WA State Department of Health: Marijuana Facts and the Sources used to help implement a plan to keep youth safe.

The state of Washington is confronted with the legalized recreational use of marijuana, through Initiative 502. The general consensus among health, safety and substance abuse professionals throughout Washington State is that under-age marijuana use[1] and use of marijuana by pregnant and breastfeeding mothers[2] is harmful and addictive[3], smoke (of any kind) is harmful to a person’s health,[4] and there are risks associated with driving while under the influence of marijuana. [5]

[1] Use of marijuana by youth is harmful an addictive. 1.) Escalation of Drug Use in Early-Onset Cannabis Users vs Co-twin Controls, (2003). Michael T. Lynskey, PhD; Andrew C. Heath, DPhil; Kathleen K. Bucholz, PhD; Wendy S. Slutske, PhD; Pamela A. F. Madden, PhD; Elliot C. Nelson, MD; Dixie J. Statham, MA; Nicholas G. Martin, PhD JAMA. 2003; 289(4):427-433. doi:10.1001/jama.289.4.427. 2.) The Teen Brain on Marijuana, (2012). Sion Kim Harris, PhD, Center for Adolescent Substance Abuse Research, Boston Children’s Hospital, Harvard Medical School.

[2] Use of marijuana by pregnant and breast feeding mothers is harmful. 1.) Trezza, V.; Campolongo, P.; Cassano, T.; Macheda, T.; Dipasquale, P.; Carratu, M.R.;Gaetani, S.; Cuomo, V. Effects of perinatal exposure to delta-9- tetrahydrocannabinol on the emotional reactivity of the offspring: A longitudinal behavioral study in Wistar rats. Psychopharmacology (Berl) 198(4):529–537, 2008. 2.) Schempf, A.H., and Strobino, D.M. Illicit drug use and adverse birth outcomes: Is it drugs or context? J Urban Health 85(6):858–873, 2008. 3.) Effects of Marijuana on the Fetus and Breastfeeding Infants. Source: Texas Tech Health Sciences University website http://www.infantrisk.com/,9.18.12 4.) Garry, et al, (2009). Cannibis and breastfeeding. Journal of Toxicology. Doi: 10.1155/2009/596149 5.) Miller, Clinical Lactation, 2012, Vol. 3-3, 102-107

[3] Marijuana is addictive. 1.) Anthony, J.; Warner, L.A.; and Kessler, R.C. Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. 2.) Exp Clin Psychopharmacol 2:244–268, 1994. Hall, W.; and Degenhardt, L. Adverse health effects of non-medical cannabis use. Lancet 374:1383–1391, 2009. 3.) Hall, W. The adverse health effects of cannabis use: What are they, and what are their implications for policy? Int J of Drug Policy 20:458–466, 2009

[4] Smoke (of any kind) is harmful to a person’s health. 1.) http://www.lung.org/healthy-air 2.) http://www.cdc.gov/tobacco/campaign/tips/ 3.) National Institute on Drug Abuse. DrugFacts: Marijuana. Revised November 2010.
[5] There are risks associated with driving under the influence of marijuana. 1.) Richer, I., and Bergeron, J. Driving under the influence of cannabis: Links with dangerous driving, psychological predictors, and accident involvement. Accid Anal Prev 41(2):299–307, 2009. 2.) O’Malley, P.M., and Johnston, L.D. Drugs and driving by American high school seniors, 2001–2006. J Stud Alcohol Drugs 68(6):834–842, 2007.
[6] Informed by key elements of Evidence-Based Approach in Public Health Practice, (EBPH) published by Julie A. Jacobs, MPH; Ellen Jones, PhD; Barbara A. Gabella, MSPH; Bonnie Spring, PhD; Ross C. Brownson, PhD in support of the Centers for Disease Control and Prevention. Framework for program evaluation in public health. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4811a1.htm. Accessed March 7, 2012. PubMed
[7] 2014 WA State Revenue Forecast http://www.erfc.wa.gov/forecast/revenueForecast.shtml
[8] Office of Juvenile Justice Definition of Minor: A youth under the age of full legal responsibility in a particular state. In Washington State a minor is defined as a youth under the age of 18 years old. However, the legal age to use recreational marijuana is 21 years old. Per this document, youth is defined as those 12-20 years of age.
[9] CSAP Strategic Prevention Framework and Six Prevention Strategies http://www.samhsa.gov/prevention

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Help reduce prescription drug abuse…Take Back Your Meds

“More people died from drug overdoses in 2014 than in any year on record. The majority of drug overdose deaths (more than six out of ten) involve an opioid.1 And since 1999, the number of overdose deaths involving opioids (including prescription opioid pain relieversand heroin) nearly quadrupled.2 From 2000 to 2014 nearly half a million people died from drug overdoses. 78 Americans die every day from an opioid overdose.

