GPs could be missing a chance to help people with depression & severe mental illness stop smoking says lifelong smoker & McPin Peer Researcher Lisa following her work on a new study.
Lisa Couperthwaite
As a person who suffers from depression, the future is a very difficult place to contemplate. When I am depressed, it feels impossible to address my smoking addiction because the negative consequences seem so far away.
When I reach for the cigarettes I’m not thinking about cancer, heart attacks or strokes – I’m thinking about relieving the crushing anxiety and the hideous craving that overwhelms me.
I am barely able to function without a cigarette and, although I wouldn’t say that smoking is a ‘pleasure’ as such, it is one of the few things that can calm and soothe me.
I become utterly selfish when I am craving a cigarette and I’m not thinking about how my family and friends would feel if I were to die. When I am depressed I feel I am worthless and I believe that everybody else feels the same about me.
Of course, I’m not always depressed and in my more balanced moments I’m terrified by the possibility of such a terrible death – which leads my anxiety to rise and the dark thoughts to creep in.
I don’t think about the future when I submit to my addiction; I can’t, and in a never-ending series of moments filled with cravings, I continue to smoke.
Smoking cessation and mental health
That’s why it was particularly interesting for me to be involved in a recent study which looked at the support available to help people with mental illness stop smoking.
The study’s aim was to look at primary care interventions (e.g. GP advice) for participants, alongside how many attempts they had made at quitting – and how many were successful. It compared the results of smokers experiencing severe mental illness against those who were not.
Being asked to consult on this project got me thinking about my own lifelong smoking habit, including some of the reasons why I find it so difficult to quit and why my mental health condition often gets in the way of me stopping smoking.
‘Addiction is a frustrated and determined child’
From listening to self-hypnosis recordings to wearing nicotine patches, over the years I’ve tried numerous methods to stop smoking but the addiction is like a frustrated and determined child; it will not stop until it gets what it wants.
I have a tendency towards dissociation when I become deeply stressed and depressed, and during these periods I’m not even aware that I’ve reached for the cigarettes.
I know that it would be wise to banish all tobacco products from the house, but the feelings of panic that arise when I try to do this are intolerable; it feels like being in deep water and suddenly realising that I am unable to swim.
I was told to ‘just quit’
When I was waiting for surgery to treat a brain aneurism last year I was told by the surgeon, in no uncertain terms, to stop smoking. “I’m not even going to tell you to cut down – just quit”, was the cessation advice I received.
I tried, I really did, because I was terrified. This would have been the perfect opportunity for my own GP to support me, but I saw very little of her during this period due to Covid restrictions. I wasn’t aware of any smoking cessation services at the time, and signposting might have been helpful.
It was only the day after the operation, when I was continuously coughing, that anyone at the hospital asked if I was a smoker. A nurse came along and slapped a nicotine patch on me a few hours later.
This helped because it relieved the coughing and other physical symptoms of nicotine withdrawal. I’m not sure whether it helped with the cravings or not, as the operation had temporarily numbed them.
A ‘relatively successful’ quit attempt
The four days I spent in hospital without access to cigarettes, or the opportunity to smoke them, resulted in what professionals (and clinical records) might term ‘a relatively successful quit attempt’.
I went without cigarettes for the longest period that I have ever managed since I began smoking at the age of thirteen.
The fear of death was imminent, but I was so relieved to be alive and without permanent disability caused by the operation that it seemed to override my desire to smoke.
The old demon came back
Unfortunately, this feeling didn’t last. The old demon raised its head again six months later, and I found myself smoking the odd cigarette here and there. This coincided with me finding out that my aneurism had been successfully treated. Foolishly, and on some level, I believed I was finally ‘safe’ to smoke again.
I am now back to smoking five per day, though this is far less than before I had the operation. This shows how deeply ingrained the habit can be and how we, as smokers, trick ourselves into having ‘just that one cigarette’ – which inevitably leads to many more.
I personally believe that some sort of rehab could be offered to smokers at key points, like as part of the follow-up care for my aneurism. Willpower alone has never been enough for me. Being in hospital, removed from an environment where I was able to smoke, even for a few days, helped enormously.
What happened since
Since my operation, I decided to ask my GP for a prescription for a smoking cessation medication.
This was the opportunity for holistic support to treat my smoking addiction as part of my mental health, but the doctors refused to prescribe the necessary medication because I was already on antidepressants.
I was offered no alternative support and though I bear the ultimate responsibility to stop smoking, had my GP been more proactive and taken advantage of the fact I was trying to quit, I may have finally had some success.
People with severe mental illness are more likely to smoke, and face additional challenges when trying to quit. I saw those challenges first-hand when I was trying to quit, such as this risk-averse culture among mental health professionals.
Different support for different groups
The study came to an end recently and, although there was some difference in the support that smokers with mental illness and those without received, these differences were small.
The main takeaway was that smokers weren’t generally referred to cessation services, regardless of their mental health status – although thankfully, this does appear to be changing.
Proactive support is needed
Personally, I am still smoking and this entire episode has reinforced my whole ethos – that no matter what hoops I jump through, the addiction will win in the end.
What I do know, though, is that without GPs being proactive, the gap between smokers with poor mental health and smokers without will continue to be an issue.
