The relationship between tobacco use, substance-use disorders and mental health: results from the National Survey of Mental Health and Well-being

Smoking initiation among nonsmokers during and following treatment for alcohol use disorders

Few studies have examined nonsmokers who enter treatment for alcohol use disorders to see what happens to their smoking status over time. Such individuals may be vulnerable to initiating tobacco use during or after treatment. Thus, the present study examined changes in the smoking status of the 387 baseline nonsmokers in Project MATCH during and following their treatment for alcohol use or dependence. Results showed that, of those who were nonsmokers at baseline, 15% initiated tobacco use during the 12- month followup period, most beginning during treatment. Smoking initiators' rates of tobacco consumption increased significantly between the 3- and 15-month followup assessments. These results suggest that smoking initiation during substance abuse treatment may be important to monitor and that efforts to help smoking initiators may be warranted.

Why is lone-motherhood so strongly associated with smoking?

OBJECTIVE

Lone mothers are among the most disadvantaged groups in many countries. Smoking prevalence among this demographic group is considerably higher than the general population. Previous work has shown that only part of this difference can be explained by age, not having a partner, living alone, and socio-economic factors. This study examined the contribution of mental health, the social environment, and the lifecourse in explaining the effect of lone motherhood on smoking status.

METHODS

Cross-sectional data from the 1995 National Health Survey and 2001 National Drug Strategy Survey were used. Smoking was defined as daily smoking. Mental health was assessed using a 14-item scale from the SF-36. Proportion of friends who smoke was used as an indicator of the social environment. Age started smoking daily (< or = 18 and > 18) was used as a lifecourse factor.

RESULTS

Mental health, proportion of friends who smoke and age of smoking initiation had strong associations with smoking status. However, they accounted for a small part of the association of being a lone mother and a smoker. After controlling for these factors, the odds of being a smoker among lone mothers were still twice those of mothers with partners (OR 2.1, 95% CI 1.7-2.7).

CONCLUSIONS AND IMPLICATIONS

Improving the socio-economic status (SES), mental health and the social environment of lone mothers could help reduce their high smoking prevalence. However, much of the effect of being a lone mother remains even after controlling for these factors. More research is needed to discover why prevalence is so high among this demographic group.

Factors associated with recreational drug use

This study aimed to examine demographic, lifestyle, mental health and personality factors associated with illicit recreational drug use, heavy alcohol consumption and smoking in a community-based population sample. A postal questionnaire survey was conducted of people who were selected at random from the Electoral registers of Cardiff and Merthyr Tydfil. Illicit drug use was associated with risk taking, neuroticism, being male, having a higher education qualification, not being married, being unemployed, being aged under 25 years, smoking, heavy alcohol consumption and living in Cardiff. Smoking was associated with anxiety, depression, being female, lower income and educational qualifications, looking after the family or home, being aged over 25 years, illicit drug use and heavy alcohol use. Heavy alcohol consumption was associated with not being depressed, experiencing sleeping problems, risk taking, being male, higher income, no higher educational qualification, not being married, being a student, being aged under 25 years, smoking and illicit drug use. Illicit drug use, smoking and heavy alcohol use were strongly associated with each other. Illicit drug use was associated with alcohol use and, to an even greater extent, with smoking. Illicit drug and alcohol use were associated with similar characteristics, but smoking was associated with a rather different demographic combination.

Smoking at age 18-20 and suicide during 26 years of follow-up-how can the association be explained?

OBJECTIVES

Several studies have shown a relation between smoking and suicide. It is not clear if this relation should be considered causal, or if other risk factors for suicide, left unmeasured in many studies, might explain the smoking-suicide association. The aim of this cohort study was to analyse the role of smoking and other potential risk factors measured in adolescence on subsequent suicide.

METHODS

Information on smoking, and other potential risk factors from childhood and adolescence was collected among 49 323 men, born 1949-1951, at conscription for compulsory military training in the years 1969-1970. Mortality data were obtained from the Swedish cause of death register for the years 1971-1996.

