Evil Twins: Smoking and Mental Illness, Part 1

by Mike Nichols – Posted in: Anxiety

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

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23 comments… add one
Kim Woodbridge October 14, 2008, 10:38 pm

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.

Mike October 20, 2008, 3:59 pm

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.

L A April 26, 2013, 12:25 pm

I googled “is horrible agitation part of not smoking” and your article came up. I have been quit now for 9 months and do not feel any better. Adderall has helped some and has kept me from smoking but on the days I don’t take the Adderall as recommended by my physician (two days off a week) I am so angry, and disgusted with everything, I almost feel like smoking just to not feel this way anymore. I’m very conflicted. I was to the point where I hated smoking and hated being a smoker. I don’ want to be a smoker, but some days………… the agitation is just over whelming and the blah flat line mood. I certainly feel much better after seeing this article and your research. I still don’t want to smoke. I just have to find a healthy alternative.

Julie Walraven November 20, 2008, 8:00 am

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?

Mike November 20, 2008, 3:23 pm

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.

Eric December 7, 2008, 7:04 pm

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!!!!

Mike December 8, 2008, 4:39 pm

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.

Eric December 8, 2008, 9:53 pm

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

Mike December 10, 2008, 3:15 am

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.

Roy February 15, 2009, 12:32 pm

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!

Bobbie Evans June 15, 2009, 4:18 pm

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).

Mrs. P. June 19, 2011, 9:29 am

Hi,
My 30 year old son smoked since he was about 17. His smoking increased when he lived away from me at college, and it also increased when he started smoking pot. I believe that he as self medicating, and doing a pretty good job of it, until he became so erratic and belligerent toward me that our relationship broke down. He started and ran many small businesses (pond cleaning, water plant distribution, selling cars, and finally his dream, a little second hand store) He was charming, incredibly handsome, self deprecating, and a natural salesman. People loved him, but he did not like me because I was the one he came to for money, and he did not like to ask because I think he felt a sense of failure. If I felt that he was on the right track, I would always tell him, and give him the money if I had it. We had many fights over money because I am not made of it, and his smoking habits were a large part of his life. He also had an underlying immune problem, he had his spleen removed when he was two. Despite my pleas to have him see a doctor or get a flu shot, he would always hang up on me.
Then one day last Dec 2010 he was living with his girl friend and decided to call me to have me take him to the Doctor because he had the flu and was coughing. (he was always coughing even when he did not have a cold so it became white noise) We were driving along and I tried to take him to a clinic that I had taken him to the year before. He got really angry with me and started yelling and screaming at me to take him home. Then when on and on and I finally did. That evening he took himself to a clinic that diagnosed him with bronchitis. The next day around 2:00 pm he went to the emergency room. He called for me about 6 pm. The doctor said they did not know if they could save him. He died 3 days later. He got sepsis from pneumonia and I will never be the same. I had been going to Nami for years trying to figure this out. I had been in therapy myself because I could not get him to go. I am in therapy now trying to no want to not be here. I have two other kids and two grand children. But my heart will forever be broken over not being able figure this out while he was alive. I believe that cigarettes and mostly pot lead to his weakened immune system, in combination with the weakened system with no spleen make his condition to an old man on the insides. My whole huge family from whom he had been pretty much estranged for the last 10 years (self estrangement for no particular reason) stayed around his bedside and prayed for his recovery. We all loved him. We are all grieving the loss of a wonderful person. Everyone out there reading this, please do your best to take care of yourself. It is so painful to lose a child. I loved him so much. I will miss him forever. The only thing that gives me any solace is that in heaven you don’t probably have the need to smoke anything, and you have no anxiety or depression. I tried to hard and so long to get him help. It seems such a really devastating ending to a beautiful young life. Mrs. P.

Jack Rivers July 13, 2011, 8:15 pm

I’ve just read part one. First of all…I quit smoking about a year ago now; I’ve been completely smoke free; I haven’t touched a cigarette since I quit. When I did smoke, although I was sometimes depressed I have to say, I had some of the best times of my life.

I don’t smoke now… Cigarettes seem like the shining light at the moment as I now, since quitting smoking, suffer with depersonalization, derealization and extreme social anxiety. The plus side is that I’m healthier…well…you know what I mean; I’m also setting up a business. Bittersweet eh. I’m fairly happy considering what I’m having to deal with and I can safely say I wasn’t that happy as a smoker.

One last thing: the derealization, anxiety etc is so extreme now that like I said earlier – smoking…looks good. It’s cool and you know it. Well you know.. Once a smoker always a smoker?

Randy December 18, 2011, 4:27 pm

Quit smoking for mentally ill:

I had symptoms of mental illness since I was a child due to abuse,bad parents and other reasons.But I was fairly ok because I excelled in school and college.I started alchol when I was 18 and was an occassional drinker.I started smoking when i was 20 and things started going down gradually.After couple of years I started heavy drinking,heavy smoking ,heavy caffeine.My food intake was pretty bad .At 28 I was diagnosed with severe depression and anxiety and was put on medication and recovered.I quit alcohol for couple of years because of its interaction with medication but later on became an ocassional drinker.For one year from nov 2007 to 2008 I abused alcohol with the medications.In 2009 I quit medication and felt better but I relapsed with in 3 months and since then none of medications work and I am suffereing.July 2011 I started a new medication and I felt better for 2 months and slowly relapsed.Doctor quit me on that medication and put me on different medication for the last 3 weeks.At the same time I quit caffeine and started decaf and cut my smoking from 1 pack a day to about 7 0r 8 a day and my anxiety has improved considerably.I have tried not smoking for 10 to 12 hours and felt better and definetely not worse.I am believer that smoking causes depression and I want to try quitting for 1 week and see if my depression improves.I will report back every day on how I feel.I believe for mental illness all of the following are factors…good or bad depends on various other things…

1.Smoking.
2.Alchohol.
3.Coffee.
4.Medication
5.Food.