We now know that overdoses from prescription opioid pain relievers are a driving factor in the 15-year increase in opioid overdose deaths. Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled,2 yet there has not been an overall change in the amount of pain that Americans report.3,4 Deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have also quadrupled since 1999.” cdc.gov

SEATTLE, November 28, 2016 – The Washington Poison Center (WAPC) announced that it is now the owner and curator of the statewide medication return website, http://www.takebackyourmeds.org/ and its social media pages. In an effort to increase awareness and expand its use across Washington State, the WAPC will incorporate Take Back Your Meds into existing statewide education outreach programs and harm reduction efforts as well as future stewardship and growth.

Currently, pharmaceutical substances account for about half of all exposure calls to the Washington Poison Center, and poisoning/overdose remains the number one cause of unintentional death in Washington state and in the U.S.. “Handling over 35,000 drug cases annually and employing two full time public health educators based in Seattle and Spokane, the Take Back Your Meds program aligns with our mission to reduce the harm caused by poisonings. It is reinforced by existing programs, services, and education outreach WAPC delivers statewide to people of all ages,” said Washington Poison Center’s Medical & Executive Director, Dr. Erica Liebelt.

Takebackyourmeds.org helps Washington state residents locate pharmacy and law enforcement locations to dispose of their unused, unwanted, and/or expired medications. Eliminating excess medication from the home can reduce the potential for unintentional injury or misuse and abuse. Promoting secure medication takeback and safe medication disposal are vital components of an overall order by Governor Inslee to address the opioid crisis nationwide and here in Washington State.

Since taking ownership of the page, the WAPC has updated the website content to include an interactive map of take back location, allowing Washingtonians to quickly locate medication return sites near them. This map also differentiates between locations that accept controlled and non-controlled substances. In addition, the site includes tips on safe storage and disposal.

Visit http://www.takebackyourmeds.org/ to find a take back location and connect with Take Back Your Meds on Facebook(@takebackyourmeds) and Twitter (@takebackurmeds).

For full article click here

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Marijuana Facts

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SJIPC Community Survey 2016

Please take a few minutes to add your insight and thoughts on our annual community survey, as it pertains to prevention, especially as we work to protect our youth from underage substance abuse. This anonymous survey is offered through the State and your answers help us, to help our community. This survey is for San Juan Island Residents. Thank you.
ONLINE SURVEY ENGLISH
ONLINE SURVEY SPANISH
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SAM (Smart Approaches to Marijuana)

Marijuana and Health

Addiction


• 1 in 10 people who try marijuana will become addicted to it, developing a dependence that produces withdrawal, cravings.

• If marijuana use starts in adolescence, the chances of addiction are 1 in 6.i

• Long-term studies from the USA and New Zealand have shown that regular cannabis smokers report more symptoms of chronic bronchitis than non- smokers.ii

• And today’s marijuana is not the marijuana of the 1960s; potency has tripled in the past 15 years, according to a 2009 report from the U.S. government. It has grown 5 times since 1960.

• In the U.S. since 1990, more people have gone to the emergency room after using marijuana even though the overall numbers of marijuana users has remained relatively stable.iii

• In the U.S., cannabis emergency rates have been rising sharply for cannabis- related admissions. Visits to hospital emergency departments because of cannabis use have risen from an estimated 16,251 visits in 1991 to more than 374,000 in 2008.iv

The Brain and Mental Health

• Marijuana use directly affects the brain, specifically the parts of the brain responsible for memory, learning, attention, and reaction time. These effects can last up to 28 days after abstinence from the drug.v

• Science confirms that the adolescent brain, particularly the part of the brain that regulates the planning complex cognitive behavior, personality expression, decision-making and social behavior, is not fully developed until the early to mid-20s. Developing brains are especially susceptible to all of the negative effects of marijuana and other drug use.vi