RESULTS

There was a clear trend of increasing suicide risk with increasing intensity of smoking reported at conscription. Those smoking >20 cigarettes/day had a strongly increased relative risk of suicide (OR = 3.03, 95% CI: 1.72, 5.34) during the first 13 years of follow-up. From 14 to 26 years after conscription, the risk was only slightly weaker (OR = 2.53, 95% CI: 1.36, 4.72). When we adjusted for other risk factors for suicide measured at the conscription examination (psychiatric diagnosis, parental divorce, low emotional control, medication for nervous problems, contact with police and childcare, heavy alcohol consumption, drug use, and education) in a multivariate analysis, the trend with smoking intensity disappeared, and there was no longer an increased relative risk for the heavy smokers (follow-up years 1-13: OR = 0.98, 95% CI: 0.53, 1.82; years 14-26: OR = 1.31, 95% CI: 0.91, 1.87).

CONCLUSION

The increased risk of suicide among smokers was almost entirely explained by an increased prevalence of heavy alcohol consumption and low mental well-being among smokers. That is, the association between smoking and suicide is probably due to confounding by these other factors. These results do not support the hypothesis that tobacco consumption itself is a risk factor for suicide.

Motivational Influences on Cigarette Smoking

Cigarette smoking is a leading cause of mortality and morbidity and a particularly common and intractable addictive disorder. Research shows that nicotine is a sine qua non of tobacco addiction and that it produces the hallmark effects of addictive drugs: sensitization, tolerance, physical dependence, and euphoria/elation. Research on the development of smoking reveals that although smoking prevalence has declined from a peak in the mid-1990s, close to 30% of twelfth graders still smoke. Smoking in adolescents is related to development of physical dependence, ethnicity, impulsivity, affective disorder, and peer influences. However, which of these exerts the greatest causal effects is unknown, and their influence no doubt varies across individuals and across development. Once dependence on tobacco smoking is established, evidence suggests that tobacco motivation is strongly influenced by a reduction in withdrawal symptoms, an expectation of stress reduction, and conditioned reinforcement. Nicotine motivation may also be influenced by modulation in stimulus incentive value.

The four Ds deconstructed

For decades, pamphlets provided by credible government authorities have reproduced tips for quitting smoking, recommended with certainly, but with no basis in facts, findings or substantiated outcomes. The 'four Ds' are an example of a universally accepted set of instructions to quit smoking that has little basis in science. This anomaly is at odds with the era of evidence-based medical interventions and should be addressed.

The impact of current tobacco use on the outcome of paracetamol poisoning

BACKGROUND

Tobacco smoke contains a number of substances that are capable of inducing cytochrome P450. Consequently, current tobacco use may enhance the hepatotoxicity from a paracetamol overdose by increasing the oxidative metabolism of paracetamol.

AIM

To evaluate, by multivariate analysis, the effect of current tobacco use on the morbidity and mortality from paracetamol-induced hepatotoxicity.

METHODS

A retrospective study was carried out on the basis of the hospital charts of 602 patients admitted with single-dose paracetamol poisoning for whom information on current tobacco use was available.

RESULTS

In patients admitted with paracetamol poisoning, the rate of current daily tobacco use of 70% (424 of 602 patients) was considerably higher than the rate of 31% in the background population (chi-squared test: P < 0.0001). Current tobacco use was an independent risk factor for the development of hepatic encephalopathy (odds ratio, 2.68; 95% confidence interval, 1.28-5.62) and mortality (odds ratio, 3.64; 95% confidence interval, 1.23-10.75). Current tobacco use was independently associated with high peak values of alanine transaminase and the international normalized ratio.

CONCLUSIONS

Current tobacco use was very frequent in patients admitted with paracetamol poisoning. It was an independent risk factor of severe hepatotoxicity, acute liver failure and death following paracetamol overdose.

