Living with a mental illness can be difficult, and some people may turn to smoking as a way to cope with symptoms or handle stressful life events. About 18 million people with mental illness currently use tobacco products, and adults with mental illness use cigarettes at higher rates than those without a mental illness.
People with mental illness or a substance use disorder also smoke more cigarettes. Despite only representing 25% of the U.S. adult population, they consume 40% of cigarettes sold in the U.S. — smoking two more packs per month than people without a mental health condition. People with serious mental illness represent only 6.9% of people who have smoked in the past month, but they consume 8.7% of all cigarettes sold.
Although it may provide temporary relief from some symptoms, smoking is not a healthy solution for managing mental illness. Nicotine can alter mood in a way that covers up symptoms, which reinforces the increased use of tobacco in people with a mental health condition. Smoking tobacco can exacerbate existing mental and physical health challenges in the short term and lead to additional negative outcomes down the road. If you or a loved one smokes, here is what you need to know about smoking and mental illness — including information to help you quit.

Mental And Physical Health Effects

Smoking takes a toll on both your mental and physical health, and the consequences can be severe. In the U.S., people with mental illness who smoke die up to 15 years earlier than people without mental illness who do not smoke. People with mental illness are four times more likely to die prematurely if they smoke cigarettes. Heart disease, cancer and lung disease are the leading causes of death for people with mental illness, so it’s important to understand how smoking affects your risk for these diseases.
Serious health effects of smoking tobacco include:

  • Increased risk of heart attack, stroke and lung cancer
  • Coughing and shortness of breath
  • Worsened anxiety, stress and depression
  • Oral health issues, including gum disease and tooth loss
  • Potential interactions with psychiatric medications
    • Smoking tobacco may decrease the effectiveness of some psychiatric medications, and you might need a higher dosage to achieve the same level of therapeutic benefit
  • Social isolation, stigma and negative self-image

Some of these harmful effects decrease immediately when you stop smoking, and the improvements add up over time. Coughing and shortness of breath are reduced in the first month after quitting, risk of heart attack decreases after one year, risk of stroke decreases after five years, and increased risk of lung cancer is dramatically reduced after 10 years.
A number of other benefits are possible when you quit, including more financial freedom, a longer lifespan and a healthier home life.

Vaping And E-Cigarettes

Although some people may believe that vaping is a safe way to use tobacco, this is a dangerous misconception. E-cigarettes are not harmless, and complete cessation from all tobacco products is the healthiest choice. Like combustible, or lighted, tobacco products, the liquid in e-cigarettes contains nicotine and can lead to dependence.
E-liquids contain additional flavorings and chemical compounds like propylene glycol and glycerol, and research has not demonstrated that these compounds are safe to inhale. Because there is little regulatory oversight, e-cigarette products purchased “off the street” may be unsafe due to adulteration of these compounds. The overall long-term health effects of e-cigarettes are also unknown.
Switching completely to e-cigarettes from combustible tobacco products may have some health benefit, but e-cigarettes are not FDA-approved tobacco cessation devices.

Youth And Tobacco Use

The use of e-cigarettes is especially common among young people, even those who had never used combustible tobacco products before. In 2018, among young adults ages 18–24, 22.1% of people who currently smoked, 36.5% of people who used to smoke and 4.6% of people who had never smoked reported using e-cigarettes.
And in 2020, 3.6 million middle and high school students reported using e-cigarettes.
However, youth tobacco use is not limited to vaping — 1.15 million middle and high school students reported smoking cigarettes in 2019. Research also suggests that, like adults, youth may turn to smoking to cope with the symptoms or stressors associated with mental illness. People aged 12–17 are 2.5 times more likely to report using cigarettes in the past month if they experienced a major depressive episode in the past year.

Fast Facts


Quitting smoking, or smoking cessation, is tough for anyone — and it can be even harder when you have a mental illness. Although tobacco use by adults has decreased in recent years, the rate of reduction is much lower among people with mental illness.

About 70% of people with mental illness who smoke say they want to quit. Quitting is not only possible, but one of the best things you can do for your overall well-being.

Cessation treatments, nicotine replacement therapy and other strategies are safe, effective and do not increase symptoms for people with serious mental illness. Also keep in mind that treating an underlying mental illness while trying to quit results in the most success for smoking cessation.

How To Quit

There is no “right” way to quit and every attempt counts — it can take multiple attempts to quit completely.

Having a mental illness is a risk factor for relapse to smoking, even for those who have avoided using tobacco for more than a year, so it’s important to have a strategy and consider cessation assistance.

Try starting with small steps such as:

  • Setting a quit date
  • Buying only one pack of cigarettes at a time so you run out on your quit date
  • Throwing away ash trays and lighters and cleaning your car’s interior
  • Identifying what triggers your urge to smoke
  • Finding healthy ways to distract yourself, like chewing bubble gum or going for a walk
  • Telling someone you’re going to quit so they can help you stay accountable

When thinking about your overall strategy for quitting, there are three common options:

  • Cold Turkey: completely quitting all tobacco and nicotine-containing products at the same time. While some people succeed using this method, most people will need additional support.
  • Nicotine Replacement Therapy (NRT): products like gum, patches, lozenges, and prescription nasal sprays or inhalers that deliver measured doses of nicotine to decrease the side effects of withdrawing from tobacco. These products are available “over the counter” to people aged 18 and older and come in a variety of strengths to help decrease nicotine consumption over time.
    • NRT can increase the chances of quitting successfully by about 50%.
    • Although NRTs are designed for short-term use, they are safe for long-term use if necessary to prevent a return to smoking.
    • Using more than one NRT at the same time is safe, and can actually increase success in quitting.
  • Prescription Medications: two medications, varenicline (Chantix®) and bupropion (Zyban® and Wellbutrin®), are approved by the FDA to aid in smoking cessation. They are both safe to use for people with mental illness.

There are some risks associated with cessation products. For example, Bupropion can interact with MAOIs, a class of psychiatric medications, and is not appropriate if you are already using Wellbutrin® for psychiatric purposes. It’s important to stay in touch with your health care provider and let them know about any worsening psychiatric symptoms.

Regardless of which strategy you think is best for you, make sure to talk to your doctor about your desire to quit. Don’t wait for your provider to bring it up — research shows that only 62% of psychiatrists ask about tobacco use and/or advise their patients to stop smoking. Your doctor will answer any questions you have and help you create a personalized quit plan. Visit Help to Quit for more information about talking to your doctor when you want to quit smoking.

No-Cost Resources

NAMI HelpLine is available M-F, 10 a.m. – 10 p.m. ET. Call 800-950-6264,
text “helpline” to 62640, or chat online. In a crisis, call or text 988 (24/7).