Citation

Prochaska JJ. Drug Alcohol Depend. 2010; 110(3): 177-182.

Copyright

(Copyright © 2010, Elsevier Publishing)

DOI

10.1016/j.drugalcdep.2010.03.002

PMID

20378281

PMCID

PMC2916693

Abstract

In mental health and addiction treatment settings, failure to treat tobacco dependence has been rationalized by some as a clinical approach to harm reduction. That is, tobacco use is viewed as a less harmful alternative to alcohol or illicit drug use and/or other self-harm behaviors. This paper examines the impact of providers' failure to treat tobacco use on patients' alcohol and illicit drug use and associated high-risk behaviors. The weight of the evidence in the literature indicates: (1) tobacco use is a leading cause of death in patients with psychiatric illness or addictive disorders; (2) tobacco use is associated with worsened substance abuse treatment outcomes, whereas treatment of tobacco dependence supports long-term sobriety; (3) tobacco use is associated with increased (not decreased) depressive symptoms and suicidal risk behavior; (4) tobacco use adversely impacts psychiatric treatment; (5) tobacco use is a lethal and ineffective long-term coping strategy for managing stress, and (6) treatment of tobacco use does not harm mental health recovery. Failure to treat tobacco dependence in mental health and addiction treatment settings is not consistent with a harm reduction model. In contrast, emerging evidence indicates treatment of tobacco dependence may even improve addiction treatment and mental health outcomes. Providers in mental health and addiction treatment settings have an ethical duty to intervene on patients' tobacco use and provide available evidence-based treatments.

Language: en

Keywords

Humans; Risk Factors; Alcohol Drinking; Depression; Substance-Related Disorders; Comorbidity; Mental Health; Suicide Prevention; Adaptation, Psychological; Harm Reduction; Stress, Psychological; Mental Health Services; Mental Disorders; Tobacco Use Disorder; Illicit Drugs; Smoking Cessation; Temperance; Alcohol Deterrents