Smoking and mental illness are tightly bound together to a surprising degree.
People with mental illnesses are up to 4 times more likely to smoke than the general populace. And people with mental illness smoke much more than other smokers.
Nicotine provides a long list of positive benefits for the mentally ill, which encourages them to start and keep smoking.
And there is a growing body of evidence that smoking can actually cause mental illness, particularly the more common ones such as Anxiety Disorders and depression.
This post is the first in a 2-part series concerning smoking and mental illness. This part deals with the following topics:
- People with mental illnesses smoke at up to four times the rate of the general population
- People who smoke have a higher rate of mental illnesses than those who don’t
- Why Do People With Mental Illness Smoke?
People with mental illnesses smoke at up to four times the rate of the general population
People with mental illnesses smoke more and smoke more heavily
About 21 percent of adults in the United States smoke cigarettes. People with mental illnesses are about twice as likely as the general population to smoke tobacco. Those with mental illnesses such as schizophrenia are three to four times as likely to smoke. Alcohol and drug abuse are also strongly associated with a high rate of smoking, with estimates ranging from 71 to 100 percent. Compounding the high prevalence of smoking is the fact that individuals who are mentally ill or have substance dependence tend to smoke much more heavily than smokers in the general population.
A new report from Australia has found that more than six in 10 (or 62 per cent) of those surveyed with mental illness smoked, compared to fewer than two in 10 (16 per cent) members of the general population. It also found that:
- Smokers with mental illness consumed 50 per cent more cigarettes daily than the general population, averaging 22 cigarettes a day
- The heaviest smokers in the group smoked up to 80 cigarettes in a day
- Almost three in five (59 per cent) said they wanted to quit smoking
- Almost three quarters (74 per cent) said they wanted to cut down
- One in 10 (12 per cent) had successfully given up smoking
People who smoke have a higher rate of mental illnesses than those who don’t
Up to half of all smokers have a mental illness
The relationship between smoking and mental disorders has been the focus of considerable research, although relatively little is known about the reasons for nicotine dependence. In study after study, it has been shown that those who smoke have mental illnesses at a much higher rate than the general population. Two studies are representative:
A 2000 Harvard University study concluded that almost half of all cigarette smokers in the United States have some form of mental illness. The researchers found that many smokers have symptoms that fit neatly into the standard psychiatric definitions of major depression, Anxiety Disorder, phobias, alcohol or other drug dependence, and antisocial personality.
Schmitz, Kruse, and Kugler reported that in a 2003 survey of 4,181 Germans that:
- More than half (52.4%) of the subjects with nicotine dependence fulfilled criteria for at least one mental disorder
- Anxiety Disorders were more than twice as common among dependent smokers than among nonsmokers
- Mood disorders, such as depression, were about twice as prevalent among dependent smokers as nonsmokers
- Dependent smokers were more likely to suffer from another substance use/abuse disorder, such as alcohol
- Most of the dependent smokers with simultaneous psychiatric conditions had two or more disorders in the last year
Why Do People With Mental Illness Smoke?
There are positive benefits to smoking for the mentally ill
Both physical and social factors are thought by researchers to reinforce the use of nicotine in the mentally ill. For many people with persistent mental illness, smoking is a major part of their daily routine. Smoking also has long been considered an integral part of the psychiatric culture. Moreover, clinicians often believe that persons with mental illness are not able or willing to quit. However, more and more psychiatric institutions are becoming smoke-free.
There are many reasons why a person may smoke. In addition to the usual reasons, people with a mental illness may find other positive effects from smoking. The effects of nicotine are so great that many psychiatrists and researchers believe that smoking is a form of self-medication. Positive effects of smoking for the mentally ill include the following:
- Nicotine increases alertness. It may enhance concentration, thinking and learning. This may be a benefit to people with mental illnesses whose symptoms or medication leads to cognitive problems.
- Nicotine’s psychoactive ingredients elevates mood. This may be a benefit to those with symptoms of mood flatness, and depression.
- Nicotine can help relaxation and stress. It can also reduce negative feelings such as anxiety, tension and anger. Smoking may help people with mental illness deal with stressful situations.
