Smoking and mental illness
People with mental health problems are more likely to smoke than the general population, it important that people know the risks associated with smoking and that they are given help if they need to quit.
Why do people with severe mental illness smoke?
9.4 million people in Great Britain smoke and 114,000 people die each year because of it.
Studies show that people with mental illness are more likely to smoke. 80% of people with schizophrenia smoke. People with psychotic disorders are especially vulnerable if they live in institutions like hospitals.
There are several reasons why people with mental illness are more likely to smoke:
- Deprivation - It is most common for people who are deprived (don't have what they need) to smoke as it can be a way that people deal with unusual amounts of stress. Mental health problems are common in deprived groups.
- Anxiety and Stress - Having a mental health problem often causes symptoms of anxiety and stress. Smoking can be seen as a way of reducing these. Someone who is addicted to nicotine will crave cigarettes and the relief they feel when the craving is satisfied is what is misunderstood as a feeling of relaxation. Smokers actually have higher levels of stress than non-smokers.
- Environmental Influences - Someone with a mental health condition is more likely to smoke if they live in hospital than if they live at home .This can be to give them a sense of control which the lack. Professionals sometimes feel that smoking is one of the few pleasure patients have and are therefore less inclined to encourage them to stop.
- There is a link between smoking and mental health - Smoking changes how people feel and can make them more vulnerable to mental illness, it can also increase feelings of anxiety. People with schizophrenia can have increased positive symptoms if they smoke.
- Self Medication - Sometimes people want to make themselves feel or different with things like alcohol, unprescribed medication, illegal drugs or nicotine. Some studies have found that smoking improves the thinking process in people with schizophrenia as well as reducing symptoms and side affects.
- Withdrawal Symptoms - It is difficult for anyone who is addicted to smoking to stop as withdrawal symptoms can make you feel irritable and restless. For people with existing problems with anxiety and depression there might be a risk of complicating or triggering mental health problems further. Giving up smoking does not make psychosis worse.
What people with mental illness need to know about stopping smoking
About half of people with mental illness who smoke want to quit. Tobacco is addictive and is hard for anyone to give up, psychologically and physically. Lots of people manage it though and here are some ways that work:
- Brief opportunistic advice - Sometimes your GP will encourage you to give up smoking when you are talking to them about a separate health concern. This type of advise increases the chances of quitting by 1-3%.
People with mental health problems are just as capable of giving up as those without. It is important to be aware that it is best not to offer treatment for smoking when the persons illness is very active.
- Cognitive behavioural therapy (CBT) - People who receive CBT for either their smoking habit or for their mental health condition have a higher rate of quitting. If an individual receives therapy for both then the rate of stopping increase even more.
For more information, visit the Talking treatments section of our website.
- Group therapy and nicotine replacement therapy (NRT) - NRT includes things like nicotine gum and nicotine patches. In a study it was found that people with schizophrenia who received only group therapy were just as likely to give up smoking as those who had group therapy and NRT. It also found that nicotine patches were more affective for people taking atypical antipsychotics than than they were for people taking typical psychotics.
In studies of smokers with schizophrenia, those who used nicotine patches were shown to be less likely to relapse in than those you were given a placebo.
- Bupropion - In the UK, bupropion is a drug that is used to help people give up smoking. In the US it is also used as an antidepressant. It is usually prescribed for people who have committed to giving up by a certain date. It is sometimes unsuitable for people already taking medication for mental illness.
