National Alliance on Mental Illness
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Smoking and Mental Illness
People living with mental illness have a very high rate of smoking. A study by The Journal of the American Medical Association reported that 44.3 percent of all cigarettes in America are consumed by individuals who live with mental illness and/or substance abuse disorders. This means that people living with mental illness are about twice as likely to smoke as other persons.
A positive note is that people who live with mental illness had substantial quit-rates, which were almost as high as the group without mental illness. NAMI has led many changes in our mental health system─getting access to the tools to quit smoking is a way to improve the quality and quantity of life. Improving lives is a new advocacy pursuit.
The Connection between Mental Illness and Smoking
There is no one single, certain reason why so many people who live with mental illness smoke. It may be a combination of brain effects, psychological effects and the social world in which we live.
From a brain-based perspective, research is being done to determine if and how nicotine is involved in some of the brain's memory functions. If nicotine is a factor, then this could explain why so many people living with an illness like schizophrenia or other illness involving cognitive deficits may smoke. Even though smoking is thought to enhance concentration and cognition, the effects are short in duration.
Researchers and the medical community have a great deal to learn about how smoking impacts the brains of those living with mental illness. It is known that people diagnosed with schizophrenia often smoke before the onset of symptoms and that they smoke more often and inhale more deeply than smokers without schizophrenia.
While we still have a lot to learn about why people smoke, there is plenty of information to support the serious health risks of smoking. So while there may be good reasons why you were attracted to smoking, the key is to figure out ways to increase rates of quitting. Nicotine isn't a health problem on its own, but when smoked and combined with hundreds of other chemicals that are present in cigarettes the practice of smoking is toxic.
Psychologically, all addictions soothe cravings. People often find themselves relaxed and less tense when their addiction is fed. This is true of cigarette smoking. Smoking can also be part of a social norm, one where people in your social circle all hang out and smoke. Some people who live with mental illness learned to smoke in a hospital or in group-living settings. These examples help illustrate how the mental health culture needs to move forward to reduce the tie between socialization and smoking.
Facts About Smoking
People die from smoking-related illnesses. Every year, smoking kills about 200,000 people who live with mental illness. Smoking harms nearly every organ of your body and diminishes your overall health. Smoking is a leading cause of cancer and of cancer-related death.
Smoking also causes heart disease, stroke and lung disease. With the increased risk of heart disease from second-generation atypical antipsychotic medications (SGAs), individuals living with mental illness must try to quit.
Inhaled cigarette smoke is made up of 4,000 chemicals, including cyanide, benzene, ammonia and carbon monoxide to name a few. There is no safe tobacco product, so switching to a smokeless or chew product will not eliminate your risk of smoking-related diseases.
People are finally waking up to the fact that smoking is a true health hazard, and people need to quit in order to live longer. More psychiatric facilities are going smoke-free, and NAMI is advocating for access to smoking cessation in outpatient settings.
State mental health commissioners and state medical directors are committed to changing the way the public mental health culture relates to smoking. Check out their toolkit (http://www.nasmhpd.org/general_files/publications/NASMHPD.toolkitfinalupdated90707.pdf) to see what policy changes and strategies they are using to create a healthier mental health system environment.
There are two types of second-hand smoke: mainstream smoke─the smoke that is exhaled by a smoker, and sidestream smoke─the smoke that comes from a burning cigarette, cigar or pipe. Second-hand smoke is inhaled by nonsmokers who are around smokers. It lingers in the air after cigarettes, cigars or pipes have been extinguished. Exposure to second-hand smoke is called involuntary smoking or passive smoking. Second-hand smoke can cause or exacerbate a wide range of adverse health effects, especially in children.
Second-hand smoke has been classified by the EPA as a known carcinogen. It contains hundreds of chemicals, including formaldehyde, benzene, vinyl chloride, arsenic ammonia and hydrogen cyanide.
According to the American Lung Association, second-hand smoke causes almost 50,000 deaths in adult nonsmokers in the United States each year, including approximately 3,400 from lung cancer and as many as 69,600 from heart disease. It can also irritate the lungs causing coughing, wheezing, increased phlegm and a feeling of breathlessness. Children who are exposed have an increased risk of asthma attacks, ear infections and lung diseases (i.e., pneumonia and bronchitis).
To protect yourself and your family from second-hand smoke, do not allow anyone to smoke in your home. If you have loved ones or coworkers who smoke, make sure they know that you would prefer them to not smoke around you and your family. Do not smoke or allow others to smoke in your car. Choose restaurants and bars that are smoke-free. Make sure your child's day care, school and after-school programs are smoke-free. Finally, ask your employer, clubhouse, hospital or day program to create a smoke-free policy.
Smoking's Effects on Symptoms and Medications
Research shows that people living with mental illness do not have worse symptoms after they quit. It is understandable that this is a concern with quitting smoking. Quitting is hard work, and it may take many efforts to be successful. Be sure to get support, talk with your doctor, set a quit date and explore the tools for success (Link to tools for success section) that are available to help you quit.
If you are a smoker and you quit, you can usually get the same treatment results from lower doses of psychiatric medications. Smoking increases the breakdown of medicines in your body, so smokers need to take higher doses to get the same results as someone who does not smoke. Without cigarettes you may need to take less medication. An additional benefit is that a dose reduction will likely reduce side effects of medicines, such as weight gain and other side effects.
Smoking and Diabetes
It is very hard to live with more than one medical problem. Diabetes is a big issue for many people who live with mental illness and, like smoking, it increases the chances of early death. The two problems together are twice as dangerous. Smoking is very bad for diabetes; the two together worsen all risks. For instance, smoking and diabetes increases your chances of having a heart attack 11 times higher than the general population. Be sure to talk with your health care provider about how to manage these risks and how to prioritize your self-care efforts.