Is smoking a mental health issue?

Minnesota is considering increasing the cost of a pack of cigarettes and the reasons make some sense: Cut down on smoking and make a couple of bucks until then.

For many people, the price of a pack of cigarettes is enough to make them quit.

But the Boston Globe presents one of the realities of smoking rarely considered in the effort to stamp it out: The mentally ill smoke as a means of controlling the symptoms of their illness.

“They rely on the cigarettes to soothe their symptoms — what the medications don’t,” April Vargas, who struggles with anxiety and depression tells the paper. The cigarettes help in “handling what they don’t know how to handle.”

People with mental illness may be less able to navigate the health care system to get to the doctors, support groups, or cessation tools that can help them quit. And, despite the significant health risks, many doctors or therapists have seen smoking as a problem that is secondary to managing symptoms of schizophrenia or depression.

Years ago, cigarettes were a pervasive part of mental health treatment, a mode of socializing at group homes and a reward given for good behavior at inpatient facilities.

“I think it’s really important to recognize that some people learned to smoke in hospitals,” said Dr. Ken Duckworth, medical director for the National Alliance on Mental Illness.

While smoking is prohibited today in nearly all mental health facilities, with many banning it even from the grounds outside, Duckworth said that the history of cigarettes in treatment has led some who work in mental health to be less aggressive in urging patients to quit.

It’s probably not mere coincidence, though, that people with mental illness have higher rates of physical illness, too.

In Massachusetts, for example, heart disease killed clients of the Department of Mental Health age 25 to 44 seven times the rate of the rest of the public.

That state is taking action. In addition to its anti-smoking efforts, it’s beginning to change its approach to mental health services to stress nutrition, exercise, and smoking cessation.

In 2000, a study revealed that nearly half of all cigarettes were smoked by someone with a mental health issue during the previous month.

And yet, curiously, it’s not considered a mental health issue in the mainstream.

  • Kassie

    Hennepin County has a smoking ban on all of their properties except the in patient mental health ward at HCMC. I think part of that is due to what is mentioned above, but my guess another part is that you don’t want someone who is in the middle of a mental health crisis to also go through withdrawal at the same time.

  • Robert Moffitt

    We (American Lung Assoc. in MN) are well aware of the toll smoking has on people dealing with mental illness. That’s why we, along with the Minnesota Department of Health, sponsored two workshops for mental health professionals in late January.

    Our goal is to better explain how tobacco addition works, and how to best help this high-risk population beat the habit. We flew in an expert from the Robert Wood Foundation to keynote the events.

    Doing nothing is not an option, and not fair to the mentally ill, who have just as much right to longer, healthier life as any other Minnesotan.

  • Robert Moffitt

    From a news release I sent out about the workshops:

    “Recent data from several states have found that people with severe mental illness die, on average, 25 years earlier than the general public. The number one cause of death in this population is heart disease related to tobacco use. People who struggle with mental disorders tend to be heavier smokers than the population as a whole. We need to better understand the unique needs of this community to help them find ways to quit tobacco, once and for all.”

  • Bob Collins

    // e, 25 years earlier than the general public. The number one cause of death in this population is heart disease related to tobacco use.

    While I’ll accept your premise that heart disease is #1 cause, my guess is that suicide skews the actual number were years are concerned.

    But, yeah.

  • Robert Moffitt

    “…my guess is that suicide skews the actual number were years are concerned.”

    That’s a very sad but likely true guess. Listened to NPR story this am about anxious/violent kids being treated with a horse tranquilizer. The catch in the mom’s voice when she recalled her mentally ill son’s suicide attempt…at age 5. Heartbreaking.

  • John R. Polito

    There’s a growing evidence that “smoking cessation does not appear to be associated with an increase in anxiety or depression and may lead to a reduced incidence of depression” (Shahab L, 2013). In the Ward “abstinence effects” study (Addictive Behaviors, 2001) 39% of smokers entering the study reported experiencing depression on the day before quitting compared to only 19% of non-smokers in the control group. On day three after quitting, the percentage in recovery indicating depression peaked at 53 percent. Reported depression had fallen to 33 percent by day seven (6 points below their starting baseline). By quitting day twenty-eight (28) only 20 percent reported depression, just one percentage point above the rate for non-smokers in the control group.

  • Jessie

    I’m no doctor. Just a worker in the behavioral healthcare community. The truth is someone who is dealing with auditory hallucinations, hallucinations, or constant noise that really isn’t there isn’t worried about their health. They’re in so much discomfort, I believe many would rather be dead than deal with their symptoms for 20, 40, or more years…NOT to say that all folks do anything about their desire to end the discomfort. My point is– if we can help control the symptoms we don’t have to worry about heart disease, lung disease or on a primitive level, smoking. There’s no need for distraction, self-medication, or the temporary reprieve smoking may offer if the symptoms are controlled. Smoking in my humble opinion is nothing more than a side effect of the mental health disorder in this population.

  • Christian

    It could partially be a mental health issue. Even if so, I believe the root to be neurological (i.e. neurological issues cause other issues, including, in some cases, a form of mental illness).

    I do believe people who smoke are self-medicating. I have never believed it’s “just an issue of willpower” or “a matter of habit.”

  • John – InternationalVaporGroup

    Only those will quit because of the price who won’t be able to afford cigarettes but what about rich people, it seems like the government is only targeting low income smokers.