- Nicotine might have an antidepressant effect. Nicotine stimulates dopamine production in the brain and so may help negative symptoms of mental illnesses, such as lack of motivation, lack of energy and flat mood.
- Nicotine may reduce negative symptoms, such as hallucinations, for a short period.
- There is some evidence to suggest that smoking is associated with reduced levels of antipsychotic induced Parkinsonism (tremor, slowed movements, rigidity, and postural instability).
- Smoking can help to relieve boredom and provide a framework for the day for those with few activities.
- Smoking can improve social interaction, something that may be of particular benefit to people with negative socialization symptoms.
Continuing in Part 2
“Evil Twins: Smoking and Mental Illness, Part 2” continues with discussions of:
- Why Should Someone With a Mental Illness Quit Smoking?
- Can smoking cause mental illness?
- In Summary
What do you think?
Did you think that there would be positive effects to smoking for people with mental illnesses? I was surprised when I was doing the research for this series to find it is not only true but there is a long list of positive benefits. As part 2 states, this makes it doubly hard for smokers with a mental illness to quit smoking.
- Are you an ex-smoker? What was your experience of quitting?
- If you are a smoker or ex-smoker, which of the reasons for smoking can you relate to?
- Do you agree with the Harvard research that says that half of all smokers have a mental illness?
As always, your comments are welcome!
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Resources used in this post:
Arehart-Treichel, Joan. (2003, October 3). Smoking and Mental Illness: Which One’s the Chicken? Retrieved October 9, 2008 from Psychiatric News Web site: http://pn.psychiatryonline.org/cgi/content/full/38/19/34
Centers for Disease Control and Prevention. (2006, October 27). Tobacco Use Among Adults — United States, 2005. Retrieved October 13, 2008 from Centers for Disease Control and Prevention Web site: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5542a1.htm
el-Guebaly, N.; Cathcart, J.; Currie, S.; Brown, D.; Gloster, S. (2002). Smoking Cessation Approaches for Persons With Mental Illness or Addictive Disorders. Retrieved October 9, 2008 from Psychiatric Services (American Psychiatric Association) Web site: http://www.psychservices.psychiatryonline.org/cgi/content/full/53/9/1166
National Business Review. (2008, October 8). Those with mental illness smoke four times more than average. Retrieved October 9, 2008 from National Business Review Web site: http://www.nbr.co.nz/article/those-with-mental-illness-smoke-four-times-more-average-36198
Nauert, Rick. (2008, October 9). Smoking Accompanies Mental Illness. Retrieved October 9, 2008 from Psych Central Web site: http://psychcentral.com/news/2008/10/09/smoking-accompanies-mental-illness/3099.html
Rethink. (2008). Smoking and Mental Illness. Retrieved October 9, 2008 from eNotAlone Web site: http://www.enotalone.com/article/3110.html
Schmitz, N.; Kruse, J.; Kugler, J. (2003, September). Disabilities, Quality of Life, and Mental Disorders Associated with Smoking and Nicotine Dependence. Retrieved October 10, 2008 from American Journal of Psychiatry Web site: http://ajp.psychiatryonline.org/cgi/content/full/160/9/1670?
Woods, Michael. (2002, May 20). Studies: Smoking may be a cause of mental illness. Retrieved October 9, 2008 from Toledo Blade Web site: http://www.toledoblade.com/apps/pbcs.dll/article?Site=TO&Date=20020520&Category=COLUMNIST29&ArtNo=105190069&Ref=AR
Related Posts:
- Evil Twins: Smoking and Mental Illness, Part 2
- Post-Traumatic Stress Disorder Risk Doubled for Smokers
- Mental Illness Awareness Week: A Cause We Can All Support!
- Scapegoating and the Stigma of Mental Illness Part 2
- Scapegoating and the Stigma of Mental Illness, Part 1
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Yay! Part 1. I’m curious to see how this works out.
Mike, do you smoke?
I have noticed that a lot of people with mental illnesses smoke – we always read about how bad smoking is so it’s interesting to read about what positive benefits there can be for some people.
Kim, thanks for the comment!
I was shocked when I was doing the research to see what was termed “benefits” of smoking to those with mental illnesses. I think we are all trained to view everything about smoking as negative, and to think there is something positive leads to some sort of cognitive dissonance!
