One of the great public health triumphs of the past century has been the steady decrease in cigarette smoking. Yet there is one group that has not benefited from this progress: persons with mental illness. Today, smoking rates among adults in the United States are at a modern low of 15.1 percent. Had smoking rates persisted at the rate they were in 1964, 8 million more Americans would have died from smoking-related illnesses, according to an article in the San Francisco Chronicle.
Persons with mental illnesses, such as depression, bipolar disease, schizophrenia and chronic anxiety, as well as those with substance-use disorders including alcohol abuse or heroin addiction, smoke at rates two-to-three times the national average. Not only that, they smoke more daily cigarettes.
As a consequence, smokers with mental illnesses consume 40 percent of all cigarettes sold in this country, despite accounting for only about 20 percent of the population. Heavy smoking comes with a huge cost. Persons with mental illness die 10 to 15 years earlier than the general population and most of those premature deaths are from smoking-related illnesses such as heart disease, lung cancer, stroke, and chronic lung disease.
For too long, smoking among persons with mental illnesses was tolerated and even encouraged because of many misperceptions: Smoking alleviates psychiatric symptoms; smokers with mental illnesses don’t want to stop smoking; even if they want to quit they won’t be able to; they deserve the pleasure from smoking to counteract the pain of their illnesses; and quitting exacerbates the underlying mental health condition. These myths were perpetuated by too many mental health professionals, and were abetted by the tobacco industry and well-intended families and friends.
Now we know different. Most smokers with mental illness do want to quit, and many are able to do so. Much of the “pleasure” of smoking a cigarette comes from avoiding withdrawal from its addictive component — nicotine. And rather than worsening symptoms, a recent review has shown that when persons with chronic depression or anxiety stop smoking, their symptoms actually improve.