People with serious mental illness are much more likely to smoke and to suffer from tobacco caused illness. For example, 60-70% of people with schizophrenia smoke compared with fewer than 20% of people without serious mental illness (1). This is the biggest reason that people with serious mental illness live 10 years less and suffer more from chronic disease(2). Significant progress has been made in reducing the prevalence of tobacco use and the resulting mortality, and morbidity, but not for those with mental illness.
There is a false and unfortunate stigma that people with serious mental illness don’t want to stop smoking, or are not capable of quitting. Much too often, they are not screened for tobacco use and do not receive treatment for tobacco dependence. Mental health symptoms may make it more difficult to stop for various reasons, but folks with mental illness do want to stop and can be successful in quitting when provided with effective support and treatment. This treatment may often take the shape of more intensive behavioral support and cessation medication use(3,4).
Another concern is that symptoms related to depression, anxiety, or too much stress will worsen once a person stops smoking. This perception may be due to the fact that these are also symptoms of withdrawal from tobacco. However, stopping smoking may actually result in improvements in mood, as well as lowered stress and anxiety. A key to supporting patients with mental illness may be to provide treatment that is sufficient to alleviate nicotine withdrawal (5,6).
For any person who smokes, stopping is the single best thing they can do to improve their physical health. This is also true for people with mental illness. Those among us who cope with such challenges should not be unfairly treated or stigmatized in regards to smoking. They can and will stop if provided the right treatment and support.
References:
1. Khanna P, Clifton AV, Banks D, Tosh GE. Smoking cessation advice for people with serious mental illness. Cochrane Database Syst Rev. 2016;1:CD009704.
2. Robson D, Gray R. Serious mental illness and physical health problems: a discussion paper. Int J Nurs Stud. Mar 2007;44(3):457-466.
3. Aubin HJ, Rollema H, Svensson TH, Winterer G. Smoking, quitting, and psychiatric disease: a review. Neurosci Biobehav Rev. Jan 2012;36(1):271-284.
4. Rollema H, Svensson TH, Winterer G. Neurosci Biobehav Rev. 2012 Jan;36(1):271-84. doi: 10.1016/j.neubiorev.2011.06.007. Epub 2011 Jun 23.
5. Tidey JW, Miller ME. Smoking cessation and reduction in people with chronic mental illness. BMJ. 2015;351:h4065.
6. Twyman L, Bonevski B, Paul C, Bryant J. Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature. BMJ Open. 2014;4(12):e006414.
