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