Dr John Robins is a research associate at the National Addiction Centre, King’s College London. He has worked as a substance use treatment and recovery practitioner across a range of settings including criminal justice, aftercare, and outreach services. After coming to King’s College London in 2017 to undertake an MSc in Addictions he won the IoPPN prize scholarship, funding his PhD which examined the profile of suicidal psychiatric patients with alcohol use disorder. John currently works in the Nicotine Research Group, funded by the NIHR Applied Research Collaboration, evaluating the implementation of tobacco dependence treatment across Southeast London and nationally.

Abstract

A closer look at the characteristics and outcomes of people with mental health disorders receiving hospital-initiated tobacco-dependence treatment

People with mental health disorders have disproportionately high rates of smoking and smoking-related morbidity, many of whom receive acute inpatient hospital care for a co-morbid physical condition. We conducted an exploratory analysis of the profile of psychiatric diagnoses among 612 patients who received tobacco dependence treatment (adapted from the Ottawa Model of Smoking Cessation) in a teaching hospital in London, England. Data relating to patient sociodemographics, smoking behaviour, and cessation outcomes were routinely collected by Tobacco Dependence Advisors. Diagnosis codes relating to ICD-10 Mental and Behavioural Disorders were obtained from patient health records. Logistic regression models were used to estimate the association of the type and count of psychiatric diagnoses with two key outcomes: making a quit attempt, and quit success at six months after discharge. Over half the cohort had a psychiatric diagnosis (n=317, 51.7%); the most frequent categories being Alcohol Use Disorders (n=132, 21.6%) and Mood disorders (n=130, 21.2%). Compared to patients with no psychiatric diagnosis, patients with psychotic or substance use disorders had 43-63% lower odds of making a quit attempt, and all disorder types except anxiety disorders had 50-80% lower odds of quit success at six months. Patients with psychiatric disorders in acute inpatient settings engage with Tobacco Dependence Advisors. However, some groups (people with psychotic or substance use disorders) may need more targeted support to make a quit attempt. In order to successfully stop smoking, most patients with psychiatric disorders need additional or entirely different support, except perhaps those with anxiety disorders.