Negative effects of a smoking ban on an inpatient psychiatry service.

Although many psychiatric inpatient units have banned smoking, the authors suggest that problems associated with implementation of no-smoking policies in these settings have been underreported. Over a two-year period after implementation of a smoking ban on inpatient units at a Veterans Affairs medical center, an estimated 20 to 25 percent of patients who smoked had difficulty adjusting to the ban, and some patients experienced major disruption in their treatment. Four cases illustrating problems in treating highly disturbed, nicotine-dependent patients are presented. The authors recommend that inpatient settings where smoking is banned should accommodate patients who cannot tolerate abrupt smoking cessation by providing smoking areas or allowing off-unit smoking breaks.