Tobacco Use Disorder

Tobacco Use Disorder (TUD) is the major cause of morbidity and mortality among people with mental illnesses, including substance disorders (SUD). Reasons for this include the inherent toxicity of chemicals in smoke, coupled with the fact that two to four times as many individuals with a mental illness, compared to the general population, are smokers. There is also evidence that smokers with mental illnesses have, on average, higher levels of nicotine dependence, and more intense withdrawal symptoms, than smokers without these conditions. Furthermore, the high cost of cigarettes poses a serious economic drain for regular smokers.

The recommended treatment for TUD is a combination of both medication and counseling to quit smoking. The seven FDA-approved medications include five nicotine replacement treatments and two non-nicotine drugs. Because decreasing or quitting smoking may induce distressing withdrawal symptoms, it is necessary to provide medications during tapering and cessation attempts as well as in settings where tobacco use is restricted, such as hospitals and other public places.

Only 1 in 4 US mental health programs offers smoking cessation treatment. Other barriers to accessing appropriate treatment for TUD in New Jersey include lack of adequate insurance coverage or onerous restrictions for medication, as well as for counseling under Medicaid, by far the major provider of mental health and SUD coverage, and other insurance plans.

Recommendations:

  1. Offer treatment to all individuals regularly using tobacco, for TUD, a diagnosable disorder.
  2. Provide medication during periods of temporary abstinence to prevent tobacco withdrawal distress.
  3. Offer expanded education about TUD by the field of medicine to physicians and mental health professionals.
  4. Provide leadership to establish tobacco-free environments whenever possible.
  5. Expand the NJ Medicaid benefit for TUD and require all other insurance plans to do the same. This includes adequate reimbursement for tobacco counseling and removal of barriers to accessing all of the seven (7) FDAapproved medications which are prescribed to aid in quitting smoking.

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