• Marijuana use is significantly linked with mental illness, especially schizophrenia and psychosis, but also depression and anxiety.vii

The Heart

• Marijuana use can cause an increase in the risk of a heart attack more than four-fold in the hour after use, and provokes chest pain in patients with heart disease.viii

The Lungs

• Research has shown marijuana smoke to contain carcinogens and to be an irritant to the lungs, resulting in greater prevalence of bronchitis, cough, and phlegm production.ix

• Marijuana smoke, in fact, contains 50-70 percent more carcinogenic hydrocarbons than tobacco smoke.x

• Evidence linking marijuana and lung cancer are mixed, with a recent study stating that “cannabis smoking increases the risk of developing a lung cancer independently of an eventual associated tobacco exposure.”xi Other studies have failed to find such a link.xii

• Marijuana smoke also includes an enzyme that converts some hydrocarbons into a cancer-causing form, potentially accelerating the changes that produce malignant cells.xiii

• Mark Gold, perhaps the most distinguished professor in the country on drugs and the brain and body, said, “It is possible, but not proven, that cannabis smoke may be less toxic than cigarette smoke, but it is not better than clean air. Clear, unbiased, and convincing evidence of safety and comparable efficacy are needed for therapeutic claims. It is smoke, after all.” “Columbus brought Tobacco to the ‘New World’ and it took nearly 500 years for absolute proof of tobacco smoke dangerousness to be established,” Gold continued. “To this day, each year, over 400,000 United States deaths are due to tobacco smoke.

Pregnancy

• Marijuana smoking during pregnancy has been shown to decrease birth weight, most likely due to the effects of carbon monoxide on the developing fetus.xiv

IQ, Learning, and Job Performance

• One of the most well designed studies on marijuana and intelligence, released in 2012, found that persistent, heavy use of marijuana by adolescents reduces IQ by as much as eight points, when tested well into adulthood.xv

• Other studies have found that marijuana use is linked with dropping out of school, and subsequent unemployment, social welfare dependence, and a lower self-reported quality of life than non-marijuana abusing people.xvi

• According to the U.S. National Survey on Drug Use and Health, youth with poor academic results were more than four times as likely to have used marijuana in the past year than youth with an average of higher grades. This is consistent with an exhaustive meta-analysis examining forty-eight different studies by Macleod and colleagues, published by Lancet, who found that marijuana use is consistently associated with reduced grades and a reduced chance of graduating from school.xvii

• In addition, studies have linked employee marijuana use with “increased absences, tardiness, accidents, workers’ compensation claims, and job turnover.”xviii

i Wagner, F.A. & Anthony, J.C. From first drug use to drug dependence; developmental periods of risk for dependence upon cannabis, cocaine, and alcohol. Neuropsychopharmacology 26, 479-488 (2002).

ii Tetrault, J. M., Crothers, K., Moore, B. A., Mehra, R., Concato, J., & Fiellin, D. A. (2007). Effects of marijuana smoking on pulmonary function and respiratory complications. Archives of Internal Medicine, 167(3):221-228.

iii Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2011). Drug Abuse Warning Network, 2008: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. SMA 11-4618. Rockville, MD.

iv Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2011). Drug Abuse Warning Network, 2008: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. SMA 11-4618. Rockville, MD.

v Hall W & Degenhard L (2009). Adverse health effects of non-medical cannabis use. Lancet, 374:1383-1391

vi Giedd. J. N. (2004). Structural magnetic resonance imaging of the adolescent brain. Annals of the New York Academy of Sciences, 1021, 77-85.

vii Moore TH, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: A systematic review. Lancet 370(9584):319–328, 2007. Also Large, M., Sharma S, Compton M., Slade, T. & O., N. (2011). Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Archives of General Psychiatry. 68. Also see Arseneault L, et al. (2002). Cannabis use in adolescence and risk for adult psychosis: longitudinal prospective study. British Medical Journal. 325, 1212-1213.

viii Hall W & Degenhard L (2009). Adverse health effects of non-medical cannabis use. Lancet, 374:1383-1391.

ix Tetrault, J.M., et al. Effects of cannabis smoking on pulmonary function and respiratory complications: a systematic review. Arch Intern Med 167, 221-228 (2007).

