The Latest Dirty Truth About Smoking

Posted on April 29, 2011 in Addictions Bipolar Disorder Pulmonary

Few things are as pathetic as a smoker who has been deprived of his habit. When I was locked up at what was then called South Coast Medical Center ((It is now known as Mission Hospital Laguna Beach)), the behavioral ward had just adopted the rule that there would be no smoking allowed on the floor. Each nicotine addict was given a patch to get her/him through the cravings but for most this didn’t satisfy. I watched one woman repeatedly attempt to break through the doors just to have a cigarette. Others smuggled them in and blew the fumes through the bathroom fan. It was open rebellion.

Other hospitals built special outside areas for smokers. At Huntington Beach Hospital, to cite one example, a cage was built where the smokers were marched out at intervals to indulge in their habit. Other hospitals went so far as to supply their charges with free cigarettes, though some complained that these were inferior brands. In some hospitals, nonsmokers had to stay inside while the smokers frolicked. (You can just imagine what my cardiologist had to say about this!) ((I know of one person who said he never smoked until he was locked up simply because smokers got to go outside while the rest of the floor remained in lockup, away from the fresh air and sunlight.))

The reasoning was that first the smokers needed to bring their mental conditions under control before they should have been put through quitting smoking. Now a new review of the literature suggests this is downright off base:

We review studies published in the PubMed database that include the keywords smoking, tobacco, nicotine and schizoaffective or bipolar disorder. Comorbidity of bipolar and schizoaffective disorder with nicotine consumption is 66-82.5 % and 67%, respectively. On the basis of this review it can be concluded that smoking results in poorer prognosis and greater clinical seriousness of bipolar and schizoaffective disorders. ((Emphasis mine.)) Use of other substances, psychiatric diagnosis, clinical seriousness and caffeine consumption are risk factors for nicotine use.

This jives with what I see in support groups. Those who smoke relapse into episode more than those who don’t. ((No studies exist on this, but I’d like to see one.)) My guess is that it is either a pharmacological effect of nicotine or just the fact that the failure to challenge one bad habit coincides with others such as failure to be med compliant. If you can’t get up the gumption to address one issue, I surmise, you will fail in others. This conjecture, of course, must be tempered by the fact that [[nicotine]] — the main reason why smokers smoke (they don’t do it for the tar) — distorts thought processes.

Which leaves us with an overwhelming question about current practices regarding smoking in mental care facilities: should ending the smoking habit be a key aim of therapy? Maybe so!