Alas, I am a smoker, as I confess in Part 2. I haven’t thoroughly thought through the “benefits” as it applies to me, but I already recognize some. In Part 2, I detail why it is so hard for the mentally ill to quit smoking, which I have tried and failed at countless times.
This post really hit me. My son (22) smokes. Your analysis to the benefits fits. He isn’t diagnosed with any illness at this point, but he has struggled with substance abuse in the past and my father was schitzophrenic with depression components.
Thanks for your insight and I still have to read part II. Now I subscribed by E-mail.
Congratulations on your HON Code certification.
Julie Walraven’s last blog post..Are You Disciplined or Does that Scare You?
Julie, thank you for the compliments, and thank you for commenting!
I began smoking at age 20 as something cool that my friends were doing. I didn’t give it up later because — I think — of all the “benefits” that it afforded. I was not diagnosed with bipolar disorder or an Anxiety Disorder at the time, but looking back, I was already having unmistakable symptoms.
I’m not saying that everyone who smokes is mentally ill, but it does seem to me to be an important indicator that one might have problems. Heavy drinking would be another. These, and other activities, are forms of self-medication for feelings that are troubling and confusing.
As I said to Kim, I didn’t realize how powerful a self-medication smoking is until I started researching this article. Sadly, it makes it all the harder to quit for those with mental illnesses.
Hello Mike, I think that I’m proof positive that your research is true to some extent. Here’s my story short and sweet. I smoked for 33 years and quit about 1 1/2 years ago. About 1 1/2 months into my quit I started to get anxiety pretty bad and was put on medication to no avail. I’m able to control the anxiety/panic but it’s exhausting. I think things to death and the only conclusion I can come up with is quitting smoking caused this onset ( or unveiled the long cover up) of anxiety at 45. I’ve been to a myriad of doctors(all types) who have no reasons. My family has a history of mental illness and my thoughts are that my smoking held mine at bay. My theory is that if most mental illness is caused by chemical imbalance and smoking alters a persons normal chemical balance/imbalance by introducing some 3000 chemicals, how can we say (or not) that smoking is bad for all people.
Now is the hard part, I don’t want to smoke, but, I don’t want this anxiety anymore. Drugs are not an option for me as the side effects were brutal and I’d rather have the anxiety. I’m trying to give my body some time to “heal” and hoping that the anxiety will subside the more smoke free time that passes. But, I’ve told my family that I might smoke again in an effort to get some relief from the anxiety. I’m also terrified if I smoke again and it doesn’t relief the anxiety, now I’m an anxious smoker!!!! It’s not a great position to be in, but, which is worse, mental health now or possible smoking related illness in the future. I would love to hear your thoughts. Thanks for your efforts with the EVIL TWINS!!!!
Thanks for commenting, Eric!
All the “benefits” of smoking for those with Anxiety Disorders have to be weighed against the obvious health risks involved. I am generally opposed to self-medication of any type, since it usually involves substances that can lead to even greater problems.
I agree that if you take up smoking again and it doesn’t work to relieve your Anxiety, then you will just be an “anxious smoker.” It is unfortunate that you have had such problems with medications that you can’t get relief that way.
Have you tried therapy or counseling? They take longer, but can be quite effective in relieving your Anxiety. I’d recommend Cognitive-Behavioral Therapy (CBT), which has a proven track record for helping those with Anxiety Disorders.
Hey Mike, Thanks for the reply. I’m currently in talk therapy and the truth is it doesn’t seem to help ,but, I continue because I have nothing else and I’m waiting for some help and I’m hopeful. I think a big part of my problem is most times I can’t pinpoint what I’m anxious about, the physical part starts and then the mental kicks in, the Doctor said this is common. I looked into CBT at the very beginning and the Therapist and I both agreed I wasn’t ready to do the work. A lot of work. I’ve had mostly negative side effects from quitting smoking which is so disappointing, I was expecting to feel so much better. But when you think about it there should be mostly negative effects. In my case my body was fed cigs for 33 years and to have just stop should be a shock. My body had to be dependent on more than just the nicotine. Now if my Doctor or other people were reading my posts they would say it’s just the junkie in me talking trying to find a reason to start smoking again, but, it’s honestly not and I don’t think smoking can be as easy as a 3 day physical withdrawal from nicotine. I think there is so much more to learn about smoking and mental disease. Again though I would hate to give up my quit after I was successful for 1 1/2 years. I’ll keep searching for an answer and hope that time will heal the GAD maybe with some other chemical swing. For the record, funny but, I also describe myself as an addictive personality. Currently my focus is coupons. Best of luck to all. I really thank you for all your efforts. Eric
Eric,
I’m glad you are in therapy. Though it may not seem like you are making any progress, many times you are and don’t realize it. Recently, I told my therapist that I thought I was not moving forward, and he recited the many milestones I had passed since we began — I was shocked that I had forgotten the bad shape I was in when I started with him!
