For the last 38 years, Vietnam Veterans of America (VVA) has been a champion for veterans on critical health issues, including shining a light on issues that fly below the radar. Today, while general population smoking rates are at historic lows, more attention must be brought to a critical group that is not benefiting from the same reductions in tobacco use: veterans living with mental health issues.
Compared to the general population, tobacco use takes a disproportionate toll on those with mental illness, including veterans. While smoking accounts for 20 percent of deaths in the United States, it accounts for one half of deaths among people living with mental illness.
Among veterans, mental illness and smoking are tightly linked, with PTSD being a known risk factor that increases the likelihood of smoking. Currently, 60 percent of Vietnam veterans with PTSD smoke.
Additionally, rates of nicotine dependence are higher among veterans with PTSD compared to those veterans who are not exposed to trauma during their service. Studies show that among Vietnam veterans who smoke, 40 percent of those smokers smoke more than 25 cigarettes per day, likely due to a greater addiction to nicotine.
The negative health consequences of tobacco use disproportionally affect those with mental illness. Tobacco-related diseases account for half of all deaths in people with schizophrenia (53 percent), bipolar disorder (48 percent), and depression (50 percent).
Currently, most mental health prevention and intervention programs for veterans do not integrate quit-smoking counseling or treatment: Only 1 in 4 mental health treatment facilities offers quit-smoking treatment plans.
This is a major missed opportunity for veterans who are trying to quit. The VA reports that only 7.2 percent of patients who are referred to a Veterans Affairs smoking cessation clinic quit after 6 months. In contrast, when veterans have integrated smoking cessation treatment in their mental health care 16.5 percent of patients are able to successfully quit.
In order to effectively treat the total health of individuals with mental illness and reduce smoking rates in all populations, treatment plans must combine specific quit-smoking initiatives and mental health programs.
While the VA currently has programs in place that try to lessen the toll of tobacco related health consequence on veterans, vets, especially vets with mental illness, need renewed emphasis and commitment to this issue. Additionally, because more than 60 percent of veterans do no use the VA, there must be increased focus on access to treatment and resources by both the FDA’s Centers for Disease Control and the Veterans Administration to ensure vets receive quality health care and access to smoking cessation treatments to make certain no veteran is left behind.
The integration of quit-smoking services into mental health programs is critical to addressing the compounded mental and physical health issues of Vietnam veteran smokers with mental illness. The unique needs of veteran smokers living with mental illness must be met to help them quit smoking and share in the positive health results of decreased tobacco use.
Thomas J. Berger, Ph.D. is the Executive Director of the Veterans Health Council of Vietnam Veterans of America.