Rehabilitation unit staff attitudes toward substance abuse: changes and similarities between 1985 and 20011,21No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or any organization with which the authors are associated.2Reprints are not available

OBJECTIVES

(1) To assess the attitudes of the members of an inpatient rehabilitation unit team toward their unit's substance abuse and tobacco use policies, and (2) to compare the findings with those of a survey 16 years earlier.

DESIGN

An anonymous repeated assessment of staff attitudes and behaviors.

SETTING

A 47-bed inpatient rehabilitation unit.

PARTICIPANTS

Rehabilitation unit nurses, occupational and physical therapists, psychologists, physicians, social workers, and speech pathologists.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Change in response with time.

RESULTS

Seventy percent (89/128) of the staff members completed the survey. Seventy-two percent believed that they were "familiar or very familiar" with the unit's substance abuse policy and 51% were "concerned" or "very concerned" about their patients' alcohol and drug use. Nineteen percent reported complaints about the policy from their patients and 8% reported complaints from family members. Support for a uniform substance abuse policy remained high: 96% supported a uniform policy in both 1985 and 2001. However, only 15% believed that staff drug abuse education was adequate and only 45% believed that the current policy was "adequate" or "very adequate." (Corresponding responses in 1985 were 20% and 50%, respectively.) All but 1 respondent considered tobacco use an addiction, but only 48% believed that their patients were routinely assessed for its use.

CONCLUSION

Support for a uniform substance abuse policy remains strong. Although most team members support the policy, they believe that their education about substance abuse is inadequate. Staff members almost unanimously accept tobacco use as an addiction, but they believe that assessment and intervention efforts are poor.

Psychiatric morbidity and substance use in young people aged 13-15 years: results from the Child and Adolescent Survey of Mental Health

BACKGROUND

Psychoactive substance use is strongly associated with psychiatric morbidity in both adults and adolescents.

AIMS

To determine which of alcohol, nicotine and cannabisis mostclosely linked to psychiatric disorders in early adolescence.

METHOD

Data from 2624 adolescents aged 13-15 years were drawn from a national mental health survey of children. The relationship between psychiatric morbidity and smoking, drinking and cannabis use was examined by logistic regression analyses.

RESULTS

Having a psychiatric disorder was associated with an increased risk of substance use. Greater involvement with any one substance increased the risk of other substance use. Analyses of the interactions between smoking, drinking and cannabis use indicated that the relationship between substance use and psychiatric morbidity was primarily explained by regular smoking and (to a lesser extent) regular cannabis use.

CONCLUSIONS

In this sample, links between substance use and psychiatric disorders were primarily accounted for by smoking. The strong relationship is likely to be due to a combination of underlying individual constitutional factors and drug-specific effects resulting from consumption over the period of adolescent development and growth.

Smoking, stress, and negative affect: correlation, causation, and context across stages of smoking

This transdisciplinary review of the literature addresses the questions, Do stress and negative affect (NA) promote smoking? and Does smoking genuinely relieve stress and NA? Drawing on both human and animal literatures, the authors examine these questions across three developmental stages of smoking--initiation, maintenance, and relapse. Methodological and conceptual distinctions relating to within- and between-subjects levels of analyses are emphasized throughout the review. Potential mechanisms underlying links between stress and NA and smoking are also reviewed. Relative to direct-effect explanations, the authors argue that contextual mediator-moderator approaches hold greater potential for elucidating complex associations between NA and stress and smoking. The authors conclude with recommendations for research initiatives that draw on more sophisticated theories and methodologies.

Patterns of co-morbidity between alcohol use and other substance use in the Australian population

The present study describes patterns of co-morbidity between alcohol use and other substance use problems in the Australian population using data from the 1997 National Survey of Mental Health and Well-Being. Multiple regression analyses examined whether the observed associations between alcohol and other drug use disorders were explained by other variables, including demographic characteristics and neuroticism. We also assessed whether the presence of co-morbid substance use disorders affected treatment seeking for a mental health problem. Alcohol use was related strongly to the use of other substances. Those who did not report alcohol use within the past 12 months were less likely to report using tobacco, cannabis, sedatives, stimulants or opiates. Higher rates again were observed among those with alcohol use disorders: half (51%) of those who were alcohol-dependent were regular tobacco smokers, one-third had used cannabis (32%); 15% reported other drug use; 15% met criteria for a cannabis use disorder and 7% met criteria for another drug use disorder. These associations were not accounted for by the demographic and other variables considered here. Co-morbid substance use disorders (sedatives, stimulants or opioids) predicted a high likelihood of seeking treatment for a mental health problem among alcohol-dependent people.

