Addressing tobacco addiction in office-based management of psychiatric disorders: Practical considerations

Tobacco addiction is the most common co-occurring substance use disorder for individuals with a psychiatric disorder. It often leads to serious consequences and death for the user. Family members and others are also at increased health risks secondary to environmental tobacco smoke exposure. Forty-four percent of all cigarettes consumed in the United States are by individuals with a psychiatric disorder; this fact highlights the disproportionate tobacco consumption in this population and has become a catalyst for change. More psychiatrists are gaining awareness of the need to integrate tobacco treatment into standard practice. Addressing tobacco is important for all psychiatrists, although there are unique issues for subspecialists in child and adolescent, adult, addiction, geriatric, and psychosomatic psychiatry. It is possible for psychiatric patients to quit smoking, although they are likely to need medications and psychosocial support. This warticle reviews how to address tobacco among psychiatric patients, including screening and assessment, treatment planning, medications, psychosocial treatments, and clinical program level changes. There are six Food and Drug Administration-approved medications for nicotine dependence and several effective psychosocial treatments, including readily available national and state Quit Lines (telephone counseling) and interactive Internet sites.