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Smoking and Mental Illness

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It has for years been a major concern that a large number people suffering from mental illness also suffer from smoking addiction. Chronic disease and preventable illnesses account for approximately 72 percent of annual health care costs (American Institute for Preventive Medicine [AIPM], 2008). The primary chronic diseases and preventable illnesses that contribute to health care costs are cardiovascular disease and stroke, obesity, cancer, diabetes, and arthritis. According to the (American Institute for Preventive Medicine [AIPM], 2008), there are three “modifiable health-damaging behaviors” that impact health care costs. Available literatures, medical reports, and number of personal documentaries abide to the fact that these medical complications remain the most expensive to manage. This therefore point to the fact an average citizen cannot to afford to purchase health care requirements to handle and manage these diseases. In addition to the above, the cost of maintaining these diseases always soar up due to the fact they affect one over long periods of time. The addictive behaviors of the mentally ill, the likelihood of cessation and why the addictive culture of smoking is always overlooked in psychiatric practice in regard to mentally ill patients will form the major sections of this paper.

Addictive behaviors of mentally ill

Available research articles abide in one fact that a large proportion of mentally ill patients are addicted to smoking. This fact is buttressed by Lasser,  Boyd  and Woolhandler  (2000)  in succinctly stating that “A proportionally large number of people with mental illness smoke and the smoking rate in the general population is just over 20% while the proportion of people with schizophrenia who smoke may be as high as 90%”. This statistical fact points to the fact that mentally ill patients are more inclined towards smoking at a higher rate in society than the average smoking rate of the rest of the population. In addition to the above, Lasser,  Boyd  and Woolhandler  (2000)  echoes that “a large number of mentally ill patients smoke because of the presence of nicotine that serves as an anti depressant”

The table below illustrates the percentage of mentally ill people who smoke against the specific mental disorder they are suffering from.



Bipolar Disorder


Major Depression




Panic Disorder


Post Traumatic Stress Disorder


El-Guebaly and Hodgins (1992)

The reason for such high levels of addiction amongst this group is not particularly hard to discern.  El-Guebaly and Hodgins (1992) points out that “There is evidence that smoking is a form of self-medication, since it appears to reduce anxiety, sedation, and improves concentration in some people and the presence of nicotine in a cigarette can have a calming effect, can increase alertness and improve memory”. These remain the chief reasons behind such a large percentage of the mentally ill association with smoking.

In addition to the above, both neurobiological and psychosocial factors are pointed to as being behind the consumption of nicotine in the mentally ill populations. According to El-Guebaly and Hodgins (1992)For many people with persistent mental illness, smoking is a major part of their daily routine and constitutes an activity that provides some structure to a day with few activities and smoking also has long been considered an integral part of the psychiatric culture”. Such practices have assisted in the increase in the prevalence of smoking culture amongst the mentally ill populations.

Likelihood of smoking cessation

As has been advanced, individuals with mental complications are more likely to smoke tobacco in comparison to other populations. In addition to the above, they are likely to consume more tobacco than the rest of populations. However, there is a strong belief that even the most addicted mentally ill patients have the capacity to stop smoking and involve in other benefiting activities. This has duly attracted calls for smoking cessation amongst this group of individuals. According to El-Guebaly and Hodgins (1992) “effective interventions in the cessation amongst this group involves the use a combination of medication and educational and cognitive-behavioral approaches.” These would adequately provide data in relation to quit rates, expired volumes of carbon monoxide and the number of cigarettes smoked in a given period of time.

The likelihood of cessation of smoking habit in the psychiatric population is generally lower that other groups that are addicted to smoking (El-Guebaly and Hodgins, 1992). The poor results in the expectations in numbers of cessations are directly linked to the applications of nicotine in the self medications amongst this group. This is more so because of the effects of nicotine in the body systems in regard to alertness, relaxation, reductions in hallucinations, release of boredom and its antidepressant effect. Furthermore, “nicotine stimulates dopamine production in part of the brain and so may help negative symptoms of schizophrenia, such as lack of motivation, lack of energy and flat mood” (Ker Leischow and Markowitz, 1996).While it is true that cessation of smoking amongst this group remains an obvious challenge due to the complications associated with the mental illness, there is demonstrated evidence that there are more health benefits of smoking cessation as opposed to the contrary. In summary, the possibilities of cessation exist if effective intervention techniques are put into use.

