Eric K. Mason
January 15, 2015
Smoking and Mental Illness
It is well known that people with mental disorders and substance use disorders are more likely to smoke cigarettes. Indeed, research indicates that they are 70% more likely than the general population to smoke. Furthermore, people with mental disorders have on average 25 year shorter life expectancies than the general population—death due to cancer, heart disease, and lung disease is common amongst those with mental disorders.
As with any drug, nicotine affects neurotransmitters in the brain. In fact, nicotine is a powerful drug and works on multiple neurotransmitters, such as dopamine and serotonin. Therefore, some people with mental disorders may use nicotine as a way to self-medicate or mask the side effects of some psychiatric medications. Furthermore, nicotine withdrawal may increase anxiety, making it more difficult for people with anxiety disorders to stop smoking (in this same way they are self-medicating). Additionally, nicotine improves attention and concentration, which may make people with disorders, such as ADHD or ADD more likely to smoke.
In addition to the biochemistry aspects, people with mental disorders often face many other risk factors that predispose them to becoming and staying addicted to nicotine. Often environmental, sociological, and financial issues contribute to nicotine addiction. A lower socioeconomic status tends to predispose one to a more stressful life which, in turn, puts one at risk for various addictions—including nicotine addiction. Limited finical resources also means that these individuals are less likely to receive healthcare that may assist them with smoking cessation.
What’s worse, some research studies claim that tobacco companies have specifically targeted individuals with mental disorders. In addition, tobacco companies have attempted to keep psychiatric hospitals from banning tobacco, as well as claim that nicotine can actually help people with schizophrenia. Indeed, there is no evidence to support this claim.
Tobacco companies are not the only ones guilty of encouraging smoking among people with mental disorders. Psychiatric hospitals have a history of rewarding good behavior with cigarettes and cigarette breaks. Indeed, some mental health professionals fear that encouraging their clients to quit smoking may exacerbate already difficulty and unpleasant symptoms of some mental disorders.
In fact, some research indicates that the opposite may be true. Smoking is generally associated with depression, other psychiatric symptoms, and suicidal ideation. Therefore, quitting smoking may actually improve psychiatric symptoms. What’s more, research has shown that people who quit smoking are more likely to stay in recovery from other addictions, as well.
Furthermore, other research has provided evidence that people with depression, schizophrenia, and PTSD can quit smoking without compromising their mental health treatment. Treatment modalities include motivational interviewing, CBT, and nicotine replacement therapies. Using these approaches, people with mental disorders are just as successful at quitting smoking as the general population. In one study, when smoking cessation therapy was integrated into treatment for military vets with PTSD, 18 months later they were less likely to still smoke. Most importantly, people with mental disorders often express a desire to quit smoking at rates comparable to the general population.
More and more mental health professionals are coming to realize that addressing nicotine addiction is part of their domain, as well. At least if clients express and interest in quitting smoking, mental health professionals should offer them the tools they need to quit. Indeed, encouraging clients to continue smoking (due to the incorrect assumption that it is too difficult for them to quit) could be considered negligent.
Weir, K. (2013, June). Smoking and mental illness. Monitor on Psychology, 39
(6). Retrieved from http://www.apa.org/monitor/