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Cigarette Smoking and Post-Traumatic Stress Disorder

Author: Disabled World

Published: 2012-11-27

Synopsis:

Studies of smoking and PTSD comorbidity have used different approaches to indexing the severity of a persons reactions.

Main Digest

Cigarette smoking is still one of the leading preventable causes of disease and death in America. Smoking results in health care costs that rank among the highest in the nation according to the Department of Health and Human Services (DHHS). Major efforts targeting smoking-cessation have assisted with addressing the issue, yet the negative impact of smoking remains widely evident.

For example, more than one-fifth of adults and nearly one-fourth of young people in America smoke. While many people who smoke are motivated to quit, most of self-quitters (around 90-95%) as well as 60-80% of people who are involved with a treat program, do relapse and start smoking again. Some scholars have suggested that smokers who fail at quitting might have unique attributes that increase their likelihood of smoking. Even though different characteristics might increase a person's risk of relapsing such as heavier levels of smoking; psychological disorders, as well as related vulnerability factors have begun to be recognized as playing a significant role in a person's ability to quit smoking successfully.

Smokers with anxiety represent a population of common and understudied people who are a segment of the smoking population and are also at increased risk of relapse. Research into this particular population has indicated that panic disorder, panic attacks, and pre-morbid risk factors for panic issues such as elevated anxiety sensitivity, are all related to the maintenance of smoking. In the same way, post-traumatic stress issues can also be related to smoking. Even though research has been conducted on traumatic events, post-traumatic stress disorder (PTSD) and smoking - a comprehensive review of the literature has yet to be performed. The lack of a review is hindering efforts to systematically evaluate the nature of the data, distill findings, and explicate methodological limitations.

Trauma and Post-traumatic Stress

A traumatic event is one during which a person experiences a perceived threat and experiences a sense of terror, horror, or helplessness. Exposure to a traumatic event is indexed in a number of ways and has been defined in various ways across different studies. For example, reporting psychological distress after a form of natural disaster has been used to index exposure to a traumatic event. Other types of studies have required self-reported peri-traumatic terror, helplessness, or horror. Exposure to a single type of event such as exposure to combat, is many times measured without assessment of exposure to additional types of trauma. By contrast, other studies measure exposure to other types of traumatic events without controlling for the type of exposure.

PTSD is a disorder involving recovery and is characterized by an inability to recover from a stress reaction to a traumatic event. An inability to recover symptoms related to a traumatic event among a substantial minority of people who have been exposed to trauma can be contrasted to the majority of people who have been exposed to trauma who recover from trauma exposure within a few months. There are a number of ways to index the degree to which a person does not recover from exposure to a traumatic event, something that is important to consider because studies of smoking and PTSD comorbidity have used different approaches to indexing the severity of a person's reactions.

One of these approaches is to examine complete symptom severity, something that is commonly calculated as a sum of frequency and intensity ratings of each of the Diagnostic and Statistical Manual (DSM) defined symptoms of PTSD. A second approach involves the examination of the intensity of a person's symptoms within empirically supported types, or clusters, of PTSD symptoms. Three specific clusters exist:

A person's failure to recover from exposure to traumatic events is also commonly indexed through the meeting of additional diagnostic criteria such as the experience of three or more avoidance or, 'numbing,' symptoms, two hyperarousal symptoms and so forth, which have endured for greater than a month and have resulted in clinically-significant distress or impairment on the part of the person.

Prevalence of Smoking among Persons with PTSD

A study by Lasser and colleagues examined the smoking status in relation to psychiatric diagnosis using a nationally representative sample of adults. Participants in the study were asked if they were daily smokers. What the study found is that of the people who have a lifetime diagnosis of PTSD 45% were current smokers while 63% reported a lifetime history of smoking. The rates were significantly higher among participants with PTSD than among those who did not have PTSD, who reported currently smoking at 22% and a lifetime habit of smoking at 39%. Among the people who had received a diagnosis of PTSD in the past month, 44% were currently smoking while 58% had been smoking for their entire life. The percentages reflect notably higher rates than for those who did not experience PTSD.

