As we mark the 40th anniversary of the first nationwide Great American Smokeout this Thursday, November 16, we cannot forget that tobacco is the number one cause of preventable deaths in the United States and around the world. The statistics are startling:
- Cigarette smoking kills nearly half a million Americans each year – more than 1,300 people every day.
- By 2030, tobacco will cause more than 8 million deaths worldwide.
- The tobacco industry spends about $1 million an hour promoting cigarettes, yet less than 2 percent of the money states collect from tobacco taxes and legal settlements is spent on prevention and smoking cessation programs.
Cigarette smoking used to be an equal-opportunity killer. But as the Surgeon General’s 2014 report on smoking made clear, cigarette-related diseases and deaths are now concentrated among people who are most vulnerable – including high school dropouts, sexual minorities, some racial/ethnic minority groups, those of low socioeconomic status and people with mental illnesses and substance use disorders.
People with a mental illness or substance use disorder account for 25 percent of the adult population, but they consume 40 percent of all cigarettes sold in the United States. They are less likely to quit smoking than adults without these conditions. Nearly half of the tobacco-related deaths each year are among people with mental illnesses and addictions.
We must address the fact that nicotine is a highly addictive drug. For too many years, we have either encouraged the use of tobacco, by using cigarettes as a reward for treatment adherence, or we have discouraged quitting, believing that people with mental illnesses and addictions either don’t want to or can’t quit. We’ve been an unwitting ally of the tobacco industry, which has directly marketed cigarettes to people with mental illnesses and supported efforts to block smoke-free policies in psychiatric hospitals.
The fact is, people with mental illnesses and substance use disorders are dying years and sometimes decades earlier than member of the general population. They are dying from preventable deaths linked to cigarettes – including heart disease, lung disease and cancer – and from lack of access to science-based treatment and recovery support services.
How do we address this public health crisis? The same way we address any type of addiction.
We counter the myths. Smoking doesn’t help psychiatric symptoms – people who smoke are at increased risk of depression, psychiatric hospitalization and suicide. Nor does quitting smoking impede recovery from other addictions; in fact, it may enhance treatment success.
We make treatment accessible. Few behavioral health providers ask about their patients’ tobacco use or offer help in quitting. Less than half of substance use disorder treatment centers offer tobacco cessation services, and only 34 percent offer cessation counseling.
We walk the talk. Today, you can’t smoke on an airplane or in most restaurants, bars or government buildings, yet only 49 percent of behavioral health facilities have gone smoke free.
We hold hope for recovery. Quitting smoking is hard. But people with serious mental illnesses and substance use disorders want to quit smoking and can with appropriate help.
We address social determinants of health. Social and environmental risk factors for smoking – including poverty, unemployment and lack of education – are more common among people with serious mental illnesses and addictions. Smoking rates are significantly higher among adults with no health insurance and those who receive Medicaid than those who have private insurance.
We do what works! Effective treatments that integrate tobacco cessation with mental health and addiction treatment are available. The National Council is helping build the knowledge base through the National Behavioral Health Network for Tobacco & Cancer Control (NBHN).
With support from the Centers for Disease Control and Prevention (CDC) Office on Smoking and Health and its Division of Cancer Prevention and Control, NBHN is one of eight CDC National Networks that ignite action to eliminate tobacco use and cancer disparities. In collaboration with the Smoking Cessation Leadership Center, the Behavioral Health and Wellness Program and the Michigan Public Health Institute, NBHN serves as a resource hub for organizations, health care providers and public health professionals seeking to combat these disparities among individuals with mental illnesses and addictions.
Together, we have the power to help people with mental illnesses and addictions lead healthier lives. The Great American Smokeout is the perfect day to start!