Impact - Let's Talk About Smoking

Jim O'Rorke

Monday, March 5, 2018

The IMPACT Project is an initiative to get information about the adverse effect of smoking on mental health and the help available to help people stop smoking, to Support Workers in the Third Sector who support people with mental health problems.

So what is the point of this? I’ve worked in Third Sector services, primarily mental health and latterly in addictions (alcohol and drugs). I was ignorant of the facts about smoking and mental health and so never had that conversation with those I supported. The IMAPCT Guidance contains information that I know if I could have shared with some people in the past, it would have motivated them to access stop-smoking services.

I look back with some amazement now but as an addictions worker I could have told you a lot about withdrawal effects from alcohol and drugs but the words “withdrawal” and “cigarette” never joined together in my mind. The fact that a heavy smoker could be suffering the effects of withdrawal (anxiety, distracted, stressed) from nicotine 20-30 times a day never occurred to me. People were telling me they felt anxious, distracted and stressed, but this was assumed to be due to their anxiety disorder or symptom of another condition which they had disclosed at assessment. And, of course, when the person went out for a fag they felt better. “Smoking helps my anxiety!” was the cry.

I now know that nicotine once inhaled into the body stimulates the release of Dopamine in the brain which produces pleasant feelings of calm and reward. I knew that cocaine does the same and was well aware of the withdrawal symptoms from cocaine once the Dopamine levels reduced but never attributed the same to withdrawal from nicotine. The symptoms are largely stress and anxiety. So, far from alleviating stress and anxiety smoking was causing or exacerbating it. If I had been able to explain this relationship to people I feel sure that some would have looked at ways to quit smoking.

I’ve visited around 50 Third Sector organizations and talked to hundreds of workers about the IMPACT Guidance and without fail the topic in the Guidance that generates the most interest is the effect of smoking upon some mental health medication. Tobacco smoke stimulates an enzyme in blood plasma which metabolizes medication more quickly than in a non-smoker. Heavy smokers in particular will have to take significantly higher doses of medication to get the same effect as a non-smoker. I certainly did not know about this when I was a Support Worker. Some anti-psychotic medications have unpleasant side effects. I know a lot of people who would gladly have considered stopping smoking if their dose could have been reduced.  It’s estimated that this costs the NHS in the UK £40 million per year.

ASH Scotland has already distributed nearly 200 IMPACT Guidance packs to Third Sector organizations in Edinburgh and the Lothians and has also delivered the free face to face IMPACT Guidance training to 40 people so far with another 7 sessions planned in the coming months.

We are now delighted to have worked with Community Pharmacy Scotland to arrange for hard copies of this guidance to be delivered to all community pharmacies across Scotland in the near future – we hope you find it as useful as other organisations have.

In the meantime, if you want to find out more just have a look at the IMPACT website for more information.