There is an article in the November 16, 2007 issue of the Psychiatric News about how state hospitals across the nation are beginning to address the issue of smoking in their facilities.
It is an interesting observation that people with problems with alcohol, drugs, and serious psychiatric disorders smoke at rates 3 and 4 times the rates of people without those problems. For example, in New York State currently, the smoking prevalence rate in the general population is 16% but among alcoholics it is 85-90% and among people with serious mental illness it is about 75%.
In New York State all alcohol and drug treatment facilities and programs which are licensed by the New York State Office of Alcohol and Substance Abuse (OASAS) must be tobacco free by July 28, 2008. The 14 Alcohol Treatment Facility run by OASAS itself are already tobacco free and this requirement is now being extended to the nonprofit facilities licensed by OASAS. The Psychiatric facilities are still behind though even though they are catching up.
"Smoking kills, and it kills seriously mentally ill people early," Mary Diamond, D.O., said at the APA Institute on Psychiatric Services in New Orleans in October.
About 75 percent of seriously mentally ill people are tobacco dependent—over three times the rate among the general population—yet 59 percent of public mental health facilities still permit smoking, she said. Even some states that have banned cigarettes in prisons continue to allow smoking in their mental hospitals.
It still is not clear why substance abusers and psychiatric patients smoke at such high rates although there is some evidence that nicotine affects the biochemical balance in the brain. It seems a shame that substance abusers get into recovery, and psychiatric patients compensate and improve, and then cigarettes wind up killing them. Dr. Bob and Bill W. the founders of AA both died from smoking.