Study links mental illness, smoking addiction

N.Y. Times News Service

People who have been smoking for years and have been unable to quit may
have more health problems than either they or their physicians realize. A
University of Michigan researcher has gathered evidence that many if not
most hardcore smokers are suffering from an underlying psychiatric problem
that nicotine may help to ameliorate.

This nottoosurprising conclusion was drawn by Dr. Cynthia S. Pomerleau,
who cited ``mounting evidence that smoking is becoming increasingly
concentrated in people at risk for major depressive disorders, adult
attention deficit hyperactivity disorder, anxiety disorders and bulimia or
bingeeating.''

The idea that many smokers may be medicating themselves with the addictive
drug in tobacco is not new. For example, several researchers have linked
smoking to an attempt to counter depression and have shown that various
antidepressants can often help a hardcore depressed smoker quit.

But the extent of the relationship between various psychological disorders
and selfmedication with nicotine has not been widely recognized or well
documented.

Dr. Pomerleau of the university's Substance Abuse Research Center and
Nicotine Research Laboratory said that it may be necessary to treat
the psychiatric problem before the person attempts to quit smoking.
She urged the development of ``new kinds of smoking interventions
tailored to the special needs of these difficulttotreat, atrisk populations.''

But researchers at the University of Pittsburgh Cancer Institute have found
that helping hardcore smokers quit before they develop a smokingrelated
disorder is no guarantee that they will escape the most feared consequence
of longterm smoking: lung cancer.

In a preliminary study of 37 people, Dr. Jill Siegfried and her colleagues
found that 77 percent of those who smoked a pack or more a day for at least
25 years developed an aberration in their lung cells that may predispose
them to cancer, even if they had not smoked for years. However, among those
who smoked for fewer than 25 years, only about 15 percent had undergone
such a cellular change.

The change involves the appearance of receptors on the lung cells that
capture circulating hormones that prompt lung cells to divide, possibly
leading to unrestrained growth. This receptor is normally present in fetal
lungs, helping them to mature. The new finding was published in the current
issue of The Journal of Respiratory and Critical Care Medicine.

Dr. Siegfried said that further studies are needed to confirm the finding
in longterm smokers and to determine more precisely the role this receptor
may play in the development of lung cancer.

Dr. Pomerleau's review of the link between smoking and psychiatric
disorders was published last spring in the journal Addiction. Although the
incidence of smoking in the United States dropped from 40 percent of adults
in 1965 to less than 29 percent in 1990, and the social pressure to quit is
now greater than ever, Pomerleau predicted that smoking rates would level
off at 15 percent to 20 percent of adults those with problems tempered
by nicotine.

She noted that nicotine is a powerful drug known to have an unusual mix of
effects on the brain. It influences several major brain chemicals that send
messages from one neuron to another, including norepinephrine, dopamine and
serotonin. Depending upon the timing, dosage and other characteristics of
nicotine use, it can have either sedating or stimulating effects. Thus, it
may help a person with anxiety disorder relax but stimulate someone who is
depressed.

Dr. Pomerleau explained that when a smoker with an underlying ``cofactor''
like depression or bingeeating tries to quit, the symptoms of the disorder
are unmasked or worsened by the absence of nicotine and the effects of
nicotine withdrawal last well beyond the two or three days it takes to
clear nicotine from the system.

Consequently, she said, smokers with cofactors are more likely to relapse
than smokers who lack such underlying problems.

In her review, Dr. Pomerleau cited a wide range of studies in support of
her conclusion. For example, a 1986 study of 628 people found that 47
percent of those with anxiety disorder and 49 percent of those with major
depression were smokers, compared with only 30 percent of people free of
these problems.

A 1991 study of 1,007 young adults found that the rate of nicotine
dependence was twice as high among those with anxiety disorder, three times
as high among those with major depression, and more than four times as high
among individuals with both disorders than it was among people with no
psychiatric disorder.

And a study by Dr. Pomerleau and her colleagues in 1994 revealed that
smoking rates were nearly double that of the general population among men
and women with attention deficit hyperactivity disorder. Furthermore, only
29 percent of those smokers with the disorder had managed to quit, compared
with 48 percent of people in the general population who had ever smoked.

In addition to improving therapeutic approaches for adult smokers
with underlying disorders, Dr. Pomerleau urged that more attention be
paid to ``the children of smokers with cofactors.'' She noted strong
familial trends for smoking as well as for several leading
psychiatric disorders. She said, for example, that some families may
be predisposed to both smoking and depression, leaving the children
highly susceptible to both.

She added, ``Prevention efforts and early identification and treatment of
the cofactor itself may be needed in these children.''