Thursday, March 28, 2013

Mental Illness, Smoking, and Weight Loss

First of all, my apologies for being late with this blog, friends. I am being tortured by Lulu Press, and it is taking all my free time. To make a long story short, they are requiring their authors to resubmit EVERYTHING, and they are insisting on uploading it in a new format with new rules I do not understand. Tech woes...I am not swift at this stuff. But I'm sorry to have made you wait. Also, while I've got your attention, let me just announce that I will be giving a webinar with the International Bipolar foundation on April 4 entitled "Outer Tips to Inner Peace." You can see the foundation's URL in my list.

Now, on to the news. I have suspected for years that the mentally ill smoked more than the general population, and now comes a study that proves it. The report is by the Substance Abuse and Mental Health Administration, also known as SAMHSA. They found that while the general population contains about 20 percent adult smokers, the percentage among those with mental illness or substance abuse was a whopping 38.3 percent - that translates to 94 percent higher! Differentiating between substance use and mental health, they found that substance abusers who smoked represented about 5 percent of the population but smoked 9 percent of the cigarettes. Contrast this with mentally ill smokers, who represented only 4 percent of the population but smoked nearly 10 percent of all cigarettes. So among us there are not only more smokers, but heavier smokers as well. Or as SAMHSA Administrator Pamela Hyde put it, “People dealing with mental illness or substance abuse issues smoke more and are less likely to quit” (Please note that most of the percentages I am using are approximate. You can view the article yourself at ).

Translate that to real life for a minute. We have hard lives, and we smoke to de-stress from it. Well, what happens when we break down and go into a hospital? First, we want to smoke MORE, because we are under more stress than average (by the way, since many of us cannot work, we are less likely to be able to afford this habit). Secondly, we relapse and go into the hospital, where 90 percent of the time  the nurses righteously take away our smokes for the duration of our stay! What’s wrong with this picture? We go into the hospital because our coping devices are not working, so they take another coping device away? Hello? This does not make sense.

I am not a smoker, but I have been in the past, and I can tell you that being deprived of cigarettes just when my emotions were at their rawest was not helpful.While I understand the hospital’s desire to keep second hand smoke away from other patients, and their health objections to smoking in general, I think they are being inconsiderate towards their patients’ needs for comfort. Just two cents from someone who’s been there.

But what was SAMHSA’s conclusion on reading this study?  That they should offer more smoking cessation programs in treatment facilities. They include substance abuse treatment facilities in their plans, and this is an even worse idea. I can tell you from experience that if you are trying to quit alcoholism, it is NOT the moment to try to quit smoking as well. You will almost surely crash BOTH efforts. Generations of rehab counselors will agree with me. Again, the crusade is understandable and well meant, but absolutely not practical and possibly counterproductive.

Well, enough of that. Some of you are bound to disagree with me, and that is fine. I’d like to hear about it.

One more study, this a hopeful one, published March 21 in the New England Journal of Medicine. In a nutshell, they have found that mental illness does not have to impede weight loss. Many patients tend to be overweight due to their medicines, and often feel there is nothing they can do about it. It is a serious problem, since the death rate of overweight or obese mental health patients is 2 to 3 times higher than the general population, mostly due to obesity related complications.

But this study enrolled 144 patients with major psychiatric disorders in a program that included nutrition advice, counseling and regular exercise classes, as opposed to a group of 147 who did not receive the extra help with weight loss.

At the end of 18 months, 38 percent of those enrolled in the weight loss program had lost 5 percent or more of their body weight, and 18 percent had lost more than 10 percent. The control group scored lower on both counts.

The study authors added that these figures are similar to figures in the general population among those who use some of the more successful weight loss programs. And for the record,  in the last two years I myself have lost 53 pounds on the popular Jenny Craig program. So maybe losing weight is not the problem, per se. Maybe the problem is just that changing a life style is hard for anybody. Maybe a little professional help is all we require.

You can see this article, too, at .

Deborah is the author of Is There Room for Me, Too? 12 Steps & 12 Strategies for Coping with Mental Illness, available at Amazon and other major vendors. Visit her web page at, or see her catalog at