x Hoffman, D.; Brunnemann, K.D.; Gori, G.B.; and Wynder, E.E.L. On the carcinogenicity of marijuana smoke. In: V.C. Runeckles, ed., Recent Advances in Phytochemistry. New York: Plenum, 1975.

xi Brambilla, C., & Colonna, M. (2008). Cannabis: The next villain on the lung cancer battlefield? European Respiratory Journal, 31:227-228.

xii Bello, D. (2006). Large study finds no link between marijuana and cancer. Scientific American, Available at: http://www.scientificamerican.com/article.cfm?id=large-study-finds-no-link

xiii Tashkin, D. P. (1999). Effects on marijuana on the lung and its defenses against infection and cancer. School Psychology International, 20(1):23-37.

xiv Hall W & Degenhard L (2009). Adverse health effects of non-medical cannabis use. Lancet, 374:1383-1391.

xv Meier et al. (2012). Persistent cannabis users show neuropsychological decline from childhood to midlife. Proceedings of the National Academy of Sciences.

xvi Fergusson, D. M. and Boden, J. M. (2008), Cannabis use and later life outcomes. Addiction, 103: 969–976.

xvii Macleod, J.; Oakes, R.; Copello, A.; Crome, I.; Egger, M.; Hickman, M.; Oppenkowski, T.; Stokes- Lampard, H.; and Davey Smith, G. Psychological and social sequelae of cannabis and other illicit drug use by young people: A systematic review of longitudinal, general population studies. Lancet 363(9421):1579-1588, 2004.

xviii National Institute on Drug Abuse (NIDA). (2011). Research Report Series: Cannabis Abuse. Accessed November 2011 at http://www.drugabuse.gov/ResearchReports/Cannabis/cannabis4.html

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Vaping Info…

“New data from the U.S. Centers for Disease Control and Prevention (CDC) show that more teens have an electronic cigarette habit than ever before.

According to the CDC, in 2015 one in four high school students and one in 13 middle school students in the U.S. reported using some type of tobacco products at least one day in the previous month. This adds up to 4.7 million students who did some type of vaping, toking or smoking, according to the CDC’s Morbidity and Mortality Weekly Report, published online on April 15.”  4/15/16 NEWSWEEK

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Board of Trustees Meeting Oct. 21st, 2016

Interested in helping Prevent Underage Substance Abuse in our Community? Want to help create a Community Culture that supports healthy choices for youth and adults in our community? Join us at the table, for a light lunch and conversations and action steps to be the change…

We thank Friday Harbor Presbyterian Church for allowing us the use of their space. We meet in the main hall. Lunch starts at 11:30am. Meeting is 12noon-2pm. All welcome. Please RSVP 378-9683

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#PreventRxAbuse

More than 1/2 of non-medical drug users get medicine from family or friends. Not drug dealers. #PreventRxAbuse

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The tobacco industry has long targeted people with mental illness. As a result, they suffer from disproportionately high tobacco use and its health consequences. #WorldMentalHealthDay

Shared from Campaign for Tobacco-Free Kids

TOBACCO USE AND MENTAL HEALTH

Despite reductions in smoking prevalence achieved since the first Surgeon General’s report on the consequences of smoking in 1964, smoking remains the leading cause of preventable death in the United States.1 Smoking accounts for more than 480,000 deaths in the United States each year, and is a major risk factor for the four leading causes of death: heart disease, cancer, chronic obstructive pulmonary disease, and stroke.2 Many subpopulations, including those with mental illness, continue to suffer from disproportionately high tobacco use and its associated health consequences.

Tobacco Use Among Persons with Mental Illness

According to data from the 2009-2011 National Survey on Drug Use and Health (NSDUH), 36.1% of adults with any mental illness were current smokers*, compared to 21.4% of adults without any mental illness. Further, about three out of ten smokers (29.5%) have a mental illness. Among those with mental illness, current smoking was even higher among men, those under age 45, and those living below the federal poverty line. Nearly half of adults with mental illness living below the poverty line are current smokers. 3 In addition to having higher smoking rates, adults with mental illness also tend to be heavier smokers.4 According to NSDUH, nearly one- third (31%) of cigarettes smoked by adults are smoked by those with mental illness.5

