Course of smoking and quit attempts among clients with co-occurring severe mental illness and substance use disorders

Abstract

Objective: Approximately three-quarters of people with severe mental illnesses smoke cigarettes, and the rate is even higher among those with co-occurring substance use disorders. This longitudinal study explored patterns of cigarette use and cessation attempts among mental health clients with co-occurring disorders.

Methods: Clients participating in a longitudinal study of co-occurring disorders (N=174) were assessed yearly over 11 years for smoking and smoking cessation behaviors, psychiatric symptoms, and other substance use, as well as social, occupational, and other characteristics. Generalized linear mixed-effects models were used to examine smoking cessation outcomes.

Results: Eighty-nine percent of participants were current smokers at baseline. Seventy-five percent of participants tried to quit at least once over the 11 years of the study, although none received nicotine replacement therapy or bupropion. Only 17% were not smoking at the 11-year follow-up. The presence of a chronic general medical condition predicted a longer duration of not smoking in the past year. Being male and having a high school education or higher were associated with more attempts to quit smoking, as were higher scores on the activation subscale of the Brief Psychiatric Rating Scale, more social contact with non-substance-using friends, and more daily activities.

Conclusions: Although many clients with co-occurring serious mental illness and substance use disorders tried to quit each year, few achieved sustained abstinence and none used evidence-based interventions (nicotine replacement therapy or bupropion). Treatment providers need to administer evidence-based interventions to help people quit successfully.