Ending the lifespan disparity for people with mental illness and addiction: Examining recovery community perspectives to support physical wellness

The San Mateo County (California) Tobacco Prevention Program partners with local behavioral health community efforts to advance physical well-being to complement mental health recovery. 50% of 549 clients surveyed at a local service agency reported regular tobacco use- consistent with high smoking rates reported in the literature. Smoking is a major contributor to the estimated 25 year shorter average lifespan for people living with mental illness and addiction issues.

Focus groups were additionally conducted at a mental health clubhouse and several substance abuse treatment centers to assess perceived tobacco use benefits and barriers among 53 consumer participants.

Emerging themes included the overwhelming prevalence of tobacco use in the community as a highly addictive substance. The groups indicated that quitting is complicated by environmental cues from other smokers, and that sharing cigarettes is a normalizing action and bonding opportunity. Boredom and the positive cultural associations with smoking were voiced as reasons people with mental illness and substance use issues continue tobacco use. Cigarette smoking as a sign of freedom (particularly when leaving psychiatric facilities) was also identified as a maintaining factor.

Respondents identified tobacco addiction as a replacement for other substances and a method of self-medication, but additionally stated that tobacco use can trigger a drug relapse. The majority of substance use recovery respondents recommended treatment programs should be tobacco-free, as they perceived smoking breaks as inconsistent with the goal of wellness.

Implications for the field include a consumer mandate for smoke-free policies and better understanding of points of cessation intervention.