It is important to note that most data on the smoking prevalence of those with mental illness are limited by the exclusion of those who are institutionalized—either in treatment or incarcerated†—and those experiencing homelessness. Research estimates that between a quarter and a third of the chronically homeless are mentally ill.6 Finally, given that NSDUH’s definition of any mental illness excludes substance abuse, these rates likely underestimate smoking among the adult population with mental illness. Other data from NSDUH has indicated that those who have received treatment for a substance use disorder are three times more likely to be current smokers.7

Data on smoking rates among youth with mental illness is very limited, and is not reported in nationally representative datasets. However, some research suggests that smoking prevalence follows patterns similar to adults with mental illness, with findings ranging from 20-60% of youth with mental illness reporting tobacco use.8

Health and Economic Consequences of Tobacco Use Among Persons with Mental Illness

Smoking accounts for more than 480,000 deaths in the United States each year, and is a major risk factor for the four leading causes of death: heart disease, cancer, chronic obstructive pulmonary disease, and stroke.9 It is estimated that over 40 percent (around 200,000) of these deaths are among persons with mental illness or substance abuse.10 According to one study, persons with serious mental illness die, on average, 25 years prematurely, primarily due to chronic illness, including tobacco-related disease.11 In addition, smoking may interfere with many prescription medications commonly used to treat mental illness by reducing the therapeutic blood levels of certain psychotropic medications, thereby undermining their effectiveness.12

In addition to the tremendous burdens that persons with mental illness often face, such as higher rates of unemployment, victimization, homelessness, poverty, incarceration and social isolation, smoking adds a significant financial burden.13 For example, persons with schizophrenia have been found to spend 27% of their

* NSDUH defines any mental illness as “having a mental, behavioral, or emotional disorder, excluding developmental and substance use disorders, in the past 12 months” and defines current smoking as “smoking all or part of a cigarette within the 30 days preceding the interview.”
† Tobacco sales have been banned in prison commissaries since 2006. In January 2015, the Federal Bureau of Prisons prohibited tobacco use in any form except as part of religious activity; however, staff and visitors may smoke in designated smoking areas except where prohibited by state or local law. While smoking cessation programs are sometimes available to prisoners, no financial support is provided to prisoners for nicotine replacement therapy. Further, contraband cigarettes continue to be a problem for US prisons. See http://www.no-smoke.org/pdf/100smokefreeprisons.pdf for more information.

1400 I Street NW – Suite 1200 – Washington, DC 20005
Phone (202) 296-5469 · Fax (202) 296-5427 · www.tobaccofreekids.org

income on cigarettes.14 Similarly, these stressful conditions can also make it harder for persons with mental illness to quit smoking and limit their access to cessation services.

Tobacco Industry Targeting of Persons with Mental Illness

The tobacco industry is infamous for targeting its products to vulnerable populations, and the mentally ill are no exception. Examination of tobacco industry documents found that in the 1980s and 1990s, the tobacco industry targeted some psychiatric hospitals with sales promotions and giveaways of value brand cigarettes. There is also evidence of mental health institutions and treatment facilities soliciting financial donations and donation of cigarettes from the tobacco industry.15 The tobacco industry has fought restrictions on smoking bans in hospitals and medical facilities—specifically psychiatric institutions.16 Finally, the industry has funded a substantial body of research in its attempts to assert that smoking is both less harmful to those with schizophrenia and that it is a necessary self-medication tool.17

Industry targeting of the homeless population—who are disproportionately burdened by mental illness—has been even more flagrant, including donation of cigarettes to homeless shelters by Lorillard and donation of blankets branded with Phillip Morris’ Merit logo to homeless shelters. RJ Reynolds’ urban marketing plan in the 1990s specifically focused on targeting value brands to “street people.”18

Helping Persons with Mental Illness Quit Smoking

Given that one in five adults in the US—over 45 million people19—have some form of mental illness, addressing the disparately high smoking rate in this population is critical. Services and policies to help people quit using tobacco consist of a variety of evidence-based, individual and population-level approaches aimed at reducing the toll of tobacco use by helping users quit. According to the U.S. Public Health Service Clinical Practice Guideline, tobacco cessation treatments are effective across a broad range of populations. It is critical that health care providers screen for tobacco use and provide advice to quit to tobacco users.20

