Addicts and the Mentally Ill Smoke Way More
According to a report released yesterday by the Substance Abuse and Mental Health Services Administration (SAMHSA), adults with a mental illness or who have a substance use disorder smoke nearly 40% of the total cigarettes puffed in America—even though these same groups make up less than a quarter of the US adult population. When you break it down, people with a substance use disorder—which SAMHSA defines as "a dependence on or abuse of alcohol or illicit drugs"—account for 4.9% of the 18-and-up population, yet smoke 8.7% of all cigarettes. Meanwhile, 38.3% of adults who suffer from mental illness or substance abuse are current smokers, compared with 19.7% of the population at large. "This report highlights a clear disparity," said SAMHSA Administrator Pamela S. Hyde. "It shows that people dealing with mental illness or substance abuse issues smoke more and are less likely to quit. We need to continue to strengthen efforts to figure out what works to reduce and prevent smoking for people with mental health conditions."
One person on the front lines of this battle is Tom McCarry, LMHC, who runs a smoking cessation program at the New York City mental-health clinic where he works. "What amazed me most about working with adults living with severe and persistent mental illness wasn’t the staggering rate of smoking, but the percentage who truly wanted to quit," McCarry tells The Fix. He noted that in the mental-health world there had long been an attitude that smoking wasn't an important area of concern, even to the extent to which smoking was encouraged by giving out cigarettes or allowing additional outdoor breaks for smokers as an incentive for participation. "This is definitely not the case today," says McCarry. And this is especially crucial for individuals with mental illness, he added, because not only does tobacco harm their health, it can also "compound psychosocial stressors, life and financial barriers, and stigma."
Of course, as anyone who's ever spent time in recovery—whether 12-step or otherwise—can tell you, active drinkers and drug users don't have a monopoly on cigarettes. Although smoking in meetings is a thing of the past in most parts of the country, it's still often said that you can find an AA meeting by looking for the crowd of smokers milling around outside of a church or community center. Brooklynite Alexis is one of those whose smoking habit actually got worse after she joined AA. Why? "For one," she tells The Fix, "I think there was a direct transference of addiction, and it helped ease my headaches and cravings. Secondly, a lot of people in the program promoted it, I felt, as 'not as bad.' People told me to smoke it up, that I would quit when I was ready, and that I should consider quitting one thing at a time, in the order in which it would kill me—the thought being, of course, that abusing booze has more imminent health implications than smoking."
Yet not everyone suddenly graduates to a pack-a-day habit when they get clean. Case in point is fellow Brooklynite (and Fix contributor) John Gordon, who actually gave up cigarettes just a few short months after he put down the bottle. "I certainly think smoking is sanctified on a certain level in AA," Gordon tells The Fix. "I think there's a taboo around speaking of its deadliness or its role as a very powerful emotional crutch. The irony to me is that it is far and away the deadliest vice most of us engage in, yet it maintains an acceptable and sometimes even encouraged role in a 'sober' lifestyle." Perhaps the recovery community, like the mental-health world, will eventually come to terms with its tacit encouragement of the habit. While Gordon doesn't believe AA should get involved in smoking cessation efforts, he says, "When I see the common occurrence of people with 10, 15 or 20 years sober still maintaining a smoking habit, it says to me that we as a community of sober-living people are doing something wrong."