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Mental illness, substance use raise smoking risk


Adults ages 18 and older who experienced any mental illness or who have had a substance use disorder in the past year are more likely to smoke and to smoke more heavily than others, according to a report by the Substance Abuse and Mental Health Services Administration.

According to the report, adults experiencing any mental illness or a substance use disorder in the past year represent 24.8% of the adult population, but that same group used 39.6% of all cigarettes smoked by adults.

Regarding cigarette smoking rates, 38.3% of adults experiencing mental illness or substance use disorders were current smokers, as opposed to 19.7% of adults without these conditions. That means the rate of current cigarette smoking among adults experiencing mental illness or substance use disorders is 94% higher than among adults without these disorders.

Although people with substance use disorders and no mental disorder constitute only 4.9% of adults older than 18, they smoked 8.7% of all cigarettes, according to the report. Similarly, although those who had experienced both mental illness and a substance use disorder represented only 3.8% of the population in the past year, they smoked 9.5% of all cigarettes.

The report defines a mental illness as any diagnosable mental, behavioral or emotional disorder other than a substance use disorder. The report defines a substance use disorder as dependence on or abuse of alcohol or illicit drugs.

“It has long been a public health priority to develop effective smoking prevention and cessation programs,” Pamela S. Hyde, SAMHSA administrator, said in a news release. “This report highlights a clear disparity. 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.”

To address the high rates of tobacco use among people with mental or substance use disorders, SAMHSA, in partnership with the Smoking Cessation Leadership Center, has developed a portfolio of activities designed to promote tobacco cessation efforts in behavioral healthcare. SAMHSA and the SCLC launched the 100 Pioneers for Smoking Cessation Campaign, which provides support for mental health and substance abuse treatment facilities and organizations to undertake tobacco cessation efforts. This program has been expanded in conjunction with state Leadership Academies for Wellness and Smoking Cessation, where the goal is to reduce tobacco use among those with behavioral health needs. Participating states bring together policymakers and stakeholders (including leaders in tobacco control, mental health, substance abuse, public health and consumers) to develop collaborative action plans.

The report is based on the findings of SAMHSA’s 2009-2011 National Survey on Drug Use and Health, the primary source of statistical information on the use of illegal drugs, alcohol and tobacco by the civilian, noninstitutionalized population of the U.S. ages 12 and older.

A PDF of the report is available at


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