Unfortunately, persons with mental illness have lower quit rates than the rest of the population. The National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative longitudinal study, found that persons with a psychiatric diagnosis‡ were 25% less likely to successfully quit.21 However, many studies find that quit intentions are just as high, if not higher, among those with mental illness than the general population.22 Further, while at the population level, persons with mental illness have lower quit rates, studies show they can achieve equal quit rates with access to appropriate cessation services.23

Myths abound that smoking is an important stress coping mechanism for those with mental illness, and therefore smoking cessation is often deprioritized by mental health providers.24 While providers should closely monitor mental health patients pursuing smoking cessation, evidence does not point to smoking cessation as disruptive to mental health treatment.25 Randomized controlled trials have shown that smoking cessation treatment among patients receiving mental health treatment is effective and does not exacerbate mental health symptoms or lead to increased use of alcohol or illicit drugs.26 Further, studies have consistently found that smoking cessation is actually associated with reduced depression, anxiety and stress, as well as improved quality of life.27 As such, both the CDC and the American Psychiatric Association (APA) encourage integration of cessation treatment with mental health services.28 Unfortunately, a 2006 study of over 800 practicing psychiatrists found that only 23% recommended nicotine replacement therapy and even fewer (11%) provided referrals, despite self-reporting greater prevalence of smoking in their patient population than other practitioners. Only 62% of psychiatrists had advised smoking patients to quit, as compared to 93% of internal medicine providers.29 Further, only a quarter (24.2%) of mental health centers and less than half (46%) of substance abuse treatment centers offer cessation services.30

In addition to individual level treatment, the adoption of consistent tobacco prevention policies across mental health and substance abuse treatment contexts could help encourage cessation among those with mental illness. Effective in 1993, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) set smoke-free standards for hospitals; however, mental health advocacy organizations successfully fought for the exclusion of psychiatric inpatient units and substance use facilities from this standard.31 Further, some

‡ Categorized as those with any lifetime or past year psychiatric diagnosis as defined by the DSM-IV. This definition includes a broader definition than defined by NSDUH data.

Tobacco Use and Mental Health / 2

outpatient mental health patients still use cigarette provision or cigarette breaks as incentives for treatment compliance.32 While many mental health facilities have subsequently implemented smoke-free policies, there is still progress to be made. The 2014 Surgeon General’s Report, The Health Consequences of Smoking—50 Years of Progress, concluded that “exposure to secondhand tobacco smoke has been causally linked to cancer, respiratory, and cardiovascular diseases, and to adverse effects on the health of infants and children.” Further, the report concluded that smoke-free laws are proven to encourage smokers to quit.33 As previously noted, smoke-free policies should be coupled with the integration of smoking cessation services and mental health treatment to prevent relapse when patients leave care.

Campaign for Tobacco-Free Kids, September 22, 2015 / Laura Bach

Additional Sources of Information

  • Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers, http://www.integration.samhsa.gov/Smoking_Cessation_for_Persons_with_MI.pdf
  • Tobacco-Free Living in Psychiatric Settings: A Best Practices Toolkit Promoting Wellness and Recovery, http://www.integration.samhsa.gov/pbhci-learning-community/Tobacco- Free_Living_in_Psychiatric_Settings_Toolkit.pdf
  • National Behavioral Health Network, http://bhthechange.org/
  • Action to Quit: Behavioral Health, http://actiontoquit.org/populations/behavioral-health/1 Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service, PHS publication 1103, 1964, http://www.cdc.gov/tobacco/sgr/sgr_1964/sgr64.htm. McGinnis, JM, et al., “Actual causes of death in the United States,” Journal of the American
    Medical Association (JAMA) 270:2207-2212, 1993.
    2 HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/. CDC, “Deaths: Leading Causes for 2010,” Table D, National Vital Statistics Reports, 62(6), December 20, 2013, http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_06.pdf.3 Centers for Disease Control and Prevention (CDC), “Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years with Mental Illness— United States, 2009-2011,” Morbidity and Mortality Weekly Report, 62(5): 81-87, 2013.
    4 See e.g., “Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years with Mental Illness—United States, 2009-2011,” Morbidity and Mortality Weekly Report, 62(5): 81-87, 2013. Lasser, K, et al., “Smoking and Mental Illness: A Population-Based Prevalence Study,” Journal of the American Medical Association, 284(2): 2606-2610, 2000.

