Smoking, mental health and mental illness

Smoking tobacco is a relatively common habit for individuals. The negative effects of smoking on the physiological health of people have been widely studied, and are publicly well known. In fact, smoking is the leading cause of death that can be prevented in the United States (Bor, Boyd, Himmelstein, Lasser, McCormick, Woolhandler, 2000). Aside from the physiological health, smoking can have an impact on the mental health of individuals, and on mental illness, especially the recovery from it. 

Interestingly, many individuals that are experiencing some form of mental illness smoke: 60% of those with a mental illness are smokers, compared to 25% of the general population, and they are the ones that smoke a lot (Adler, et al, 2001). Individuals with mental illness represent 40.6% of the total number of smokers in the United States, and they comprise 44.3% of the tobacco market. Overall, individuals with mental illness are the ones that are more likely to smoke, consume more cigarettes and have a lifetime prevalence of smoking (Bor, Boyd, Himmelstein, Lasser, McCormick, Woolhandler, 2000). From such statistics we can detect that there is a link between smoking and mental health and illness.

Smoking can have an effect on mental health: it has been argued that smokers experience psychopathological symptoms more severely than non-smokers. One key example is schizophrenia, and the disorders of the psychotic spectrum. It has been found that smokers with schizophrenia tend to have more intense symptomatology that non- smokers, despite that smoking has not been particularly linked to specific symptoms. Smoking is also linked with symptoms of depression and anxiety – both to individuals suffering specifically from depression and to those having depression as a symptom (while being diagnosed with schizophrenia for example) (Bromet, Guey, Kotov, Schwartz, 2010). On top of that, there are certain myths linking smoking to mental health- for example many believe that smoking might help them cope with their symptoms (whatever those may be), fact which is far from true. Simultaneously, clinicians often focus on other aspects of the life of the person, such as dealing with his/ her psychopathology, and tend to neglect smoking. In this manner, both clinicians and individuals who suffer might end up believing that smoking can help them relax, and take a breath from their symptoms, and that quitting it is the least of their concerns (Prochaska, 2011).

Smoking can also have an impact on the recovery of mental illness. As a habit, it alters the way psychopharmacology is received: specifically, smoking accelerates the metabolic rate of psychiatric medication, leading to lower levels of the drug into the blood. In this manner, smokers need a higher dose of the drug and the smaller doses have a smaller effect than in the non- smokers (Prochaska, 2011). Therefore smoking alters in a quite practical manner the attempt to recover form a mental illness.

Overall, smoking comes along with certain other characteristics, that are faced by all smokers, but can be more profound to smokers with a mental illness, since they have an additional ‘fight’ to give. Smokers have higher rates of hospitalization, and may spend more time in hospitals than non- smokers (Prochaska, 2011). This might in turn increase their symptomatology (for example intensify feelings of depression). Moreover, smoking can be seen as an economic burden as well, not only to the smoker himself/ herself, but also to their families and the society at large, especially if the person does not work and is not economically independent (as in the case of individuals with severe mental illness) (Prochaska, 2011).

Overall, the smoker is less likely to have a healthy way of life and of coping as a whole, fact which interacts with mental health, leading to more severe symptoms and with no focus on quitting, and with the recovery of mental illness, since it affects psychopharmacology. Looking at the situation as a whole, the characteristics of smokers (like the financials aspect of smoking and the physiology linked to it) may create a vicious cycle along with mental illness, and prevent a person from full recovery. To conclude, it should be noted that ‘people with psychiatric disorders are far more likely to die from tobacco- related diseases than from mental illness’ (Prochaska, 2011, 198). Quitting smoking can be a goal of psychiatric rehabilitation in the future.

Literature:

Adler, L., E., Benhammou, K., Berger, R., Breese, C., R., Drebing, C., Freedman, R., Gault, J.,Lee, M., J., Leonard, S., Logel, J., Olincy, A., Ross, R., G., Stevens, K., Sullivan, B., Vianzon, R., Virnich, D., E., Waldo, M., Walton, K., (2001). Smoking and mental illness. Pharmacology, Biochemistry and Behavior, 70, 561-570 

Bor, D., H., Boyd, J., W., Himmelstein, D., U., Lasser, K., McCormick, D., Woolhandler, S., (2000). Smoking and mental illness, A population- based prevalence study, Journal of American Medical Association, 284 (20), 2606-2610

Bromet, E., J., Guey, L., T., Kotov, R., Schwartz, J., E., (2010). Smoking in schizophrenia: Diagnostic specificity, symptom correlates and illness severity, Schizophrenia Bulletin, 36 (1), 173-181

Prochaska, J., J., (2011). Smoking and mental illness- Breaking the link. The New England Journal of Medicine, 196-198