Smoking

Smokers often say that smoking helps to cope with stress. However, smoking causes serious health risks so that help should be provided to those who want to quit.

There are several theories why people with mental illness smoke:

Smoking is most popular in the most deprived groups. Researchers suggest that people with mental health problems smoke in a similar way to other deprived group, such as a way of coping with the stresses of their everyday lives.

Smokers often report that smoking helps to relieve feelings of anxiety and stress. However, smokers show higher levels of stress in their lives than non-smokers. Once someone is addicted to nicotine, when their nicotine levels start to drop they begin to crave for a cigarette. This craving makes the smoker feel stressed. The relief felt when this craving is finally satisfied is the feeling that smokers commonly mistake as 'relaxing'.

Rates of smoking are higher in people who live in institutions (like a hospital) than those with similar illnesses living at home. Patients may feel that smoking was something they could control in an otherwise uncontrollable environment.  Patients also describe peer pressure to smoke when in hospital, and staff were reluctant to talk about stopping smoking when they saw it as one of the few pleasures that people with severe mental illness have.

Self-medication is consistent with several studies which show that smoking can reduce some of the positive and negative symptoms of psychotic illness, improve cognition and may also help reduce some of the side effects of antipsychotics.

Tobacco is an addictive substance and can be physically hard to stop as well as psychologically difficult. Here are a number of ways of stopping smoking that have proved effective with people with mental illness.
 

• Advice -  such as when a doctor tells you to stop smoking because it is not good for your health (such as after a heart attack) is not as effective compared to other methods of stopping.
• Cognitive and behavioural therapy - A study carried out with cigarette smokers who had experienced major depressive disorder in the past found that cognitive behavioural smoking cessation treatment plus cognitive behavioural therapy for depression resulted in 25-33% abstinence (stopping). Further research showed that for some smokers, two treatments were better than one.
• Group therapy and nicotine replacement therapy - Nicotine replacement therapy (NRT) includes nicotine gum or nicotine replacement patches. Research shows that group therapy and NRT has approximately a 50% success rate.
• Bupropion
  Bupropion is licensed as an antidepressant in the USA and for smoking cessation in the USA and UK. Bupropion has been shown to be effective in both reducing smoking and in helping people quit smoking. However, bupropion is unsuitable for many people taking medication for mental illness.

Read about support provided by Rethink and other organisations to quit smoking:

• The Croft smoking cessation programme
• West Midlands smoking cessation progarmme
• No Smoking Day