    5 CDC, “Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years with Mental Illness—United States, 2009-2011,” Morbidity and Mortality Weekly Report, 62(5): 81-87, 2013.
    6 SAMHSA, “Current Statistics on the Prevalence and Characteristics of People Experiencing Homelessness in the United States,” July 2011, http://homeless.samhsa.gov/ResourceFiles/hrc_factsheet.pdf.

    7 SAMHSA, “Nicotine Dependence among Persons Who Received Substance Use Treatment,” The NSDUH Report, June 23, 2011. http://archive.samhsa.gov/data/2k11/WEB_SR_031/WEB_SR_031.htm.
    8 See e.g., DeHay, T, et al., “Tobacco use in youth with mental illnesses,” Journal of Behavioral Medicine, 35: 139-148, 2012; Upadhyaya, H, et al., “Psychiatric disorders and cigarette smoking among child and adolescent psychiatry inpatients,” American Journal on Addictions, 12: 144-152, 2003. MacPherson, L, et al., “Association of post-treatment smoking change with future smoking and cessation efforts among adolescents with psychiatric comorbidity,” Nicotine & Tobacco Research, 9: 1297-1307, 2007. Morris, CD, et al., “Predictors of tobacco use among persons with mental illnesses in a statewide population,” Psychiatric Services, 42: 393-402, 2006.
    9 HHS, The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014, http://www.surgeongeneral.gov/library/reports/50-years-of-progress/. CDC, “Deaths: Leading Causes for 2010,” Table D, National Vital Statistics Reports, 62(6), December 20, 2013, http://www.cdc.gov/nchs/data/nvsr/nvsr62/nvsr62_06.pdf.
    10 See, e.g., Grant, B, et al., “Nicotine Dependence and psychiatric disorders in the United States: Results from the National Epidemiological Survey on Alcohol and Related Conditions,” Archives of General Psychiatry, 61(11): 1107-1114, 2004.Schroeder, SA, et al., “Confronting a Neglected Epidemic: Tobacco Cessation for Persons with Mental Illnesses and Substance Abuse Problems,” Annual Review of Public Health, 31: 297-314, 2010.
    11 Colton, CW, et al., “Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states,” Preventing Chronic Disease, 3: A42, 2006.
    12 See e.g., Zevin, S, et al., “Drug interactions with tobacco smoking. An Update,” Clinical Pharmacokinetics, 36: 425-438, 1999.
    13 CDC, “Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years with Mental Illness—United States, 2009-2011,” Morbidity and
    Mortality Weekly Report, 62(5): 81-87, 2013.
    14 Steinberg, ML, et al., “Financial implications of cigarette smoking among individuals with schizophrenia,” Tobacco Control, 13: 206, 2004.
    15 Apollonio, DE, et al., “Marketing to the marginalized: tobacco industry targeting of the homeless and mentally ill,” Tobacco Control, 14: 409-415, 2005. 16 Prochaska, JJ, et al., “Tobacco Use Among Individuals With Schizophrenia: What Role Has the Tobacco Industry Played?” Schizophrenia Bulletin, 34(3): 555-567, 2008.
    17 Prochaska, JJ, et al., “Tobacco Use Among Individuals With Schizophrenia: What Role Has the Tobacco Industry Played?” Schizophrenia Bulletin, 34(3): 555-567, 2008. See also Hirshbein, L, “Scientific Research and Corporate Influence: Smoking, Mental Illness and the Tobacco Industry,” Journal of the History of Medicine and Allied Sciences, 2011.
    18 Apollonio, DE, et al., “Marketing to the marginalized: tobacco industry targeting of the homeless and mentally ill,” Tobacco Control, 14: 409-415, 2005.

Tobacco Use and Mental Health / 3

19 Centers for Disease Control and Prevention (CDC), “Adult Smoking: Focusing on People with Mental Illness,” CDC Vital Signs, February 2013. 20 Fiore, MC, et al., Treating Tobacco Use and Dependence: 2008 Update—Clinical Practice Guideline, U.S. Department of Health and Human Services. Public Health Service, May 2008, http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf.

21 Smith, PH, et al., “Smoking and mental illness in the US population,” Tobacco Control, published online on April 12, 2014.

