Is Smoking A Mental Illness?

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) would seem to think smoking is indeed a mental illness, since it has plunged into the debate about e-cigarettes. It takes a wonderfully fence-sitting position in its July 2017 submission to the ‘Inquiry into the use and marketing of electronic cigarettes and personal vaporisers in Australia’ of the Senate Standing Committee on Health, Aged Care and Sport of the Parliament of Australia.

In a covering letter the President, Dr Kym Jenkins, says:

The RANZCP believes that harm minimisation is an essential component of any policy framework that aims to improve health outcomes for people who smoke.

This wordy sentence overlooks the obvious fact that the way to improve health (never mind health outcomes) for people who smoke is not through any policy framework, but through stopping smoking.

He goes on:

E-cigarettes and vaporisers provide a safer way to deliver nicotine to those who are unable to stop smoking…

Dr Jenkins is making some rather big assumptions here. No one yet knows whether e-cigarettes (the words ‘and vaporisers’ are redundant) are safer than smoking, so he should qualify this statement by saying, for example, ‘we believe e-cigarettes provide a safer way…’ And who are ‘those who are unable to stop smoking’? Does he mean all smokers, because, au fond, this why all smokers smoke – their inability to quit – or does he mean a special group for whom all known stop-smoking treatments have failed?

The sentence continues, repetitively:

…thereby minimising the harms associated with smoking tobacco.

Obviously, if e-cigarettes are indeed safer than smoking the harms associated therewith would, in theory, be reduced, but it’s another assumption to say they would be minimised.

Now we come to the fence-sitting:

The RANZCP therefore supports a cautious approach that takes into account both the significant health benefits which these products present and the need to mitigate potential risks.

Dr Jenkins’s upbeat stance in his letter, however, is contradicted by what’s written in the submission itself:

…the long-term effects of vaping are unknown…Furthermore, there is simply no safe level of nicotine exposure, while excessive exposure presents the risk of nicotine poisoning.

And a little further on:

The devices and liquids used in e-cigarettes should be subject to strict regulations to ensure users are adequately protected from the inhalation of impure or poisonous substances…Nicotine is a toxic substance in any form. (Emphasis added.)

Now, if nicotine is a toxic substance and they propose, not just ordinary regulations, but strict regulations so that users will not only be protected, but adequately protected from the inhalation of poisonous substances, then it follows that nicotine-containing e-cigarettes should not be allowed.

So, what is the good Dr Jenkins trying to say? I hope he will forgive me if I take the liberty of clarifying the matter for him in these words:

Cigarette smoking causes serious harm. This is especially evident in people who suffer from mental illnesses. Mental patients are just as capable as anyone else of stopping smoking if they are given the right sort of help. Studies show that if they stop smoking their mental as well as their physical health can improve.

It is particularly important for patients with mental illnesses to stop smoking, quite apart from the chemical imbalance from which they allegedly suffer due to the illness. The drugs used to treat mental illnesses, by design, disturb the brain’s neurochemistry. It therefore it makes no sense to add another drug, nicotine, to cause a further chemical disturbance in the brain.

E-cigarettes should not be promoted as a way to stop smoking. They are an alternative nicotine-delivery device that it is hoped will be safer than smoking cigarettes. Since we do not yet know the long-term effects of using e-cigarettes they cannot at present be recommended.

As the President of the RANZCP, Dr Jenkins is no doubt aware that smoking is largely a psychological problem, not a physical illness. It therefore needs to be treated by helping smokers, including mental patients, to gain understanding of why they really smoke and why it seems so difficult to quit.

Then stopping smoking and all nicotine use can be much easier than most people imagine.

This approach is set out here.

Text © Gabriel Symonds