A different study performed by Acierno and colleagues examined smoking in relation to adolescents and PTSD. Participants were asked, 'During the past 30 days, on how many days did you smoke cigarettes' Among the teenagers involved, positive histories of PTSD were associated with a two-fold likelihood of the rate of regular smoking. It is important to note, however, that the study revealed that after controlling for race, exposure to trauma, and familial substance use - PTSD was not related to current smoking among this population.

A third study involving women who receive outpatient services through the Department of Veterans Affairs performed by Dobie and associates examined self-reported rates of smoking over the prior year as a function of PTSD. A symptom checklist to be used for self-reporting was mailed to the people who participated and used to screen for PTSD. The specific question used to measure smoking was not identified. Women who screened positive were more likely to report smoking over the past year than those who screened negative for PTSD - 39% in comparison to 22%.

A different study performed by Beckham and colleagues estimated rates of smoking among Vietnam Veterans seeking treatment who also had PTSD where the rates of smoking were not compared to other groups. The study found:

A general consensus exists across the various studies that have been performed indicating both current and lifetime smoking rates are notably higher among people with either a current or lifetime history of PTSD in comparison to people who do not experience PTSD. A number of the studies examined representative populations, strengthening confidence in the results of the studies. The pattern of smoking among people with PTSD appears to be relatively age-invariant with similar patterns appearing among both adults and young people. There is evidence that PTSD is associated with an increased rate of smoking across genders as well.

It appears that in America, around 45% of people with PTSD also smoke. In comparison to the general population, the current rate of those who smoke is around 22%. Another conclusion that can be drawn is that PTSD and smoking appears at least twice as prevalent as it is among people with other forms of mental health disorders such as major depression, obsessive-compulsive disorder, or panic disorder. People with PTSD seem to be heavy smokers as well, with more than 70% of people with PTSD smoking in excess of a pack a day and increased levels of nicotine dependence.

Quitting Smoking and PTSD Data

Unfortunately, there is a limited amount of research related to the examination of smoking quit rates among people with PTSD in comparison to other groups. The studies that have been performed explored the hypothesis that people with PTSD are relatively unable to quit the habit. Lasser and colleagues examined smoking quit rates among this population and found that the quit rates were notably lower for people with a lifetime diagnosis of PTSD than for people without PTSD. They also noted that people who had received a diagnosis of PTSD in the past month also presented notably lower rates of quitting smoking than people without PTSD.

Hapke and colleagues pursued a similar study related to PTSD and smoking-cessation. When compared with people who had not been exposed to trauma, the rates of quitting smoking were notably lower among people with PTSD, yet not for trauma-exposed people without PTSD. The presence of PTSD in a person's life, but not exposure to trauma of itself, also predicted significantly lower rates of remitted nicotine dependence in comparison to people who were not exposed to trauma.

Information from studies such as these are consistent with the hypothesis that people with PTSD do indeed have a hard time quitting smoking. The quit rates for people with PTSD can be compared to rates among other populations. For example, while no direct statistical comparisons were reported, smoking-cessation rates for people with lifetime PTSD were lower than for people in other populations with lifetime histories of other forms of mental-health disorders such as major depression or obsessive-compulsive disorder - both of which have been linked to smoking.

Combining PTSD, Stop-Smoking Therapies Works
www.webmd.com/smoking-cessation/news/20101207/combining-ptsd-stop-smoking-therapies-works

People with military-related post-traumatic stress disorder have a better chance of quitting smoking if their PTSD therapy is combined with clinical treatment for fighting their nicotine habit, new research indicates.

Smoking Could Make PTSD Worse
www.drugfree.org/join-together/drugs/smoking-could-make-ptsd-worse

Researchers say that the effect of nicotine on brain activity may exacerbate Post-Traumatic Stress Disorder (PTSD) among smokers, and that alcohol, tobacco and other drug use by PTSD patients suggests the need for simultaneous treatment of co-occurring addictive and mental-health disorders.

Nicotine Dependence, PTSD Symptoms, and Depression Proneness Among Male and Female Smokers
www.ncbi.nlm.nih.gov/pmc/articles/PMC1513639/

In a cross-sectional study of 157 current regular smokers, severity of nicotine dependence (but not cigarettes smoked per day) was positively correlated with total PTSD symptoms, hyperarousal symptoms, and avoidance symptoms.

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