22 See e.g., Joseph, AM, “A randomized controlled trial of concurrent versus delayed smoking intervention for patients in alcohol dependence treatment,” Journal of Abnormal Psychology, 111(4): 670-675, 2004. Prochaska, JJ, et al., “Depressed smokers and stage of change: implications for treatment interventions,” Drug and Alcohol Dependence, 76(2): 143-151, 2007.
23 Hickman, NJ, et al., “Treating Tobacco Dependence at the Intersection of Diversity, Poverty, and Mental Illness: A Randomized Feasibility and Replication Trial,” Nicotine & Tobacco Research, 17(8): 1012-1021, 2015.
24 Prochaska, JJ, “Smoking and Mental Illness—Breaking the Link,” New England Journal of Medicine, 365(3): 196-198, 2011.
25 See e.g., Prochaska, JJ, “Smoking and Mental Illness—Breaking the Link,” New England Journal of Medicine, 365(3): 196-198, 2011. Prochaska, JJ, “Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction?” Drug and Alcohol Dependence, 110(3): 177- 182, 2010.
26 See e.g., Hall, SM, et al., “Treatment of smokers with co-occurring disorders: emphasis on integration in mental health and addiction treatment settings,” Annual Review of Clinical Psychology, 5: 555-567, 2009. Cavazos-Rehg, et al., “Smoking cessation is associated with lower rates of mood/anxiety and alcohol use disorders,” Psychological Medicine, 44(12): 2523-2535, 2014. Prochaska, JJ, et al., “A Meta-Analysis of Smoking Cessation Interventions With Individuals in Substance Abuse Treatment or Recovery,” Journal of Consulting and Clinical Psychology, 72(6): 1144-1156, 2004.
27 Taylor, G., “Change in mental health after smoking cessation: systematic review and meta-analysis,” BMJ, 348, 2014.
28 CDC, “Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years with Mental Illness—United States, 2009-2011,” Morbidity and Mortality Weekly Report, 62(5): 81-87, 2013.
29 Association of American Medical Colleges. Physician Behavior and Practice Patterns Related to Smoking Cessation. http://www.legacyforhealth.org/content/download/566/6812/file/Physicians_Study.pdf.
30 SAMHSA, “About 1 in 4 Mental Health Treatment Facilities Offered Services to Quit Smoking,” The N-MHSS Report, November 25, 2014 http://www.samhsa.gov/data/sites/default/files/Spot148_NMHSS_Smoking_Cessation/Spot148_NMHSS_Smoking_Cessation.pdf. Data from the 2010 National Mental Health Services Survey (N-MHSS). See also SAMHSA, “Nearly Half of Substance Abuse Treatment Facilities Offer Counselign or Medication to Help Clients Quit Tobacco Use,” The N-SSATS Report, June 17, 2014. http://www.samhsa.gov/data/sites/default/files/NSSATS_Spot142_TobCes_06-10-14/NSSATS-Spot142-TobCess-2014.pdf. Data from the 2012 National Survey of Substance Abuse Treatment Services (N-SSATS).
31 Prochaska, JJ, et al., “Tobacco Use Among Individuals With Schizophrenia: What Role Has the Tobacco Industry Played?” Schizophrenia Bulletin, 34(3): 555-567, 2008.
32 Prochaska, JJ, “Smoking and Mental Illness—Breaking the Link,” New England Journal of Medicine, 365(3): 196-198, 2011.
33 U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014. http://www.surgeongeneral.gov/library/reports/50-years-of-progress/index.html

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Resources available…Drug addiction and mental health issues such as depression often co-occur.

Brief Description

The term “comorbidity” describes two or more disorders or illnesses occurring in the same person. They can occur at the same time or one after the other. Comorbidity also implies interactions between the illnesses that can worsen the course of both. Learn more

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Comorbidity: Addiction and Other Mental Illnesses

Published December 2008Revised September 2010. Introduces a report that focuses on the topic of comorbid drug use disorders and other mental illnesses, a research priority for NIDA.

Comorbidity: Addiction and Other Mental Disorders

Revised March 2011. Offers basic facts about comorbidity between drug use disorders and other mental illnesses, including why these disorders can co-occur, how common they are, and how they are diagnosed and treated. En Español

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