28 Feb 2023

Dear College Members


On SCOPE Issue 3:  The toughest battle yet: Tobacco Use Disorder


Many people find it puzzling that Tobacco Use Disorder is classified as a mental illness under the

DSM-5. In fact, a smoker most often doesn’t consult a psychiatrist to kick the habit. Most smoking

cessation aids are sold over the counter as nicotine replacement products and can be dispensed

without a prescription. This ease of self-medication belies the often-intractable task of smoking



Studies across the world have shown that short term (think monthly to 3 monthly) quit rates are

around 30% whilst longer term quit rates are even more dismal. Once an addiction to Nicotine (the

addictive component in tobacco) is established, it can be quite an uphill battle to remain abstinent.

Some experts have compared the addictive potential of Nicotine to Cocaine and Heroin, saying

plenty about this not often mentioned addiction. Nicotine is found not just in cigarette smoke, but

also in Electronic Cigarettes and the way Vaping has gotten out of control in other countries is a

timely reminder that we need to protect our people, especially our Youth, from its harmful effects.


Amongst patients with mental health illnesses (PMHI), the prevalence of smoking and Tobacco Use

Disorder is much higher than the general public. This makes the term “dual-diagnosis” almost

superfluous in the patients that we treat. This has serious implications, not least the number of

years of quality life lost as a result of smoking induced morbidity. Various studies have estimated

that PMHIs lose 2 decades of life from smoking induced complications, a stark reminder that

psychiatric and physical morbidity often go hand in hand in the patients we treat.


What can we psychiatrists do about this? The hard truth is, like any addiction, it is difficult to treat.

With so much else to handle in our day-to-day consults with patients, this aspect is often missed

due to a lack of time. Just asking whether someone smokes and directing them to the appropriate

services can often go a long way to helping patients quit smoking.


With that in mind, the Section of Addiction Psychiatry together with the College of Psychiatrists have

put together a dinner lecture to spread further awareness on this topic. Our guest lecturer, Professor

Peter Selby, who has been brought here on a MOH HMDP expert grant, will kindly speak to us on

the topic “Smoking Cessation in Patients with Psychiatric Ailments” on 14 March 2023. This lecture

promises to deliver new insights into smoking cessation for PMHIs.  See you there!


Yours Sincerely,

Dr Lambert Low Tchern Kuang


Section of Addiction Psychiatry

College of Psychiatrists, Academy of Medicine, Singapore