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Smoking Cigarettes and Mental Illness: Is There a Connection?
First off, smoking does not cause mental illness. However, there is scientific evidence that individuals diagnosed with a mental illness are significantly more likely to smoke cigarettes than individuals who are not diagnosed with a mental illness of some type. According to some studies, this may be due to the seemingly positive side effects of smoking.
Some studies have actually indicated that for mental disorders like schizophrenia, there might be a therapeutic effect from nicotine. But these findings are not fully understood nor are the mechanisms by which this effect might occur .
Nicotine has also been empirically demonstrated to improve attention and concentration, although these improvements are very short-lived (about 5 minutes on average ). This quick improvement in one’s ability to concentrate is an appealing side effect for many people with and without mental illness and, given its short–term benefit, may lead to people smoking more often.
Researchers have also suggested that people who have a mental illness and take medication for it may be using cigarettes or tobacco to mask medication side effects or even the side effects of some of the general symptoms that occur in nearly all mental illnesses. Nearly every form of mental illness has an element of depressed mood and anxiety associated with it . Smoking may relieve this anxiety. Moreover, individuals who are prone to experiencing higher levels of anxiety may smoke more often to avoid the anxiety associated with withdrawal from nicotine once they stop smoking.
Because there is actually a physical withdrawal that includes feeling anxious and even depressed when an individual quits smoking cigarettes, individuals with mental illness will often experience an increase in the severity of the symptoms of their particular illness if they quit smoking. Thus, these individuals may smoke more often and have more difficulty quitting smoking . Individuals who take antidepressants may experience anxiety as a side effect and cigarettes may reduce some of this anxiety as well.
When cigarette smoking is an addiction, engaging in the addictive behavior obviously soothes cravings. When their cravings are soothed, individuals find themselves feeling more relaxed. Thus, individuals with mental illnesses may smoke more often as it releases tension associated with their symptoms and with an addictive behavior. Moreover, individuals with mental illnesses may have picked up smoking from other individuals in group homes, clinics, etc. They may have learned to expect that smoking cigarettes will ease their tension, even if the real effect is only marginal. To say the least, expectations are very powerful motivators for individuals to behave in a particular way.
A Targeted Population
People who have mental disorders or mental illness are more likely to have experienced more stressful events in their lives, have poorer living conditions, more homelessness, and come from lower social economic status than individuals without a diagnosed mental disorder. There is evidence that the big tobacco companies have targeted these types of individuals in their advertising campaigns for years and a recent study suggested that people with schizophrenia were specifically targeted by tobacco companies . Research has suggested that the big tobacco companies may have also been involved in attempting to lift smoking bans from psychiatric hospitals .
Surprisingly, the mental health system itself traditionally rewarded people with severe mental illnesses for smoking. A common habit in psychiatric clinics and hospitals in the past has been to reward people with severe mental illness for good behavior by allowing them to smoke or giving them “smoking breaks” outside. Moreover, people who were admitted to such clinics often learned to smoke from other patients as a means to relieve tension and stress. Thus, many individuals with mental illness have high expectations that cigarette smoking will relieve their symptoms. These expectations, even if they are not really true, can lead to a sort of self–fulfilling prophecy where the mere expectation of symptom or stress relief from smoking itself leads to an individual feeling less stressed.
The Final Analysis
Due to the potential harmful effects of cigarette smoking, individuals diagnosed with a mental disorder should be encouraged to quit. The aforementioned factors, however, make it more difficult for these individuals to abandon the habit compared to individuals without a mental disorder. In addition, quitting smoking is already extremely hard anybody. These individuals need to be empowered to quit smoking and taught that in the long run, their treatment will likely become more effective, their symptoms less intense, and their health vastly improved.
 Center for Disease Control (2013). Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years with Mental Illness — United States, 2009–2011. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6205a2.htm?s_cid=mm6205a2_w
 Hatfield, R. C. (2013). The everything guide to the human brain. Avon MA: Adams.
 Prochaska, J. J., Hall, S. M., & Bero, L. A. (2008). Tobacco use among individuals with schizophrenia: what role has the tobacco industry played? Schizophrenia bulletin, 34(3), 555-567
Dr. Hatfield is a clinical neuropsychologist with extensive experience assessing and treating neurological and psychiatric disorders. His areas of expertise include neurobiology, behavior, dementia, head injury, addiction, abnormal psychology, personality disorders, statistics, rehabilitation psychology and research methodology.