use and Health (NSDUH) from 2006 to 2019. They discovered that while individuals with severe depression, substance use disorder, or both were more likely to smoke cigarettes than individuals without these disorders. Those with these psychiatric disorders saw positive changes in smoking cessation over 14 years. The NSDUH, which is performed yearly by SAMHSA, offers nationally official statistics on cigarette smoking, tobacco use, severe depression episodes, and substance use disorders among the civil, quasi-adult population in the U.S. About 53% of the people surveyed were women, 41% were between the ages of 18 and 25, and 62% were non-Hispanic white.

After accounting for age, sex, race/ethnicity, education, and household income, the researchers found that last month, smoking rates fell by 13.1% among individuals who had a past-year severe depression episode and by 8.2% among adults who had not. The gap in the last month’s cigarette smoking between individuals who had a past-year severe depressive episode and those who did not have shrunk dramatically, from 11.5% in 2006 to 6.6% in 2019.

Likewise, smoking in the previous month fell by 10.9% among individuals with a past-year substance use problem and 7.8% among adults without. Throughout this 14-year period, smoking rates declined by 13.7% among those with co-occurring substance use disorder and significant depression, and by 7.6% among adults without these illnesses.

“These declines tell a public health success story,” said Wilson Compton, M.D., NIDA’s Deputy Director and the senior author of the study. “However, there’s still a lot of work to be done to ensure tobacco use in patients with substance use disorder, depression, or other psychiatric conditions continue to decrease. It is crucial that healthcare providers treat all the health issues that a patient experiences, not just their depression or drug use disorder at a given point in time. To do this, smoking cessation therapies need to be integrated into existing behavioral health treatments. The result will be longer and healthier lives for all people.”

Image Source: National Institutes of Health

From 2006 to 2019, last month cigarette smoking fell among individuals with past-year severe depressive episodes or substance use disorder in every age, sex, and racial and ethnic category studied, apart from non-Hispanic American Indian and Alaska Native adults. Considering that among racial and ethnic minorities in the U.S., American Indian and Alaska Native communities have the greatest smoking and poorest quitting rates, more preventive and treatment activities are needed in these areas. 

The researchers say that data on some populations at substantial risk of psychiatric problems and cigarette smoking, such as institutionalized individuals or those who are homeless but do not live in a shelter, should be included in future studies. During the COVID-19 epidemic, more investigation is required to track nationwide changes in tobacco use and nicotine vaping among adults with and without psychiatric illnesses, which includes substance use disorder. 

Information from National Institute on Drug Abuse
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There Has Been a Decrease in Tobacco Smoking Rates in Individuals with Severe Depression & Substance Use Disorder
Ashlyn Pieri 7 June, 2022
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