Is there a role for assessment in smoking cessation treatment?

Recent strides have been made in smoking cessation as a number of behavioral and pharmacological treatments have proven effective. These treatments are briefly reviewed. The role of assessment in the treatment process, however, is less clear. Indeed, to date, there are few data suggesting that specialized assessment can be used to guide prescriptive treatment. As such, the question becomes one of how, or whether, assessment should be used in smoking cessation. We address these questions and argue that despite the dearth of empirical substantiation, certain aspects of smoking behavior should be assessed in that they: (1) help identify behavioral, physiological, and psychological conditions that maintain smoking, (2) help describe the problem (smoking) with enough clarity to foster both clinical understanding and diagnosis, and (3) offer prediction and evaluation of treatment process and outcome. Promising assessment-based treatments are also discussed, as well as recommendations for future directions pertaining to the role of assessment in smoking cessation.

Current perspectives on smoking cessation among substance abusers

The prevalence of nicotine dependence among alcohol or other substance abusers is extremely high, and surveys have revealed that many patients in drug or alcohol treatment programs are interested in smoking cessation. However, smoking cessation has not been a traditional focus in clinical interventions for this population. Recent evidence from clinical trials among individuals abusing alcohol, marijuana, cocaine, or opioids have shown the following: 1) smokers with a past but not current history of alcohol dependence have a similar rate of success compared with non-alcoholic smokers; 2) tobacco abstinence does not increase alcohol relapse; 3) continued smoking adversely affects treatment for marijuana dependence; 4) patterns of cocaine and nicotine use are interrelated; 5) smoking cessation rates among opioid-dependent individuals are several times lower than in the general US population. Smoking cessation is indicated for substance dependent persons already in recovery and may protect against relapse to the illicit drug of abuse.

The genetics of tobacco use: methods, findings and policy implications

Research on the genetics of smoking has increased our understanding of nicotine dependence, and it is likely to illuminate the mechanisms by which cigarette smoking adversely effects the health of smokers. Given recent advances in molecular biology, including the completion of the draft sequence of the human genome, interest has now turned to identifying gene markers that predict a heightened risk of using tobacco and developing nicotine dependence

Anxiety, affect, and activity in teenagers: monitoring daily life with electronic diaries

OBJECTIVE

The everyday experiences of a community sample of adolescents differing in anxiety level were compared by means of electronic diaries.

METHOD

One hundred fifty-five ninth-grade adolescents completed electronic diaries every 30 minutes for two 4-day intervals, reporting their moods, activities, social settings, dietary intake, smoking, and alcohol use. Teenagers were stratified into low-, middle-, or high-anxiety groups on the basis of diary ratings and, separately, questionnaire scores.

RESULTS

High-anxiety teenagers, compared with low-anxiety teenagers, expressed higher levels not only of anxiety and stress but also of anger, sadness, and fatigue, along with lower levels of happiness and well-being. They reported fewer conversations and less recreational activity relative to achievement-oriented pursuits, stronger eating and smoking urges, and more tobacco use. There were few gender differences. Despite a tendency to spend less time with peers, high-anxiety teenagers were more likely to show reduced anxiety when in the company of friends. Sharper differentiations among anxiety subgroups emerged when stratification was based on diary reports rather than on questionnaire scores.

CONCLUSION

Even when anxiety problems fall below diagnostic thresholds, the daily lives of anxious adolescents differ meaningfully from those of their peers in affective, behavioral, and contextual domains.