I want to give my self a chance to cure myself…so completely quit alcohol…no improvement,cut down smoking …no improvement and quit cofee to decaf…anxiety has improved..will try eliminating smoking for a week and see if there is improvement….I am pretty sure I cant get any worse by quitting smoking…..

CandyK. March 22, 2012, 6:35 pm

I first want to start by saying it has been helpful to hear everyone’s story or input. I have spent years denying or even rebuking the fact that I suffer with mental ailments…AKA (mental illness). I first started seeing a psychiatrist at the age of 14. It went from an eating disorder to drug use and alcoholism. I spent years on different meds (prescribed by doctors and self prescribed). Some years were better than others, but I have always had this depression lingering over me for as long as I can remember. My happiest times were self induced heavily medicated street narcotics followed by extreme lows which were mostly unbearable…throughout the years I would smoke off and on, but always able to quit…especially when I was not doing the street narcotics…I believed i was doing well, moved to Maui and was successful for a while..my Dr. put me on stimulants for adhd which made me smoke for a little over the last year and it has been nearly impossible to put them down…I have been taught that mental illness is weak and have much shame attached to it. I have made poor choices with selecting healthy partners…naturally, you cannot attract what your not…However, I have this crazy flip side to me where I put all my focus and energy on working out and eating organic and thrive and am so happy and love myself at these times…I have recently lost that spot and have not figured out how to get back…I believe I spun out on the stimulants which were inducing my desire to smoke…I am in my second day of not smoking, I am active in juicing and drinking all healthy ingredient smoothies…working on getting daily exercise..it is hard when you are depressed…I too, have recently started suffering from anxiety disorder since I have left Maui…would love to get back…I had never felt more alive, more love for myself and others, and feelings of usefulness. Every little thing you can do that is positive for yourself-try to do it….baby steps…It is nice to know and alleviates the shame of struggling with mental illness that I am not alone….care and love yourself, were not perfect, I guess were not meant to be…peace and love….Candace

CandyK. March 22, 2012, 6:43 pm

Also my grandmother was diagnosed with Schizophrenia. She smoked for years and increased her cigarette intake throughout the years..She suffered from cancer earlier in her life and swore she would never smoke again…

However, once she was better it was just necessary for her to have her cigarettes…it was the one thing she really loved and I think it obviously released the chemicals in her brain to make her feel better…she was a wonderful lady who went through an extreme amount of stress for a woman in her time…

She in the end was taken by cancer, but I do believe she would take the same death if to do over….she just needed those cigarettes…Love you Grandma Klingbeil

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Scott August 19, 2012, 8:53 am

Due to the recession, unemployment, and the complete draining of my bank accounts, and 401k, I was up to 2 packs of cigarettes a day…. (side track) I had noticed many years ago, when the tobacco industry had added the “extra chemicals” in their product to make them “safer’. Something about making them (the cigarettes) go out, so people who fall asleep wouldn’t catch themselves on fire, or if it fell out of the ash tray it would go out. I immediately noticed a major difference, in the taste, they actually made my tounge tingle. Satisfaction, right after I would put one out, I would light up another, some times, I would pull one out and go to light it with a lit one in my hand. So, I went up in my “dosage”, From half a pack, whole pack to almost three packs a day, varying on job/life stress levels. (side track back in to about a month ago) I have gone from 2 packs a day, to one, to half, to rationing them out. Over the past month, I have felt myself “slipping”, questioning my sanity, night sweats, night terrors, increased visits from the “Sooners” (side note; The sooners are a Steven King like re-occuring antagonist in my nightmares. I would wake up soaking wet from sweat, have to change my clothes and sheets, just to go back to sleep, for a few hours, and have the dreams pick up where they left off.) I started logging my up/down time, and intervules. I am staying up longer, sleeping less, and the nightmares are not only episodic, but full length vivid features in the past few weeks, I have logged only 3 hours of continuos sleep max, with an exponential increase of up time. ex: Yesterday, woke up at 4:00 am, was up for 23 hours, slept for 2. Now I am having awake, halucinations, no seriously, the little bar that flashes at the end of a sentence when you stop typing, I could swear, as I was re-reading what I just wrote, started to flash slower, and slower, then it stopped, ok, it did it again, I’m not halucinating, I’m just paranoid. My major concern is, going back to the begining. I’m broke, literaly, and figuritively. My anger at trivial matters is at an all time high, my o.c.b. as I call it has reached new heights. I’m starting to sort 30 year old jars of screws nuts and bolts by lengh, thread pitch, color etc… and worst of all, the five gallon sparklettes jug full of change is now empty, that last pack of “Marbs” it bought, is down to one, and I’ve been ranting on in this respond window typing frantically to avoid the innevitable….lighting up my last smoke……… Is tobacco the cause, or is it the cure? Maybe, just maybe it’s both.

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