TOBACCO USE AND PSYCHIATRIC AND SUBSTANCE USE DISORDERS
People with psychiatric and substance use disorders, including youth and young adults, are far more likely to use tobacco than those in the general population, yet they are less likely to have a diagnosis of and receive treatment for nicotine addiction. These people deserve treatment of their nicotine addiction and can successfully quit using tobacco.Although people with psychiatric and substance use disorders are more likely to relapse in their tobacco-cessation efforts than the population at large, there is little evidence that nicotine withdrawal will escalate psychiatric symptoms.One study of patients in a maximumsecurity forensic hospital showed a decrease in sick calls, total disruptive behavior, and verbal aggression after a smoking ban was implemented. Several psychiatric facilities, including facilities for adolescents, have successfully eliminated tobacco use. Because nicotine withdrawal may unmask psychiatric symptoms or disorders, this potential should be anticipated, and treatment of these symptoms or disorders should be considered an adjunct to treatment of tobacco use and dependence
The prevalence of cigarette smoking is greatest among adults who live below the poverty line and those who have not completed high school52; accordingly, SHS exposure disproportionately affects children who live in low-income households.52 Use of other forms of tobacco is similarly distributed according to income and education levels.53 The costs associated with tobacco use exacerbate the health harms to children by decreasing available family funds while increasing the likelihood of poor health in their parents, which can lead to decreased family income and stratification of tobacco use in the population that is least able to afford the consequences