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 ( ) to see what policy changes and strategies they are using to create a healthier mental health system environment.

Second hand Smoke

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.

Continue for information on quitting smoking >>

Stop smoking treatments — nhs choices

If you smoke, giving up is probably the greatest single step you can take to improve your health.

Smoking is responsible for one in every five deaths in adults aged over 35 in England, and half of all long term smokers will die prematurely due to a smoking related disease.

Giving up smoking increases your chances of living a longer and healthier life. You’ll start to notice the benefits soon after quitting. For example

• after one month your skin will be clearer, brighter and more hydrated
• after three to nine months your breathing will have improved, and you will no longer have a cough or wheeze
• after one year your risk of heart attack and heart disease will have fallen to about half that of a smoker

Read more health benefits of stopping smoking.

If you want to quit smoking, it’s is a good idea to see your GP. They can provide help and advice about quitting, and refer you to an NHS Stop Smoking support service. These services offer the best support for people who want to give up smoking.

Studies show that you are four times more likely to quit smoking if you do it through the NHS. For more information, call the NHS Stop Smoking helpline on 0300 123 1044 (England only).

Read more about how NHS stop smoking advisers can help you to quit.

Stop smoking help from your GP

If you don’t want to be referred to an NHS Stop Smoking support service, your GP can still offer treatment to help you quit.

You’ll be assessed to get an idea of your level of addiction and to outline the benefits of quitting. This is also a chance to identify potential triggers, such as if you live with others who smoke or you’re under stress.

Your GP can prescribe several different stop smoking treatments. The type prescribed will depend on your personal preference and whether you’ve used any before.

Read more about how your GP can help you to quit smoking.

Nicotine replacement therapy (NRT)

Nicotine is highly addictive, and it’s the nicotine in cigarettes that causes you to become addicted to smoking. Nicotine replacement therapy (NRT) works by releasing nicotine steadily into your bloodstream at much lower levels than in a cigarette, without the tar, carbon monoxide and other poisonous chemicals present in tobacco smoke.

This helps control your cravings for a cigarette that happen when your body starts to miss the nicotine from smoking.

Read more about coping with cravings for a cigarette.

NRT comes in different forms, including

• skin patches
• chewing gum
• inhalators, which look like plastic cigarettes through which nicotine is inhaled
• tablets and lozenges, which you put under your tongue
• nasal spray
• mouth spray

Your GP can prescribe NRT or you can buy it from a pharmacist.

There’s no evidence that one particular type of NRT is more effective than another. The one you choose is down to personal preference.

When deciding, it helps to think about the type of smoker you are. For example, are you a heavy smoker who needs a cigarette as soon as you wake up, or are you an occasional smoker who only smokes when they are out having a drink, or after a meal?

Some heavy smokers find a 24 hour patch useful, as it helps to relieve the cigarette craving when waking up. Others prefer using an NRT nasal spray or mouth spray, because they’re the fastest acting form of NRT.

Some smokers find it useful to combine NRT products. For example, they wear patches through the day, then use gum or an inhalator to help relieve a sudden craving for a cigarette.

Most courses of NRT last eight to 12 weeks before you gradually reduce the dose and eventually stop. Most people stop using NRT altogether within three months, although heavy smokers may need to use it for longer.

Side effects of NRT include

• skin irritation when using patches
• irritation of nose, throat or eyes when using a nasal spray
• disturbed sleep, sometimes with vivid dreams
• upset stomach
• dizziness
• headaches

Side effects are usually mild to moderate, but if they become particularly troublesome, contact your GP as your dosage or type of NRT may need to be adjusted.

Also, the nasal spray can cause sneezing and watering eyes for a short time after use. So, don’t use an NRT nasal spray while driving, or just before driving.

Read more about the different types of NRT.

Nicotine replacement therapy and pregnancy

If you are pregnant or breastfeeding and you want to quit smoking, it’s best to stop completely and immediately without any treatment.

However, if you feel you cannot stop smoking without help, your GP may recommend NRT to control your cravings.

Nicotine is not good for your baby, but the greatest risk from smoking is posed by carbon monoxide, which can cause foetal hypoxia (a severe lack of oxygen). So although using NRT is not ideal for your baby, the risks of nicotine are far outweighed by the risks of continuing to smoke.

