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The importance of smoking cessation in improving the physical heath of people with mental disorder: The evidence

Debbie Robson, Senior Post Doc Researcher in Tobacco Addiction at the National Addiction Centre at Institute of Psychiatry, Psychology & Neuroscience, Kings College Hospital NHS Trust dicusses the importance of smoking cessation in improving the physical heath of people with mental disorder and the evidence at today"s conference. In her presentation Debbie discussed:

  • impact of smoking on mental health, physical health and mortality he facts around smoking, physical health and mortality in mental health
  • impact of smoking cessation on mental health and physical health
  • smoking cessation interventions in people with mental disorder 

Debbie Robson"s full presentation is available for download at the end of this page.

Despite being the biggest preventable cause of illness and premature death, smoking is embedded within the culture of mental health services. We expect and accept it in our hospitals. Smoking cessation interventions are among the most cost-effective health care interventions available .Yet historically, the clinical treatment of tobacco dependence during an inpatient stay or when receiving community mental health treatment has been neglected. In this presentation Debbie will give an overview of the impact smoking and stopping smoking has on mental and physical health. She will also discuss evidence based smoking cessation interventions for people with a mental health disorder, including the use of NRT, varenicline and bupropion.

In her presentation Debbie stated: 

“Biggest risk factors are smoking, obesity, lack of exercise & alcohol use – our patients tend to smoke much more than the general population”

“National campaigns tends not to resonate with our patients and taxes just put them into more poverty”

“People with SMI and or a substance use are more exposed to what’s inside a cigarette”

“Schizophrenia, bipolar disorder, depression, generalised anxiety disorder and substance abuse disorders are all associated with an increased risk of coronary artery disease, which is the leading cause of death in people with a mental illness.”


  • is the single biggest avoidable cause of cancer in the world.
  • causes one in five cancer cases
  • causes over a quarter of cancer deaths in the UK”

“Poor oral health is linked to diseases such as coronary heart disease, stroke and respiratory disease. Some effects of smoking are obvious such as smelly breath and stained teeth. Less obvious is gum disease – the gums and bone recede and teeth are lost. Smoking also increases the risk of developing oral cancers….People with a serious mental illness have higher rates of tooth decay and have 3.4 higher odds of losing all their teeth compared to mentally healthy people. They face additional challenges of maintaining good oral hygiene because of their mental health symptoms and because a number of psychotropic medications reduce the flow of saliva resulting in dry mouth. However stopping smoking is one of the most effective ways of reducing gum disease, tooth loss and oral cancers.”

“Smoking impedes mental health recovery”

“Smoking contributes to poor mental health (more severe symptoms of psychosis, higher rates of depression, longer time in hospital)”

“Smoking is associated with suicide: there are 3 mechanisms that can explain this:

  • smokers have pre-existing conditions that increase their risk for suicide
  • smoking causes painful and debilitating conditions that might lead to suicide
  • smoking decreases serotonin and monoamine oxidase levels”

Smoking when taking these meds speeds up their metabolism .This affects response to the medication – make the drug ineffective because it has not been in the body long enough to have an effect….Inducers stimulate the production of the enzyme – increasing the rate of metabolism causing the victim drug to clear out faster. This affects response to the medication – make the drug ineffective because it has not been in the body long enough to have an effect…Stopping/restricting tobacco smoke (tar not nicotine) may increase plasma levels, therefore need to monitor and may have to reduce dose.”

“Stopping smoking is associated with improved mood, anxiety and wellbeing. This effect is equal or larger to that of anti-depressant/anxiolytic treatment for mood disorders”

“What can you expect if you are a smoker in UK, and how effective is it?  the gold standard treatment is Medication (Nicotine Replacement Therapy or bupropion or varenicline), combined with intensive behavioural support (6-12 weeks) delivered by an NHS Stop Smoking Service”

“The role of pharmacotherapy

  • Reduce the strength, duration or frequency of urges to smoke
  • Reduce unpleasant withdrawal symptoms
  • Reduce the pharmacological reward from smoking”

“It’s important that patient have control over the NRTs they use”

“NRTs and Specialist stop smoking services give the best results in stopping smoking. – just getting a nicotine replacement won’t help”

“Smoke free environments in hospitals are changing the smoking culture”

Debbie Robson"s Biography:

Debbie Robson, RMN, PhD is a mental health nurse and tobacco addiction researcher with the National Addiction Centre at the Institute of Psychiatry, Psychology, and Neuroscience, King"s College London. She is the Project Lead for the BEAT study, one of many projects within The Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London. This study aims to improve access and uptake of physical health interventions for people with psychosis, including developing and evaluating tobacco dependence treatment pathways and training interventions for staff. She is also involved in policy development and training for smokefree settings.

Future conferences of interest:

Improving Physical Health for People with Mental Health Conditions
Monday 14 September 2015 
Hallam Conference Centre, London

Implementing the national objective to end Prone/Face Down Restraint: Examining Restraint Positions in Practice
Tuesday 22 September 2015 
ICO Conference Centre, London

Improving Mental Health Crisis Care
Thursday 15 October 2015 
Hallam Conference Centre, London

Positive and Proactive Care Meeting the New National Guidance on Reducing Seclusion
Tuesday 20 October 2015 
Hallam Conference Centre, London

Download: Debbie Robson"s Full Presentation

11 May 2015


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