Special Commentary

SAMHSA Report on Adults with Mental Illness or Substance Use Disorder Account for 40% of All Cigarettes Smoked: A Special Commentary from Steven Schroeder, MD, SCLC Director


The year 2000 publication in JAMA by Lasser and colleagues showing that persons with behavioral health conditions, defined as mental illness and/or substance abuse disorders, accounted for 44% of all cigarettes smoked in the United States challenged previously held assumptions. "These persons need their cigarettes in order to function better." "They are not interested in quitting." " They are not able to quit." "Their underlying conditions are so much more important than smoking that smoking cessation is not a relevant clinical priority." 


Over the past decade, each of these assumptions has been refuted, and increasing efforts are now focused on how to help persons with behavioral disorders stop smoking in for better health and to protect their loved ones and their clinicians from the harm caused by exposure to second-hand smoke. In February 2013 the federal Substance Abuse and Mental Health Services Administration (SAMHSA) issued a joint MMWR/Vital Signs report with the Centers for Disease Control (CDC) about the high prevalence of smoking among those with mental illness, essentially reinforcing the earlier article by Lasser. That new report garnered much media attention, and refocused the spotlight on the need to help persons with mental illness stop smoking.


The March 20, 2013 report by SAMHSA/NSDUH adds new information on this subject. The report found that adults with mental illness and/or substance abuse disorders account for nearly 40% of all cigarettes smoked. Since persons reporting either of these conditions accounted for about 25% of the population, it is apparent that those with behavioral health conditions consume almost twice as many cigarettes as the general population. Furthermore, these persons are twice as likely to be smokers.


SAMHSA is to be congratulated for expanding its efforts to included smoking cessation as an essential part of the agency's mission. Without attention to smoking, SAMHSA's constituency would have been consigned to early and painful death and disability. Let us hope that this new attention will translate into higher rates of quit attempts and successful quitting.



Steven A. Schroeder, MD
Distinguished Professor of Health and Health Care,
Department of Medicine

Director, Smoking Cessation Leadership Center

University of California, San Francisco


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Smoking Cessation Leadership Center
University of California, San Francisco

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