2023-08-24 10:06:34
The French Observatory of Drugs and Addictive Tendencies (OFDT) publishes a review of the social science literature on the trajectories of consumption and quitting smoking. Among vulnerable populations, a focus is proposed on people suffering from mental disorders, for whom weaning comes up against multiple obstacles.
This literature review is part of the project “Trajectories of consumption and quitting smoking” (Tabatraj), financed by the Fund for the fight against addictions managed by the National Health Insurance Fund, which proposes a survey qualitative focus on the role of social inequalities in health in these smoking “dropout” trajectories.
The available studies indicate that the majority of smokers choose to quit spontaneously and without assistance, despite the existence of numerous support devices and methods. Yet, a minority of studies focus on autonomic weaning and its associated trajectories. They reveal that users attach a very high symbolic value to this method of quitting and that the norm of abstinence after quitting is also valued.
The weight of socioeconomic position on the smoking cessation experience
In France and abroad, smoking and the social inequalities in health associated with it are major public health concerns. People who have a low level of education, a reduced income and/or who are unemployed are more inclined to smoke. A number of studies focus on targeted population groups, for whom weaning represents particular difficulties: pregnant women, people with psychiatric pathologies and people who have had a migration experience and/or who are exposed to discrimination.
The psychiatric hospital, a place “conducive” to tobacco
A chapter of the report is thus specifically devoted to psychiatry. The literature shows that people
with psychiatric pathologies have a higher prevalence of smoking. Smoking cessation can improve mental health, but it is also more difficult for people living with these pathologies, in particular because of a more intense experience of adverse withdrawal symptoms or insensitivity to pharmacotherapy in some cases. In addition, caregivers are sometimes reluctant to encourage withdrawal from these patients.
The report notably mentions an intervention research project on the social representations associated with the smoking of people with mental disorders (Ketterer et al., 2022). “These results demonstrate that smoking is still symbolically and structurally anchored in the daily life of psychiatric services. The psychiatric hospital is perceived as a space conducive to smoking because its daily life is organized around many low periods or latency, often spent in isolation. In addition, cigarettes and coffee are two products associated with the figure of the psych patient. In addition, the object constitutes the support for specific interactions between patients and caregivers or between patients: currency of exchange, mode of management of discipline on a punishment-reward model,
even sociability between patients and nurses. As a result, while smoking cessation is a concern for patients – also identified in Mr. Khodja’s thesis (Khodja, 2022) – this theme constitutes a negligible priority for the professionals interviewed, some of whom express the inevitability of the failure of withdrawal attempts or even the fact that this type of care does not come under their duties. Unless explicitly requested, the patient is not referred by psychiatrists for a consultation – despite the risk of interaction with certain treatments – but may be referred on an ad hoc basis by the nursing staff (nurses, psychologists). » This research offers various avenues and recommendations for improving care.
• Quitting smoking: a review of the social science literature. Report, OFDT, July 2023, in pdf.
– Ketterer F., Roelandt J.-L., Chevreul K. (2022) Smoking in psychiatry: realities and implications for its management. Public Health, Vol. 34, no. 5, p. 643-651.
– Khodja M. (2022) For an improvement in the management of smoking in psychiatric patients. Identification of strengths, weaknesses, opportunities and threats, and proposals. Grenoble Alpes University, UFR Medicine (UGA UFRM), Medical thesis, 106 p.
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