In my opinion, it would be a big mistake to start smoking again, whatever the “benefits” are. I know you are pretty miserable, but just keep plugging away and things will get better. I’ve found that my progress is not a smooth upward climb, but happens in fits and starts: I’ll go for a long time seeming not to make any headway, then suddenly I am able to do something I hadn’t been able to do in years (it happened just this week).
So hang in there, and keep me posted on your progress! You can use the “Contact” tab at the top of the page to send me an email directly, or you can just add another comment to this post.
I recently had an episode of schizophrenia last year and found something very interesting, with the schizophrenia I was pushed into a extremely heightened state which continually got stronger and stronger, with it came steady and fast increases in paranoia, visual hallucinations and the perception of time in the world (things seeming to happen at a extremely fast rate). In this extremely scary and heightened state, smoking a cigarette would quickly bring me back “down to earth”, I found usually 3 puffs of a store purchased, processed cigarette would lower my state back to that of normality, with the effects of schizophrenia then slowly climbing back up to how they were before over the next hour, smoking a full cigarette seemed to continue to slow things down but the other negative effects would soon come back, paranoia and hallucinations. I had to find a steady balance of how many puffs of a cigarette to take to calm me down to a somewhat normal state during this time, I later found smoking “Chop Chop”, slang for pure unprocessed tobacco, was a lot easier and more beneficial in keeping me in a calm and controlled state without basically any negative side effects, the use of processed tobacco containing tar and many other chemicals had a differing effect, many times bringing an uncomfortable feeling into my body and as mentioned before if too much of a cigarette was smoked it would still have the calming and slowing effect on my perception of time, however increase the hallucinations and paranoia and push me into a new state of consciousness. It was a very interesting experience as I had never felt such profound effects from tobacco or nicotine, there is definitely a major difference in the mental effects of processed, chemical enriched tobacco over that of pure unprocessed tobacco though, I have no doubt of that. Nicotine itself was definitely a benefit during my episode of schizophrenia however the chemicals added to processed tobacco created more mental problems than that of just nicotine intake alone. Unfortunately where I live in Australia “Chop Chop” or growing tobacco at home is highly illegal, and purchasing it needs to be done via illegal means, needless to say it becomes extremely hard to get and risky to possess (can be charged and fined a large excess of money), so I am stuck to smoking processed tobacco, although it has no noticeable effects to me now my schizophrenia has passed, I know it definitely does far more damage mentally than pure tobacco or the drug nicotine alone. Problem is, I am entirely addicted to it, so it is extremely hard for me to quit because I rely on it so much to stabilise my everyday mood, going without leads to even troubles like increased anxiety and anger. Welcome to the never ending cycle of a smoker with mental illness!
I am 49 years old. I saw my first psychiatrist when I was 11. I have major depressive disorder.
I started smoking at age 15. When I have been in psych hospitals that didn’t allow smoking, I became more depressed.
I agree that the majority of the mentally ill smoke. I believe that it is mainly to self medicate.
I don’t believe that smoking causes mental illness. Many of the smoking mentally ill people I know had mental illness as children or in their teenage years before they started smoking.
Also the state hospitals used to give free cigarettes to patients as a reward or incentive. I know this through my own experience. I believe some formally non-smoking mentally ill were encouraged to smoke by mental health staff at the state hospitals, and thus became addicted that way.
Also in 1987 when I was in a state hospital in Nebraska, smoking was allowed only once an hour. One day the staff decided to withhold my cigarette as a way to punish me. I quit for the next 9 days(Untill I was discharged).