Read more about how to stop smoking during pregnancy.

Stop smoking medication

Two medications are available on the NHS to help you stop smoking.

Zyban (bupropion)

Bupropion was originally designed to treat depression, but it was discovered that it also helped people quit smoking. It’s not entirely clear why, but most experts believe it affects parts of the brain involved in addictive behaviour.

Bupropion is prescribed as one to two tablets a day.

You need to take bupropion for 7 14 days before you try to quit as the medication takes this long to reach its maximum effect. A course of treatment usually lasts seven to nine weeks.

Bupropion is not suitable for

• children and young people under 18
• women who are pregnant or breastfeeding
• people with anorexia or bulimia
• people with a central nervous system tumour
• people with severe cirrhosis of the liver

Bupropion can also increase your risk of having a seizure (fit), so it’s not suitable for people who already have a higher than average risk of having seizures, such as people

• with epilepsy
• with bipolar disorder
• with serious alcohol misuse problems
• who are treating diabetes with hypoglycaemic medication or insulin

Bupropion can cause several side effects, including

• dry mouth
• upset stomach
• insomnia (trouble sleeping)
• headaches
• difficulty concentrating
• dizziness
• drowsiness

Read more about Zyban.

Champix (varenicline)

Varenicline is currently the only medication specifically designed to help you quit smoking.

It works by preventing nicotine from binding to receptors (parts of your brain that respond to nicotine), which eases cravings and reduces the rewarding and reinforcing effects of smoking.

If you’ve not stopped smoking completely before starting varenicline, aim to do so within 7 14 days of starting treatment. It’s recommended you take varenicline for 12 weeks. If you successfully stop smoking in this time, you may be prescribed another 12 weeks of treatment to ensure you do not start smoking again.

Varenicline is not suitable for

• children and young people under 18
• women who are pregnant or breastfeeding
• people with epilepsy
• people with advanced kidney disease

Side effects of varenicline include

• nausea and vomiting
• headaches
• insomnia (trouble sleeping)
• unusual dreams
• increased appetite
• constipation or diarrhoea
• swollen stomach
• slow digestion
• flatulence
• dry mouth
• tiredness
• dizziness
• drowsiness

T
here have been reports of people experiencing feelings of depression and suicidal thoughts after beginning treatment with varenicline.

While there’s no evidence these symptoms are directly linked to the medication, if you feel depressed or have thoughts of suicide, stop taking varenicline immediately as a precaution, and contact your GP.

Read more about Champix.

Read 10 myths about stop smoking treatments

Electronic cigarettes

Electronic cigarettes or e cigarettes are electrical devices that mimic real cigarettes but using an electronic cigarette or vaping as its come to be known, produces a vapour that s potentially less harmful than tobacco smoke. Many e cigarettes contain nicotine and, when they do, it s the vapour that gives the nicotine hit.

E cigarettes are currently not available on the NHS. They are not the same as the inhalator, which is a type of nicotine replacement therapy that is available on the NHS.

Since their emergence around five years ago, e cigarettes have become increasingly popular. They re typically marketed as a healthier (and cheaper) alternative to traditional cigarettes. And, because they don t smell or produce smoke, they may be used in places where smoking is banned, like bars, restaurants, public transport, planes and even hospitals (though it is courteous to get permission from those around you beforehand).

While e cigarettes may be safer than conventional cigarettes, we don t yet know the long term effects of vaping on the body. There are other potential drawbacks to using them

• Electronic cigarettes aren t currently regulated as medicines so you can t be sure of their ingredients or how much nicotine they contain whatever it says on the label
• The amount of nicotine you get from an e cigarette can change over time
• They aren t proven as safe. In fact, some e cigarettes have been tested by local authority trading standards departments and been found to contain toxic chemicals, including some of the same cancer causing agents produced from tobacco
• So far, there s no proof that they can help people to stop smoking

There are clinical trials in progress to test the quality, safety and effectiveness of e cigarettes, but until these are complete, the government can t give any advice on them or recommend their use.

Read more about electronic cigarettes.

Read more articles to help you stop smoking.