Tobacco Use Disorder

  • Oliver Freudenreich
Part of the Current Clinical Psychiatry book series (CCPSY)


The majority of patients with schizophrenia currently smokes or has smoked in the past, at much higher rates than seen in the general population. Psychiatry needs to make smoking cessation a priority and help their patients quit smoking and remain quit. In this chapter, I discuss the assessment of smoking and treatment tools for successful smoking cessation for patients with serious mental disorders. Emphasis is placed on the use of pharmacotherapy, particularly varenicline, and opt-out care, with treatment being the default option in a chronic disease model. E-cigarettes may be a harm reduction option for patients seriously addicted to cigarettes.


Tobacco use disorder Nicotine dependence Smoking status Motivational interviewing Pharmacotherapy Nicotine replacement therapy (NRT) Bupropion Varenicline EAGLES trial Nicotine withdrawal Treatment cascade Chronic disease model Opt-out care E-cigarettes 


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Additional Resources

    Web Sites

    1. – The smoking and tobacco use site put out by the Centers for Disease Control and Prevention.
    2. – Refer all patients, assuming they use computers or smart phones, to this US Government website from the National Cancer Institute.
    3. – A web-based support program by the non-profit Truth Initiative that has set out to create a smoke-free culture in America, targeting our youth and young adults so they do not become the next generation of smokers.


    1. Barua RS, Rigotti NA, Benowitz NL, Cummings KM, Jazayeri MA, Morris PB, et al. 2018 ACC expert consensus decision pathway on tobacco cessation treatment: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2018;72:3332–65. – Very well organized document by the American College of Cardiology about how everything you need to know about smoking cessation, including assessment and pharmacology.PubMedCrossRefPubMedCentralGoogle Scholar
    2. Cather C, Pachas GN, Cieslak KM, Evins AE. Achieving smoking cessation in individuals with schizophrenia: special considerations. CNS Drugs. 2017;31:471–81. – An excellent review of smoking cessation with special consideration for patients with schizophrenia; from my hospital’s own smoking cessation program.PubMedPubMedCentralCrossRefGoogle Scholar
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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Oliver Freudenreich
    • 1
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA

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