Smoking and Mental Health

People with mental health issues are much more likely to smoke than the general population. If we’re going to help reduce smoking-related illness and death in people with mental health issues, it’s essential to understand the link.

Smoking is the leading preventable cause of death in the U.S., and it affects people from all walks of life. However, not everybody is equally likely to smoke, with some groups smoking at much higher rates than others. People with mental health issues are one such group, generally smoking a lot more often (and more cigarettes per day) than people without such issues, and understanding the reasons for this is essential in order to reduce the harm caused by tobacco to people with issues such as schizophrenia, depression, anxiety and other conditions.

Smoking and Mental Health Statistics

The number of people with mental health problems who smoke is consistently higher than the corresponding numbers in the general population. Smoking and mental health statistics show this clearly. The CDC used data from the 2009 to 2011 Surveys on Drug Use and Health, and found that 36% of people with a mental illness smoke, in comparison to 21% of adults without a mental illness. Roughly, this means that over 1 in 3 people with a mental illness smoke, in comparison to just over 1 in 5 of those who don’t have a mental health issue.

In this study, mental illness didn’t include substance abuse issues, and required individuals to have a mental, behavioral or emotional condition within the past year that meets the criteria for a diagnosis. The survey also found that people with mental illness who smoke have more cigarettes per day than people without a mental illness who smoke, 331 in the past month compared to 300.

Explaining the Link Between Smoking and Mental Health Issues

The high smoking rate among people with mental illness suggests that something about having a mental health condition predisposes you to smoking. There are many potential explanations for this, and some disagreement about the best explanation.

Firstly, having a mental health condition like depression or anxiety could lead to smoking in much the same way as it does with many other smokers. Cigarettes provide a coping mechanism and make you (temporarily) feel a little better, and if the individual doesn’t have other coping techniques to use, this will be more appealing. Similarly, smoking is very addictive, whether you have mental health issues or not, so this is always a factor.

One of the more controversial proposals is the “self medication” hypothesis. This suggests that smoking helps people with mental health issues manage their conditions in some way. This has been proposed for depression and other issues too, but one of the most plausible versions is for suffers of schizophrenia who smoke. Nicotine’s effect could “normalize” the neuronal deficits seen in people with schizophrenia, as well as some sensory issues. Finally, nicotine affects the levels of many psychotropic medicines, and this could mean people taking them smoke to minimize adverse effects from them.

Finally, social factors could play a role. Mental health services generally accept smoking among patients, so there may be little motivation to quit. This is changing, but it could still be a partial explanation for the link between smoking and mental health issues.

Difficulty Quitting Smoking for People With Mental Health Issues

In addition to higher smoking rates, although people with mental health issues are as likely to want to quit smoking as anybody else, they are less likely to successfully quit. One study, for example, found that people with mental health issues were 25% less likely to have quit by the end of the study than people without mental health issues who smoked.

This could be due to the self medication hypothesis discussed above, because smokers with mental health issues would have to cope with nicotine withdrawal and the lack of the self-medicating effect making their condition harder to manage. However, since there are several approaches to quitting that are very effective for people with mental health issues, the issue could be closely related to mental health services often not encouraging patients to quit smoking or offering enough support.

Helping People With Mental Health Issues Quit Smoking

People with mental health problem can be helped to quit smoking using the same techniques as for the general population, but ordinarily the success rates will be slightly lower. However, medicines like Zyban and Chantix have both been shown to help smokers with schizophrenia, but nicotine replacement therapies don’t seem to work as well. For depression and smoking, nicotine replacement therapies and counseling can be effective solutions.

The important thing is that people with mental illness need to be encouraged to make quit attempts, and suitable interventions need to be more widely available for them. If changes continue in mental health treatment facilities and targeted programs are used to help more people with mental health issues quit, the smoking rate in this at-risk group could be brought closer to that of the general population in future.