Overlooking Smoking in psychiatric practice

While there is documented evidence of the negative effects of smoking, it has been the culture that this addiction is overlooked in psychiatric practice because it forms one of the temporary curative measures. This is because according Ker Leischow and Markowitz (1996),  “studies have shown that smoking increases psychotic symptoms because antipsychotic drugs are flushed out of the body quicker due to the effects smoking has on kidneys.” This has been exploited by psychiatrists to reduce the levels of anxiety, increase blood flow and enhance relaxation. Furthermore, the temporary effects of smoking amongst this psychiatric group has been demonstrated to include the improvement of concentration, calming effect especially in agitated patients, increase in levels of alertness and improvement in memory.

Furthermore, available literature point to the fact that more doses of tobacco may be used to enhance the proper functions of the liver. This has effectively demonstrated one core reason as to why psychiatrists have continuously ignored the tobacco consumption cessation amongst the mentally ill patients. This fact is buttressed by Ker Leischow and Markowitz (1996) in clearly stating that “Substances found in tar in cigarettes stimulate enzymes in the liver, which increase the metabolism of some antipsychotics, including clozapine, fluphenazine, haloperidol and olanzapine and this result in higher doses being needed”.

In addition to the above, the proper functioning of the liver comes along with increased levels of proper drug consumption in the body during medications. The same drugs found in tar have the capacity to stimulate liver enzymes and has such psychiatrists have over the years relied on the consumption of tobacco amongst this group to review their medications. This has also contributed to the reasons behind the overlooking of smoking addiction by psychiatrists in the course of their drug administration to their patients. While smoking has also been pointed as another core reason behind serious side effects of medication such as increase of antipsychotic medication related to akathesia (restlessness) and tardive dyskinesia (slower involuntary movements), it is however very advantageous in that assists in the  reduction of some of the grave side effects of Parkinson’s. Lyon (1999) clearly states that “Poorer outcomes for smoking cessation strategies among psychiatric patients may have been expected because of the suspected use of nicotine for self-medication in this population”.  “Nevertheless, post treatment and 12-month quit rates for psychiatric patients appear to be only marginally lower than those for non-psychiatric samples” (Ker Leischow and Markowitz, 1996) because of the need to balance the immediate needs of the patient with those objectives of future medications.

Conclusion and Recommendations

Several researchers (Lasser, Boyd and Woolhandler, 2000; El-Guebaly and Hodgins, 1992 and Ker, Leischow and Markowitz I, 1996) all view early provisions of smoking cessation and effective and timely health promotion programs as an intervention strategy that can be used to change the behavior of those struggling with common psychiatric conditions such as bipolar disorder, major depressions, Schizophrenia, panic disorder and post traumatic stress disorder.  In addition to the above, steps aimed at stopping smoking would not only assist in health care costs among this group but would be effective in other addicted groups as well. A ‘stop smoking’ element of employee wellness programs can save between $404 -$40,849 per employee, depending on the age and sex of the employee (Lyon, 1999).

The effective recommendations that would become best strategies in handling the problem of smoking amongst this group include the modifications of conventional attitudes of the patient in line with the demands of his nature of the mental condition.  This would go along way in ensuring that each and every patient is handled in accordance with the mental condition. More resources are required for the proper handling of this group so that cessation efforts are intensely directed towards this group. Lastly, clinicians can best achieve their goals of treatment if they become more open on their inquiries about the interests of the patients in quitting smoking. In conclusion, smoking is a serious problem amongst psychiatric patients that can be solved through the application of effective strategies.

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